title: Pulmonary function and CT biomarkers as risk factors for cardiovascular events in male lung cancer screening participants: the NELSON study.
abstract: OBJECTIVE
  The objective of this study was to investigate the association of spirometry and pulmonary CT biomarkers with cardiovascular events.
  
  
  METHODS
  In this lung cancer screening trial 3,080 male participants without a prior cardiovascular event were analysed. Fatal and non-fatal cardiovascular events were included. Spirometry included forced expiratory volume measured in units of one-second percent predicted (FEV1%predicted) and FEV1 divided by forced vital capacity (FVC; FEV1/FVC). CT examinations were quantified for coronary artery calcium volume, pulmonary emphysema (perc15) and bronchial wall thickness (pi10). Data were analysed via a Cox proportional hazard analysis, net reclassification improvement (NRI) and C-indices.
  
  
  RESULTS
  184 participants experienced a cardiovascular event during a median follow-up of 2.9 years. Age, pack-years and smoking status adjusted hazard ratios were 0.992 (95% confidence interval (CI) 0.985-0.999) for FEV1%predicted, 1.000 (95%CI 0.986-1.015) for FEV1/FVC, 1.014 (95%CI 1.005-1.023) for perc15 per 10 HU, and 1.269 (95%CI 1.024-1.573) for pi10 per 1 mm. The incremental C-index (<0.015) and NRI (<2.8%) were minimal. Coronary artery calcium volume had a hazard ratio of 1.046 (95%CI 1.034-1.058) per 100 mm(3), an increase in C-index of 0.076 and an NRI of 16.9% (P < 0.0001).
  
  
  CONCLUSIONS
  Pulmonary CT biomarkers and spirometry measurements were significantly associated with cardiovascular events, but did not contain clinically relevant independent prognostic information for cardiovascular events.
  
  
  CONCLUSIONS
  • Pulmonary CT biomarkers and spirometry are associated with cardiovascular events • These pulmonary measurements do not contain clinically relevant independent prognostic information • Only coronary calcium score improved cardiovascular risk prediction above age and smoking.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands, P.O. Box 85500, R.A.P.Takx@umcutrecht.nl.
authors.forename: Richard A P
authors.initials: RA
authors.lastname: Takx
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Firdaus A A
authors.initials: FA
authors.lastname: Mohamed Hoesein
authors.forename: Ivana
authors.initials: I
authors.lastname: Išgum
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Carlijn M
authors.initials: CM
authors.lastname: van der Aalst
authors.forename: Pieter
authors.initials: P
authors.lastname: Zanen
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
authors.forename: Eva M
authors.initials: EM
authors.lastname: van Rikxoort
authors.forename: Michael
authors.initials: M
authors.lastname: Schmidt
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
mesh_terms: D001530:Belgium / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D055088:Early Detection of Cancer; D005541:Forced Expiratory Volume; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors; D013147:Spirometry; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014797:Vital Capacity