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Take a look at the colon: cardiovascular risk scores predict colorectal advanced adenoma and carcinoma in a large asymptomatic screening cohort

Session Poster session 5

Speaker David Niederseer

Event : ESC Congress 2015

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention
  • Session type : Poster Session

Authors : D Niederseer (Oberndorf,AT), A Stadlmayr (Oberndorf,AT), U Huber-Schoenauer (Oberndorf,AT), M Ploederl (Salzburg,AT), D Lederer (Oberndorf,AT), W Patsch (Salzburg,AT), E Aigner (Salzburg,AT), C Datz (Oberndorf,AT)

Authors:
D. Niederseer1 , A. Stadlmayr1 , U. Huber-Schoenauer1 , M. Ploederl2 , D. Lederer1 , W. Patsch3 , E. Aigner4 , C. Datz1 , 1General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Department of Internal Medicine - Oberndorf - Austria , 2Suicide Prevention Research Program, Paracelsus Medical University - Salzburg - Austria , 3Paracelsus Medical University, Department of Pharmacology - Salzburg - Austria , 4Paracelsus Medical University, Department of Internal Medicine I - Salzburg - Austria ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 809-810

Background: Cardiovascular risk is estimated using specific risk scores that integrate cardiovascular risk factors. Obesity, type 2 diabetes, smoking, age or poor dietary habits and physical inactivity are not only risk factors for cardiovascular diseases but also for colorectal cancer.

Purpose: To study whether established cardiovascular risk scores such as the Framingham risk score (FRS) and the Heart Score of the European Society of Cardiology (HS) predict colorectal neoplasias in a large asymptomatic screening cohort.

Methods: We investigated 2138 subjects (59.6±10.2 years, 50% males, BMI 27.2±4.6 kg/m2) that underwent simultaneous cardiovascular risk evaluation and screening colonoscopy. The FRS and HS were calculated for each subject. Colonoscopic findings were classified as tubular adenoma or advanced neoplasia (including polyps with villous or tubulovillous features, size ≥1 cm or high-grade dysplasia or carcinoma after a combined analysis of macroscopic and histological results). Subsequently, the results of the screening colonoscopy were correlated with the cardiovascular risk scores.

Results: Of 2138 screened subjects, 1427 (66.7%) had a low FRS (0–10), 572 (26.8%) an intermediate FRS (11–20) and 139 (6.5%) a high FRS (>20), whereas 1527 (71.5%) had a low HS (0–3), 348 (16.3%) an intermediate HS (4–6) and 236 (11.0%) a high HS (>6). In total, 1555 (72.7%) subjects had no colorectal lesions, 490 (22.9%) had tubular adenoma and 93 (4.4%) had advanced neopasia. Correlations between cardiovascular risk scores and colonoscopic findings revealed r=0.20 (p<0.001) for FRS and r=0.18 (p<0.001) for HS. This linear association holds true for proximal (FRS: r=0.17, p<0.001; HS: r=0.19, p<0.001), distal (FRS: r=0.15, p<0.001; HS: r=0.16 p<0.001) and rectal (FRS: r=0.09, p<0.001; HS: r=0.08; p<0.001) lesions. Also, the number of the lesions correlated with FRS (r=0.22, p<0.001) and HS (r=0.24, p<0.001). In 1 out of 2.5 (FRS) or 2.1 (HS) patients with high cardiovascular risk we found a least one colorectal lesion, and in 1 out of 17.3 (FRS) and 9.4 (HS) subjects with high cardiovascular risk we found an advanced colorectal neoplasia, respectively.

Conclusions: In a large asymptomatic screening cohort, subjects with high cardiovascular risk had a significantly higher probability of early and advanced colorectal neoplasia, presumably due to shared risk factors. Our data provide compelling evidence for considering screening colonoscopy particularly in subjects with high cardiovascular risk in order to detect potentially treatable colorectal neoplasia.

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