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

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Prevalence of Colorectal Neoplasm Among Patients with Newly Diagnosed Coronary Artery Disease ORIGINAL CONTRIBUTION Prevalence of Colorectal Neoplasm Among Patients With Newly Diagnosed Coronary Artery Disease Annie On On Chan, MD, PhD Context Colorectal neoplasm and coronary artery disease (CAD) share similar risk Man Hong Jim, MD factors, and their co-occurrence may be associated. Kwok Fai Lam, PhD Objectives To investigate the prevalence of colorectal neoplasm in patients with CAD Jeffrey S. Morris, PhD in a cross-sectional study and to identify the predisposing factors for the association of the 2 diseases. David Chun Wah Siu, MD Design, Setting, and Participants Patients in Hong Kong, China, were recruited Teresa Tong, BSc for screening colonoscopy after undergoing coronary angiography for suspected CAD Fook Hong Ng, MD 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, pa- Siu Yin Wong, MD tients were considered CAD-negative (n=208). An age- and sex-matched control group Wai Mo Hui, MD was recruited from the general population (n=207). Patients were excluded for use Chi Kuen Chan, MD of aspirin or statins, personal history of colonic disease, or colonoscopy in the past 10 years. Kam Chuen Lai, MD Main Outcome Measures The prevalence of colorectal neoplasm in CAD- Ting Kin Cheung, MD positive, CAD-negative, and general population participants was determined. Bivari- Pierre Chan, MD ate logistic regression was performed to study the association between colorectal neo- plasm and CAD and to identify risk factors for the association of the 2 diseases after Grace Wong, MD adjusting for age and sex. Man Fung Yuen, MD, PhD Results The prevalence of colorectal neoplasm in the CAD-positive, CAD-negative, Yuk Kong Lau, MD and general population groups was 34.0%, 18.8%, and 20.8% (PϽ.001 by ␹2 test), prevalence of advanced lesions was 18.4%, 8.7%, and 5.8% (PϽ.001), and preva- Stephen Lee, MD lence of cancer was 4.4%, 0.5%, and 1.4% (P=.02), respectively. Fifty percent of the Ming Leung Szeto, MD cancers in CAD-positive participants were early stage. After adjusting for age and sex, Benjamin C. Y. Wong, MD, PhD 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 ad- Shiu Kum Lam, MD vanced 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 OLORECTAL CANCER IS THE (OR, 4.74; 95% CI, 1.38-18.92; P=.02) were independent factors for the association second most prevalent can- of advanced colonic lesions and CAD. 1 cer worldwide. There were Conclusions In this study population undergoing coronary angiography, the preva- about 1 million new cases and lence of colorectal neoplasm was greater in patients with CAD. The association be- C500 000 deaths due to colorectal can- tween the presence of advanced colonic lesions and CAD was stronger in persons with cer in 2002.1 It has been estimated that the metabolic syndrome and a history of smoking. 1 in 20 healthy individuals will even- JAMA. 2007;298(12):1412-1419 www.jama.com tually develop colorectal cancer. Coro- nary artery disease (CAD) is the single Author Affiliations: Departments of Medicine (Drs A. pital (Drs G. Wong and Szeto), Hong Kong, China; O. O. Chan, Jim, Siu, Hui, C. K. Chan, Lai, Cheung, Department of Biostatistics, M. D. Anderson Cancer leading cause of death in the United P. Chan, Yuen, Lee, B. C. Y. Wong, and S. K. Lam and Center, Houston, Texas (Dr Morris). States and other industrialized coun- Ms Tong) and Statistics and Actuarial Science (Dr K. Corresponding Author: Annie On On Chan, MD, PhD, 2 F. Lam), University of Hong Kong, Department of Department of Medicine, University of Hong Kong, tries. We previously published a ret- Medicine, Ruttonjee Hospital (Drs Ng, S. Y. Wong, and Queen Mary Hospital, Pokfulam Road, Hong Kong, rospective study that reported a strong Lau), and Department of Medicine, Tuen Mun Hos- China ([email protected]). 1412 JAMA, September 26, 2007—Vol 298, No. 12 (Reprinted) ©2007 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/25/2021 COLORECTAL NEOPLASM IN NEWLY DIAGNOSED CORONARY ARTERY DISEASE association between colorectal cancer/ tal, and Ruttonjee Hospital. These are re- They were age- and sex-matched to the adenoma and CAD, possibly due to the gionalhospitalsservingpatientswithheart CAD-positive group within 5 years on a sharing of common environmental risk disease in the Hong Kong West cluster. nearly case-to-case basis. This group did factors.3 The study was approved by the insti- not undergo coronary angiogram. The Colorectal cancer and CAD share tutional review boards of the Univer- same exclusion criteria were also ap- similar environmental risks factors, such sity of Hong Kong/Queen Mary Hospi- plied