Association Between Colorectal Neoplasia and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals

Advanced colorectal neoplasia (CRN) and coronary artery disease (CAD) are major health problems with common underlying pathogenic mechanisms. This study sought to investigate the association between the presence of advanced CRN and subclinical coronary atherosclerosis through a large cohort of asymptomatic Korean individuals who voluntarily underwent colonoscopy and coronary computed tomography angiography (CCTA) as routine health screening tests.

A total of 6,044 Korean individuals aged ≥ 20 years who underwent a general health examination at the Health Promotion Center of Ulsan University Hospital between January 2009 and March 2020 were retrospectively analyzed. Advanced CRN was defined as the presence of invasive cancer or adenoma with a villous component, high-grade dysplasia, and/or a size of ≥ 1 cm. Subclinical coronary atherosclerosis was evaluated by CCTA.

Participants with any CRN (n = 1,916, 31.7%) or advanced CRN (n = 240, 4.0%) had a higher coronary artery calcium score and a higher prevalence of any coronary, calcified, mixed, and non-calcified plaques, and obstructive CAD (≥ 50% diameter stenosis) on CCTA compared with participants with non-CRN (n = 4,128, 68.3%) (all P < 0.05). In the multivariable analysis to evaluate the association between CRN and CCTA findings, the advanced CRN group showed a statistically significant association with obstructive CAD (odds ratio, 1.65; 95% confidence interval, 1.09-2.50; P = 0.019).

Asymptomatic subjects with CRN showed a higher prevalence of subclinical coronary atherosclerosis compared to those with non-CRN. Advanced CRN was independently associated with obstructive CAD on CCTA.