Colorectal Neoplasm

Prevalence of Colorectal Neoplasm Among Patients With Newly Diagnosed Coronary Artery Disease

Annie On On Chan, MD, PhD; Man Hong Jim, MD; Kwok Fai Lam, PhD; Jeffrey S. Morris, PhD; David Chun Wah Siu, MD; Teresa Tong, BSc; Fook Hong Ng, MD; Siu Yin Wong, MD; Wai Mo Hui, MD; Chi Kuen Chan, MD; Kam Chuen Lai, MD; Ting Kin Cheung, MD; Pierre Chan, MD; Grace Wong, MD; Man Fung Yuen, MD, PhD; Yuk Kong Lau, MD; Stephen Lee, MD; Ming Leung Szeto, MD; Benjamin C. Y. Wong, MD, PhD; Shiu Kum Lam, MD

JAMA. 2007;298:1412-1419.

Context Colorectal neoplasm and coronary artery disease (CAD) share similar risk factors, and their co-occurrence may be associated.

Objectives
To investigate the prevalence of colorectal neoplasm in patients with CAD in a cross-sectional study and to identify the predisposing factors for the association of the 2 diseases.

Design, Setting, and Participants Patients in Hong Kong , China , were recruited for screening colonoscopy after undergoing coronary angiography for suspected CAD during November 2004 to June 2006. Presence of CAD (n = 206) was defined as at least 50% diameter stenosis in any 1 of the major coronary arteries; otherwise, patients were considered CAD-negative (n = 208). An age- and sex-matched control group was recruited from the general population (n = 207). Patients were excluded for use of aspirin or statins, personal history of colonic disease, or colonoscopy in the past 10 years.

Main Outcome Measures
The prevalence of colorectal neoplasm in CAD-positive, CAD-negative, and general population participants was determined. Bivariate logistic regression was performed to study the association between colorectal neoplasm and CAD and to identify risk factors for the association of the 2 diseases after adjusting for age and sex.

Results
The prevalence of colorectal neoplasm in the CAD-positive, CAD-negative, and general population groups was 34.0%, 18.8%, and 20.8% (P < .001 by ?2 test), prevalence of advanced lesions was 18.4%, 8.7%, and 5.8% (P < .001), and prevalence of cancer was 4.4%, 0.5%, and 1.4% (P = .02), respectively. Fifty percent of the cancers in CAD-positive participants were early stage. After adjusting for age and sex, an association still existed between colorectal neoplasm and presence of CAD (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.25-2.70; P = .002) and between advanced lesions and presence of CAD (OR, 2.51; 95% CI, 1.43-4.35; P = .001). The metabolic syndrome (OR, 5.99; 95% CI, 1.43-27.94; P = .02) and history of smoking (OR, 4.74; 95% CI, 1.38-18.92; P = .02) were independent factors for the association of advanced colonic lesions and CAD.

Conclusions
In this study population undergoing coronary angiography, the prevalence of colorectal neoplasm was greater in patients with CAD. The association between the presence of advanced colonic lesions and CAD was stronger in persons with the metabolic syndrome and a history of smoking.