Among 3,100 statin-naive adults aged 50–80 who met 2019 ACC/AHA primary prevention criteria and underwent lung cancer screening (LCS) at a Missouri academic health system between 2015–2023, only 27.3% received a statin prescription within one year. Uptake was sluggish throughout: just 10.5% were prescribed statins by 90 days. Faster initiation correlated with higher calculated ASCVD risk, prior cardiology contact, and former (vs. current) smoking status. Notably, race, insurance type, and area deprivation showed no independent association with timing.
Lung cancer screening populations are uniquely high-risk for cardiovascular disease — they are older, heavily smoking-exposed, and often harbor multiple metabolic comorbidities — making LCS encounters a potentially powerful but chronically underused cardiovascular prevention touchpoint. Prior literature has documented statin underprescription broadly, but this retrospective analysis specifically quantifies the time dimension, revealing that inertia compounds the gap: even among patients already flagged as eligible, most never received therapy during a year-long follow-up window. The finding that cardiology contact — rather than primary care alone — predicted earlier initiation suggests care-coordination gaps between screening radiology workflows and preventive medicine.
Limitations are significant: this is a single academic health system in Missouri, limiting generalizability, and retrospective EHR data cannot confirm whether prescriptions were filled or statins obtained elsewhere. As a preprint not yet peer-reviewed, these findings should be treated as preliminary. Still, this work makes a clinically actionable, if incremental, case for embedding automated ASCVD risk calculators and preventive decision-support directly into LCS workflows.
