Decreased cardiovascular mortality in the ITALUNG lung cancer screening trial: Analysis of underlying factors
| Autor: | Fabio Falaschi, Eugenio Paci, Maurizio Bartolucci, Alessandro Rosselli, Ferruccio Aquilini, Giulia Picozzi, Donella Puliti, Laura Carrozzi, Alessandro Barchielli, Francesco Pistelli, Francesca Carozzi, Andrea Lopes Pegna, Michela Grazzini, Mario Mascalchi, Marco Zappa |
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| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine Pulmonary and Respiratory Medicine Cancer Research medicine.medical_specialty Lung Neoplasms Cardiovascular mortality Databases Factual Psychological intervention Coronary arteries calcifications Coronary Artery Disease Disease 03 medical and health sciences 0302 clinical medicine Risk Factors Lung cancer screening Internal medicine Humans Medicine Risk factor Vascular Calcification Lung cancer Early Detection of Cancer Aged Randomized Controlled Trials as Topic Retrospective Studies business.industry Middle Aged medicine.disease Control subjects Survival Rate 030104 developmental biology Oncology Case-Control Studies 030220 oncology & carcinogenesis Coronary artery calcification Female Tomography X-Ray Computed business Follow-Up Studies |
| Zdroj: | Lung Cancer. 138:72-78 |
| ISSN: | 0169-5002 |
| Popis: | Objectives In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. Materials and methods The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. Results The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. Conclusions LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy. |
| Databáze: | OpenAIRE |
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