Author + information
- David Niederseer, MD, PhD, BSc,
- Andreas Stadlmayr, MD,
- Ursula Huber-Schönauer, PhD,
- Martin Plöderl, PhD,
- Christian Schmied, MD,
- Dieter Lederer, MD,
- Wolfgang Patsch, MD,
- Elmar Aigner, MD and
- Christian Datz, MD∗ ()
- ↵∗Department of Internal Medicine, General Hospital Oberndorf/Salzburg, Teaching Hospital of the Paracelsus Medical University Salzburg, Paracelsusstrasse 37, 5110 Oberndorf, Austria
Colorectal cancer is a potentially preventable disease, as early lesions may be detected and removed during screening colonoscopy. Emerging evidence suggests associations between cardiovascular disease and several cancers, including colorectal cancer. The relationship is thought to arise from common risk factors including obesity, diabetes, hypertension, smoking, unhealthy diet, and physical inactivity (1).
We studied potential associations of cardiovascular risk (CVR), as assessed by the Framingham Risk Score (FRS) (2) or the presence of coronary artery disease (CAD), with colorectal neoplasia detected by screening colonoscopy in a Caucasian cohort without gastrointestinal symptoms.
The study was conducted in 2,098 participants of a health-screening program according to national screening recommendations for colorectal cancer between 2010 and 2014. All consecutive patients <79 years of age without gastrointestinal symptoms that asked to be screened and agreed to participate in the study were included. The study complies with the Declaration of Helsinki and was approved by the local ethics committee. Informed consent was obtained from all participants.
Colonoscopic findings were classified as tubular adenoma or advanced neoplasia (i.e., villous or tubulovillous features), size ≥1 cm or high-grade dysplasia, or carcinoma after analysis of macroscopic and histological results. Colonoscopic findings were defined as outcome variables, while all other variables as explanatory variables.
We used Statistica version 7.0 (StatSoft, Tulsa, Oklahoma) or Stata version 13.0 (Stata Corporation, College Station, Texas) statistical software. For comparison of categorical or continuous variables, we used a contingency chi-square test or analysis of variance, respectively. We estimated the odds ratio (OR) with 95% confidence interval (CI) by univariate logistic regression analysis. To provide separate ORs for the middle and upper FRS tertiles and the group with CAD history, we used 3 dummy variables with the low tertile as reference.
Clinical characteristics of our study population revealed associations of colonoscopic results with several CVR factors (Table 1). Our population included 108 (5%) subjects with a self-reported history of CAD. In 55 subjects, a previous coronary angiography verifying CAD was available. In the remaining 53 subjects, CAD history was verified by review of medical records. ORs for having any adenoma or advanced neoplasia in subjects with CAD history were 1.51 (95% CI: 1.10 to 2.27; p = 0.047) and 2.62 (95% CI: 1.31 to 5.20; p = 0.007), compared with subjects without CAD history, respectively.
Logistic regression models with FRS as predictor variable in subjects without CAD revealed that a 1-percentage-point increase of FRS was associated with ORs of 1.07 (95% CI: 1.06 to 1.09; p < 0.001) and 1.07 (95% CI: 1.04 to 1.12; p < 0.001) for the detection of any and advanced neoplasia, respectively.
In comparison to the low-risk FRS tertile (reference), the intermediate-risk (OR: 1.95; 95% CI: 1.49 to 2.55) and the high-risk tertiles (OR: 3.35; 95% CI: 2.59 to 4.33) showed stepwise increases in ORs for any colorectal adenoma (all p < 0.001) (Table 1). Additionally, for advanced neoplasia, a stepwise increase in ORs was observed as well: low-risk tertile (reference), intermediate-risk tertile (OR: 1.66; 95% CI: 0.81 to 3.39; p = 0.163), high-risk tertile (OR: 3.83; 95% CI: 2.04 to 7.19; p < 0.001), and CAD (OR: 5.47; 95% CI: 2.34 to 12.93; p < 0.001). Essentially, nearly identical results were observed when applying the Heart Score of the European Society of Cardiology (3) for the estimation of CVR (data not shown).
Our study has some limitations. CAD was established via questionnaire or medical history; however, neither coronary angiography nor other screening tests for CAD are justifiable in a population-based screening study. Furthermore, FRS does not include diabetes, obesity, red meat or saturated fat intake, or family history of colorectal cancer, all of which are relevant for the assessment of colorectal cancer risk.
In conclusion, we report an association of CVR factors and colorectal neoplasms. In this screening cohort without gastrointestinal symptoms, subjects with known CAD and high CVR had a significantly higher probability of early and advanced colorectal neoplasia compared with subjects with low CVR, presumably due to shared risk factors. Our data suggest screening colonoscopy to be indicated particularly in subjects with known CAD or high CVR to detect potentially treatable colorectal neoplasia.
Please note: This work was supported by a grant from SPAR Austria to Dr. Datz. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The authors gratefully acknowledge laboratory technical support by Elke Albrecht, Monika Ratkowitsch, Karoline Zastrow, Miriam Schatz, and Carmen Winkler (Oberndorf Hospital).
- 2017 American College of Cardiology Foundation
- Koene R.J.,
- Prizment A.E.,
- Blaes A.,
- Konety S.H.
- Wilson P.W.F.,
- D’Agostino R.B.,
- Levy D.,
- Belanger A.M.,
- Silbershatz H.,
- Kannel W.B.
- Conroy R.M.,
- Pyorala K.,
- Fitzgerald A.P.,
- et al.