Incidental coronary calcium in cancer patients treated with anthracycline and/or trastuzumab

Matthew C Hooks, Gurmandeep Sandhu, Tejaswini Maganti, Ko Hsuan Amy Chen, Michelle Wang, Ryan Cullen, Pratik S Velangi, Christina Gu, Jason Wiederin, John E Connett, Roland Brown, Anne Blaes, Chetan Shenoy, Prabhjot S. Nijjar

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Aims Cancer patients are at increased risk of cardiovascular disease (CVD) after treatment with potentially cardiotoxic treatments. Many cancer patients undergo non-gated chest computed tomography (NCCT) for cancer staging prior to treatment. We aimed to assess whether coronary artery calcification on NCCT predicts CVD risk in cancer patients. Methods Six hundred and three patients (mean age: 61.3 years, 30.8% male) with either breast cancer, lymphoma, or sarcoma were and results identified retrospectively. Primary endpoint was a major adverse cardiac event (MACE) composite including non-fatal myocardial infarction, new heart failure (HF) diagnosis, HF hospitalization, and cardiac death, with Fine-Gray analysis for non-cardiac death as competing risk. Secondary endpoints included a coronary composite and a HF composite. Coronary artery calcification was present in 194 (32.2%) and clinically reported in 85 (43.8%) patients. At a median follow-up of 5.3 years, 256 (42.5%) patients died of non-cardiac causes. Coronary artery calcification presence or extent was not an independent predictor of MACE [sub-distribution hazards ratio (SHR) 1.28; 0.73–2.27]. Coronary artery calcification extent was a significant predictor of the coronary composite outcome (SHR per two-fold increase 1.14; 1.01–1.28), but not of the HF composite outcome (SHR per two-fold increase 1.04; 0.95–1.14). Conclusion Coronary artery calcification detected incidentally on NCCT scans in cancer patients is prevalent and often not reported. Coronary artery calcification presence or extent did not independently predict MACE. Coronary artery calcification extent was independently associated with increased risk of CAD events but not HF events.

Original languageEnglish (US)
Pages (from-to)2200-2210
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Issue number17
StatePublished - Nov 1 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email:


  • CT
  • Cancer
  • Cardiotoxicity
  • Chemotherapy
  • Coronary artery calcification

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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