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The contribution of diabetes and pericardial fat to mortality from lung cancer and cardiovascular disease in the National Lung Screening Trial

Principal Investigator
Name
Janet Snell-Bergeon
Degrees
PhD, MPH
Institution
University of Colorado AMC
Position Title
Associate Professor
Email
About this CDAS Project
Study
NLST (Learn more about this study)
Project ID
NLST-159
Initial CDAS Request Approval
Nov 24, 2015
Title
The contribution of diabetes and pericardial fat to mortality from lung cancer and cardiovascular disease in the National Lung Screening Trial
Summary
Type 2 diabetes and its treatment has been associated in some studies with an increase in cancer incidence. Type 2 diabetes is also associated with an increase in ectopic fat deposition, particularly pericardial fat. As pericardial fat is located in close proximity to the coronary arteries and lungs, it is possible that the increased pericardial fat in people with diabetes increases the risk for both cardiovascular disease and lung cancer.

The National Lung Screening Trial (NLST) enrolled 53,454 adults 55 to 74 years of age starting in 2002, and randomized them to receive low- dose computed tomography or radiography. Approximately 10% (5,000) subjects had self-reported diabetes at enrollment. Subjects were followed for lung cancer development and mortality from all causes through 2009. There were 2001 lung cancer cases and 556 lung cancer deaths. We propose to examine whether diabetes at enrollment is associated with an increased risk for lung cancer incidence and mortality, and to obtain measures of pericardial fat from the CT scans obtained at the baseline NLST visit. Lung cancer incidence and mortality and cardiovascular mortality will then be examined in association with pericardial fat volume among patients with diabetes.
Aims

Specific Aim 1: Examine whether study participants with self-reported diabetes (n=~5,000) at screening have an increased risk for cancer incidence and mortality:
Hypothesis 1.1: Patients with self-reported diabetes at enrollment will have an increased risk for incident lung cancer.
Hypothesis 1.2: Having diabetes at enrollment will be associated with higher risk for mortality from all cancers and from lung cancer specifically.
Specific Aim 3:
Examine whether higher levels of pericardial fat in patients with type 2 diabetes are associated with different rates of lung cancer diagnosis and survival compared to patients with type 2 diabetes with lower levels of pericardial fat.
Hypothesis 3.1 : Patients with diabetes who have higher levels of pericardial fat will have a higher risk for developing lung cancer than patients with diabetes who have lower volume of pericardial fat
Hypothesis 3.2: The risk for lung cancer and all cancer mortality will be higher in patients with diabetes who have higher levels of pericardial fat versus those who have lower pericardial fat.
Hypothesis 3.3: A higher volume of pericardial fat will be associated with a higher risk for cardiovascular mortality among people with diabetes than in non-diabetic individuals.

Collaborators

Kavita Garg, MD, Radiology Department, University of Colorado Anschutz Medical Campus
Satish Garg, MD, Barbara Davis Center, University of Colorado Anschutz Medical Campus