Racial differences in prevalence of coronary artery calcification among patients undergoing lung cancer screening.

Abstract

e23341 Background: Coronary artery calcification (CAC) is a known risk factor for coronary heart disease. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) can detect lung cancer at earlier stages and reduce mortality. Additionally, CAC are common incidental findings among patients undergoing LDCT for LCS. However, racial differences in incidental findings of CAC among LCS patients have not been thoroughly investigated. We examined the association between race and presence of moderate to severe CAC among patients undergoing LDCT for LCS. Methods: We conducted a retrospective analysis of electronic health records (EHR) from Henry Ford Health (2016-2023) among patients undergoing LDCT for LCS. CAC was classified as moderate or severe (vs. none or mild). Race was categorized as Black, White, Asian, American Indian/Alaskan Native, Other and Unknown. We focused on Black and White patients, owing to the small sample size in the other groups. Multivariable logistic regression was used to examine the association between race and presence of moderate to severe CAC, adjusting for age, sex, and tobacco smoking status. Results: A total of 15,911 patients who were eligible for LCS and completed at least one screen during our study period were included. Of these, 79.6% were White and 20.4% were Black. The mean age of patients was 63.8±5.8 years; 50.4% were male and 61.4% reported current tobacco smoking. Demographic comparisons show that White patients were more frequently male compared to Black patients (50.9% vs 47.9%, p = 0.002). In addition, Black patients were slightly older (64.3±5.7 vs 63.6±5.8 years) and reported a higher current tobacco smoking status (67.9% vs 59.7%, p < 0.0001) compared to White patients. The prevalence of moderate to severe CAC was 10.9% overall and was higher among Black vs White patients (16.1% vs 9.6%, p < 0.0001). After covariate adjustment, Black patients had significantly higher odds of moderate to severe CAC compared to White patients (odds ratio [OR] = 1.8, 95% CI 1.6–1.9, p < 0.0001). Conclusions: The study findings suggest significant racial differences in the prevalence of CAC among patients undergoing LCS. Race may be an important factor when assessing cardiovascular risk in patients undergoing LCS and may have implications for screening protocols and preventive strategies. Future research is needed to explore the impact of these differences on risk and mortality from cardiovascular diseases.