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Objectives <p>This study aimed to evaluate the frequency of carotid plaques detected by carotid Doppler ultrasound (CDU) and their potential contribution to therapeutic recommendations, among participants in a lung cancer screening (LCS) programme—notably in those with absent or limited coronary artery calcification (CAC).</p> Materials and methods <p>This prospective study included 250 individuals from the “PEOPLHE” LCS-trial who were evaluated by CDU between November 2022 and August 2023. Stenosis was classified as measurable or severe when &gt; 20% or ≥ 50%, respectively. A health questionnaire was administered to assess conventional cardiovascular (CV) risk factors. Ultra-low-dose computed tomography (ULDCT) scans were analysed using an automated AI-driven CAC quantification software, with CAC expressed as the Agatston score. A retrospective analysis was performed to identify individuals potentially eligible for lipid-lowering therapy initiation by sequentially integrating CT, clinical and CDU data.</p> Results <p>Overall, 122/250 (48.8%) subjects showed measurable carotid plaques, with 18 (7.2%) classified as severe plaques. 80/240 (33.3%) subjects with absent or limited CAC (A0/A1) had measurable plaques, including 10 (55.6%) of the 18 severe plaques. In the retrospective analysis, 23 subjects (23/173, 13.3%) were deemed eligible for lipid-lowering therapy based on CAC data. Among A0/A1, a further 26 individuals were reclassified as eligible: 18/150 (12%) according to conventional CV risk factors, and 8/132 (6%) based solely on CDU findings.</p> Conclusion <p>A considerable proportion of LCS participants showed carotid plaques, confirming subclinical atherosclerosis even in those with absent or limited CAC. CDU, as part of an integrated strategy, may help identify individuals eligible for lipid-lowering therapy.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>Can CDU improve CV risk assessment by detecting subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications</i>?</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Measurable carotid plaques (&gt; 20%) were detected in 33.3% participants with absent or limited coronary calcifications (A0/A1). CDU findings reclassifying 5% of A0/A1 subjects as eligible for lipid-lowering therapy</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>CDU may reveal subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications, improving CV risk assessment and identifying individuals who may benefit from lipid-lowering therapy initiation</i>.</p> Graphical Abstract <p></p>

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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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月24日

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  • Rebecca Mura,
  • Roberta Eufrasia Ledda,
  • Luca Moderato,
  • Ludovica Leo,
  • Pasquale Favia,
  • Carlotta Zilioli,
  • Antonella Priore,
  • Francesca Lucia Maffucci,
  • Vita Ida Gallone,
  • Camilla Roberti,
  • Silvia Schirò,
  • Mario Silva,
  • Nicola Sverzellati,
  • Gianluca Milanese

摘要

Objectives

This study aimed to evaluate the frequency of carotid plaques detected by carotid Doppler ultrasound (CDU) and their potential contribution to therapeutic recommendations, among participants in a lung cancer screening (LCS) programme—notably in those with absent or limited coronary artery calcification (CAC).

Materials and methods

This prospective study included 250 individuals from the “PEOPLHE” LCS-trial who were evaluated by CDU between November 2022 and August 2023. Stenosis was classified as measurable or severe when > 20% or ≥ 50%, respectively. A health questionnaire was administered to assess conventional cardiovascular (CV) risk factors. Ultra-low-dose computed tomography (ULDCT) scans were analysed using an automated AI-driven CAC quantification software, with CAC expressed as the Agatston score. A retrospective analysis was performed to identify individuals potentially eligible for lipid-lowering therapy initiation by sequentially integrating CT, clinical and CDU data.

Results

Overall, 122/250 (48.8%) subjects showed measurable carotid plaques, with 18 (7.2%) classified as severe plaques. 80/240 (33.3%) subjects with absent or limited CAC (A0/A1) had measurable plaques, including 10 (55.6%) of the 18 severe plaques. In the retrospective analysis, 23 subjects (23/173, 13.3%) were deemed eligible for lipid-lowering therapy based on CAC data. Among A0/A1, a further 26 individuals were reclassified as eligible: 18/150 (12%) according to conventional CV risk factors, and 8/132 (6%) based solely on CDU findings.

Conclusion

A considerable proportion of LCS participants showed carotid plaques, confirming subclinical atherosclerosis even in those with absent or limited CAC. CDU, as part of an integrated strategy, may help identify individuals eligible for lipid-lowering therapy.

Key Points

Question Can CDU improve CV risk assessment by detecting subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications?

Findings Measurable carotid plaques (> 20%) were detected in 33.3% participants with absent or limited coronary calcifications (A0/A1). CDU findings reclassifying 5% of A0/A1 subjects as eligible for lipid-lowering therapy.

Clinical relevance CDU may reveal subclinical atherosclerosis in LCS participants with absent or limited coronary calcifications, improving CV risk assessment and identifying individuals who may benefit from lipid-lowering therapy initiation.

Graphical Abstract