in this second control group. as diabetes mellitus; smoking; hyperlip- tal, Grantham Hospital, and Ruttonjee All individuals in the 3 groups were idemia; sedentary lifestyle; high-fat, low- Hospital, all in Hong Kong. All partici- invited to participate. Information on fiber diet; obesity; and hypertension.4-6 pants provided written informed consent. age, sex, history of smoking, diabetes The metabolic syndrome is being in- Consecutive patients with suspected mellitus, hypertension, family history creasingly recognized as a significant CAD (ie, those with angina or abnor- of colorectal cancer, and use and du- health hazard worldwide.7 It com- mal exercise stress test results) who pre- ration of aspirin and statins was re- prises a constellation of metabolic risk sented for the first time for coronary an- corded. Waist circumference was mea- factors, including most of the underly- giography were invited to participate in sured. Blood was drawn and fasting ing risk factors for both colorectal can- the study. Because we aimed at study- glucose level and complete lipid pro- cer and CAD: diabetes or impaired glu- ing the prevalence of colorectal neo- file were measured. The metabolic syn- cose tolerance, hypertriglyceridemia, low plasm in patients with newly diag- drome was defined as at least 3 of the high-density lipoprotein cholesterol nosed CAD, and to avoid the potential following criteria set forth by the Na- level, central obesity, and hyperten- protective effect of aspirin and statins on tional Cholesterol Education Pro- sion. Persons with the metabolic syn- colorectal neoplasm, patients with a his- gram’s modified Adult Treatment Panel drome have been reported to have in- tory of CAD for more than 1 year or who III (Asian Pacific Region criteria)13: creased risk of developing CAD.8,9 We had been taking aspirin or a statin for (1) abdominal obesity: waist circum- postulated that the metabolic syn- more than 1 year were excluded. In ad- ference of at least 36 in (91 cm) for men drome might also be an important risk dition, those presenting for coronary an- and 32 in (81 cm) for women; (2) low factor for the development of both co- giography for reasons other than sus- high-density lipoprotein cholesterol lorectal cancer and CAD. pected CAD (eg, congestive heart failure, level: 40 mg/dL (1.03 mmol/L) or lower Hong Kong is an industrialized re- cardiomyopathy) were also excluded. for men and 50 mg/dL (1.3 mmol/L) or gion with incidences of and mortality due Additional exclusion criteria were his- lower for women; (3) hypertriglyceri- to colorectal cancer and CAD similar to tory of colonic disease, such as colorec- demia: 150 mg/dL (1.7 mmol/L) or that in western countries.10-12 Although tal cancer, polyp, and inflammatory higher; (4) hypertension: blood pres- we observed an association between co- bowel disease, and history of colorectal sure 130/85 mm Hg or higher; and (5) lorectal cancer and CAD in our previ- surgery or colonoscopy within the pre- impaired glucose tolerance: fasting glu- ous study,3 we were not able to identify vious 10 years. cose 110 mg/dL (6.1 mmol/L) or higher. the risk factors involved because of its Consecutive patients with coronary retrospective nature.3 We thus de- angiogram were invited for colonos- Colonoscopy signed and conducted the current cross- copy regardless of hemoglobin status to Colonoscopy was scheduled within 8 sectional study, the primary aim of which avoid preselection in the CAD-positive weeks after assessing for eligibility or af- was to investigate the prevalence of co- group of patients with gastrointestinal ter revascularization for critical pa- lorectal cancer and adenoma (colorec- tract bleeding due to aspirin or clopido- tients. All patients received the same tal neoplasms) in patients with newly di- grel therapy. In accordance with Ameri- bowel preparation. Colonoscopies were agnosed CAD. A secondary aim was to can College of Cardiology/American repeated the next day for those with poor identify the underlying risk factors, af- Heart Association guidelines, patients bowel preparation. Patients taking clo- ter adjusting for age and sex, that pre- were defined as CAD-positive if at least pidogrel had their treatment changed to disposed to the 2 conditions. The re- 50% diameter stenosis in any 1 of the ma- subcutaneous heparin 2 days before colo- sults have important implications in jor coronary arteries was found on coro- noscopy. Endoscopists were blinded to prevention of both colorectal neoplasm nary angiography; otherwise, patients the CAD status of the patients. The with- and CAD, as well as for the screening were defined as CAD-negative. drawal time of the colonoscopy proce- strategy of colorectal cancer.
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