Original article
The association between coronary calcification and adenomatous polyps of colon in Korean adults

https://doi.org/10.1016/j.clinre.2014.01.004Get rights and content

Summary

Background and objective

Adenomatous polyps of colon is a precancerous lesion. Many studies have shown that the adenomatous polyps of colon and cardiovascular disease share several common risk factors. This cross-sectional study aimed to investigate whether coronary calcification is associated with the adenomatous polyps of colon.

Methods

Among 1637 Korean adults, we examined the association between coronary calcium score (CCS) as a measurement of coronary calcification and the presence of adenomatous polyps of colon via multi-detected row computed tomography (MDCT) and colonoscopy, respectively. CCS values were categorized as follows: 0, 1–17, 18–105, or  106. The odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of adenomatous polyps of colon were calculated across CCS groups.

Results and conclusions

After adjusting for confounding variables, the adjusted ORs (95% CIs) for the presence of adenomatous polyps of colon in each of the four CCS groups were 1.00 (reference), 1.44 (0.91–2.33), 1.88 (1.15–3.01) and 3.61 (2.23–5.74). And higher CCS values were associated with multiple polyps (P  0.001), villous histologic features or high-grade dysplasia (P = 0.02), and advanced adenomatous polyps (P  0.001). A higher level of CCS was found to be strongly and independently associated with the presence of adenomatous polyps of colon in Korean adults. This finding suggests that people at high risk for coronary atherosclerosis through MDCT should be considered for further evaluation of adenomatous polyps.

Introduction

Colon cancer is one of the most common malignancies and is a leading cause of cancer-related death worldwide [1]. An adenomatous polyp of colon is a precancerous lesion, and screening for detection and removal of these polyps has been shown to reduce colorectal cancer mortality [2]. In addition to being precancerous lesions, there are many studies, which have shown that the adenomatous polyps of colon are associated with and increased incidence of cardiovascular disease (CVD) [3], [4]. Recently, it has been reported that adenomatous polyps of colon related to obesity [5], [6], type 2 diabetes, and insulin-resistance [7], [8]. We previously demonstrated that a higher pulse wave velocity (PWV), which is a reliable indicator of atherosclerosis, may be independently related with the presence of the adenomatous polyps of colon, regardless of whether the patient exhibits conventional cardiovascular risk factors [9].

Coronary calcification is closely related to mural atheromatous plaque [10], which can be quantified by multi-detected row computed tomography (MDCT). The coronary calcium score (CCS) is proportionally associated with the severity of atherosclerotic disease [11], and is a strong predictor of future coronary artery event, independent of the traditional risk factors [12].

Taken together, these findings suggest that there may be a positive correlation between CCS and the presence of adenomatous polyps of colon, though few studies to date have examined this relationship. Therefore, a cross-sectional study was performed to examine whether coronary calcification as determined by CCS is associated with adenomatous polyps of colon among Korean adults.

Section snippets

Study population

We reviewed the medical records of 2135 visitors between the ages of 18 and 83 who had undergone both MDCT and colonoscopy between January 2007 and October 2010, at the health promotion center of Gangnam Severance Hospital in Seoul, Korea. Subjects meeting any of the following criteria were excluded from this study: history of hypertension or use of antihypertensive agents, history of diabetes or use of antidiabetic agents, missing covariate information, and history of colon disease such as

Results

The prevalence of adenomatous polyps of colon was 23.2% (380 patients).

The percentage of serrated polyps was 11.1% (42/380 patients). Table 1 shows the demographic and biochemical data for all subjects according to CCS group. The average age was 51.7 ± 9.5 years. The mean BMI (kg/m2) was 23.5, and the percentage of patients that were current smokers was 32.6%. The mean age, number of male subjects, BMI, SBP, DBP, FPG, and ALT level were higher in the CCS  106 group, whereas the percentage of

Discussion

In this population-based cross-sectional study, we found that adenomatous polyps of colon may be associated with a high risk of coronary artery atherosclerosis in Korean adults. This association remained significant after adjusting for potentially confounding variables.

CCS is considered to be a reasonable risk stratification tool in asymptomatic intermediate-risk patients [9], and can be used to assess the progression or regression of coronary artery disease [15].

There is some controversy

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgements

We would like to express our gratitude to Professor Sang-Yol Mah (Department of Urology, GangNam Severance Hospital) and Professor Young-Won Yoon (Department of Cardiology, GangNam Severance Hospital) who generously advised us to go ahead with our thesis.

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