Lipid-lowering therapy use among cancer survivors undergoing lung cancer screening: A cross-sectional analysis.

Abstract

12029 Background: Cardiovascular disease (CVD) causes 56% of non-cancer deaths among cancer survivors, yet lipid-lowering therapy (LLT) remains underutilized. Moreover, lung cancer screening (LCS) populations exhibit a dual high-risk profile, characterized by heavy smoking exposure and a history of cancer. We sought to examine the utilization of LLT among cancer survivors undergoing LCS and to identify disparities based on demographics, clinical factors, and social determinants of health. Methods: We conducted a cross-sectional study of 7,778 cancer survivors aged 50–80 years who underwent LCS through Barnes-Jewish Healthcare's LCS program between 2015 and 2023. The primary outcome measured was LLT use, specifically statins or statin substitutes, as documented in electronic health records. We assessed for associations with demographics (age, sex, race), clinical factors (prior ASCVD, cancer type), healthcare access (insurance status, rurality via Rural-Urban Commuting Area codes), and the Area Deprivation Index (ADI). The data were analyzed using multivariable logistic regression, adjusted for demographics, insurance status, smoking, indication, and provider, with results stratified by race and sex. Results: Overall, 65.8% of cancer survivors undergoing LCS used LLT. Compared with lung cancer, prostate (AOR = 1.35; 95% CI 1.08–1.71), hematologic (AOR = 1.35; 95% CI 1.03–1.76), and other solid cancers (AOR = 1.23; 95% CI 1.07–1.42) were associated with higher LLT use. When stratified by race, among White patients, male sex was associated with higher LLT use (AOR = 1.13; p = 0.036) and rural residence was associated with lower LLT use (AOR = 0.81; p = 0.005); these were not significant factors in Black patients. Prior ASCVD was the strongest associated factor (AOR = 2.54, p < 0.001), followed by age ≥65 years (AOR = 1.41, p < 0.001). Rural residence was associated with 29% lower odds of LLT use (AOR = 0.71, p < 0.001) even after adjusting for all other factors. Insurance status, and neighborhood deprivation were not associated with LLT use. Conclusions: LLT remains underused among cancer survivors at high cardiovascular risk, even during routine LCS. Rural patients were less likely to receive therapy, underscoring persistent geographic gaps in preventive care. The strong association of prior ASCVD with LLT use suggests that therapy is still primarily utilized reactively rather than preventively. Improving follow-up and care coordination during screening could help close prevention gaps and reduce heart disease deaths in cancer survivors.