Exploring the prevalence and clinical impact of carotid plaque burden by Doppler ultrasound in lung cancer screening participants with limited coronary artery calcification - Report - MDSpire
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Exploring the prevalence and clinical impact of carotid plaque burden by Doppler ultrasound in lung cancer screening participants with limited coronary artery calcification
Carotid Plaque Load via Doppler Ultrasound in Lung Cancer Screening with Minimal CAC
Overview
In lung cancer screening participants with minimal or absent coronary artery calcification (CAC), carotid Doppler ultrasound (CDU) revealed a significant prevalence of subclinical carotid plaques. This finding suggests that CDU can uncover additional cardiovascular risk not detected by CAC scoring alone, potentially influencing lipid-lowering therapy decisions.
Background
Cardiovascular disease (CVD) shares risk factors with lung cancer, notably cigarette smoking. Low-dose computed tomography (LDCT) used in lung cancer screening (LCS) quantifies coronary artery calcium (CAC), a strong predictor of coronary artery disease, but absence of CAC does not eliminate cardiovascular risk. Carotid Doppler ultrasound (CDU) can detect subclinical carotid plaques, which are associated with increased cerebrovascular risk and may modify cardiovascular risk stratification, especially in individuals with low or absent CAC. Integrating CDU into LCS programs may enhance cardiovascular risk assessment and guide preventive therapy.
Data Highlights
Parameter
Definition/Threshold
Coronary Artery Calcium (CAC) Score Categories
A0: 0 AU (very low risk); A1: 1–99 AU (mild risk); A2: 100–299 AU (moderate risk); A3: ≥300 AU (high risk)
Intima-Media Thickness (IMT)
Measured on distal common carotid artery; abnormal if > 0.9 mm
Carotid Plaque Definition
Structures encroaching lumen with IMT > 1.5 mm or > 50% thickness increase vs surrounding segment
Stenosis Severity
Measurable if > 20%; severe if ≥ 50%; hemodynamic significance if peak systolic velocity > 125 cm/s
Key Findings
Participants aged 50–75 years with significant smoking history were enrolled in a lung cancer screening program.
Coronary artery calcium was quantified using ultra-low-dose CT and AI-driven software, categorizing participants into risk groups based on Agatston scores.
Carotid Doppler ultrasound detected subclinical plaques in participants with absent or minimal CAC, identifying additional cardiovascular risk.
Carotid plaques were characterized by number, location, echogenicity, and degree of stenosis, providing detailed vascular assessment.
Findings support the role of CDU as a complementary tool to CAC scoring for cardiovascular risk stratification in lung cancer screening populations.
Clinical Implications
Incorporating carotid Doppler ultrasound into lung cancer screening protocols can identify subclinical atherosclerosis in patients with low or absent coronary artery calcification, refining cardiovascular risk assessment. This approach may guide earlier initiation of lipid-lowering therapies and preventive strategies, potentially reducing cerebrovascular and cardiovascular events in this high-risk population.
Conclusion
Carotid Doppler ultrasound reveals clinically significant subclinical atherosclerosis in lung cancer screening participants with minimal CAC, underscoring its value as a complementary cardiovascular risk assessment tool. Integrating CDU may improve preventive cardiovascular care in this population.
References
Mura, R. et al. 2025 -- Assessing the Frequency and Clinical Significance of Carotid Plaque Load via Doppler Ultrasound in Participants Undergoing Lung Cancer Screening with Minimal Coronary Artery Calcification
