Prevalence of colorectal neoplasm among patients with newly diagnosed coronary artery disease
Prevalence of colorectal neoplasm among patients with newly diagnosed coronary artery disease
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DOI：
10.1001/jama.298.12.1412
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发表时间：
2007-09-26
影响因子：
120.7
通讯作者：
Lam, Shiu Kum
中科院分区：
文献类型：
--
作者：
Chan, Annie On On;Jim, Man Hong;Lam, Shiu Kum
背景 结直肠肿瘤和冠状动脉疾病 (CAD) 具有相似的危险因素，并且它们的同时发生可能相关。 目的 通过横断面研究调查 CAD 患者结直肠肿瘤的患病率，并确定这两种疾病关联的诱发因素。 设计、背景和参与者 2004 年 11 月至 2006 年 6 月期间，招募中国香港的患者，在因疑似 CAD 进行冠状动脉造影后进行结肠镜检查。存在 CAD (n = 206) 的定义是任意 1 条主要冠状动脉直径至少有 50% 狭窄；否则，患者被视为 CAD 阴性 (n = 208)。从普通人群中招募了年龄和性别匹配的对照组（n = 207）。患者因使用阿司匹林或他汀类药物、结肠疾病个人史或过去 10 年进行结肠镜检查而被排除。 主要结果指标 确定 CAD 阳性、CAD 阴性和一般人群参与者中结直肠肿瘤的患病率。采用双变量逻辑回归研究结直肠肿瘤与 CAD 之间的关联，并在调整年龄和性别后确定这两种疾病关联的危险因素。结果 CAD 阳性、CAD 阴性和一般人群中结直肠肿瘤的患病率分别为 34.0%、18.8% 和 20.8%（通过 chi(2) 检验，P < .001），晚期病变的患病率为 18.4%， 8.7% 和 5.8% (P < .001)，癌症患病率分别为 4.4%、0.5% 和 1.4% (P = .02)。 CAD 阳性参与者中 50% 的癌症处于早期阶段。调整年龄和性别后，结直肠肿瘤与 CAD 之间仍然存在关联（优势比 [OR]，1.88；95% 置信区间 [CI]，1.25-2.70；P = .002），晚期病变与 CAD 之间仍然存在关联（OR，2.51；95% CI，1.43-4.35；P = .001）。代谢综合征（OR，5.99；95% CI，1.43-27.94；P = .02）和吸烟史（OR，4.74；95% CI，1.38-18.92；P = .02）是晚期结肠病变与 CAD 关联的独立因素。 结论 在接受冠状动脉造影的研究人群中，患有以下疾病的患者结直肠肿瘤的患病率较高：计算机辅助设计。在患有代谢综合征和有吸烟史的人中，晚期结肠病变与 CAD 之间的关联性更强。
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 chi(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.