Association of Cardiovascular Risk Assessment with Early Colorectal Neoplasia Detection in Asymptomatic Population: A Systematic Review and Meta-Analysis

Figures & data

Figure 1 Flowchart of inclusions of studies about relation of CVD risk to CRN.

Note: Adapted from Moher D, Liberati A, Tetzlaff J, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:7. Creative Commons license and disclaimer available from: http://creativecommons.org/licenses/by/4.0/legalcode.³⁶
Abbreviations: CVD, cardiovascular disease; CRN, colorectal neoplasia.

Table 1 Basic Characteristics of Included Studies About Relation of CVD Risk to Colorectal Neoplasia

Study	Country	Study Period	Number of Participants	Age (Years, Mean±SD)	Male, N (%)	Outcome^c	Data Source	Cecum Intubation Rate^d	CVD Risk Assessment
Yamaji Y, 2014^Citation29	Japan	2006–2010	907	57.3 ± 8.7	652 (71.9)	AD, AN	MR+Q	100%	ABI
Kim J, 2019^Citation30	Korea	2012–2016	4871	54.7 ± 8.4	2492(51.2)	AD, HRA	MR+Q	NR	CAP
Kim H, 2018^Citation31	Korea	2013–2017	548	53.0^b	412 (75.2)	AD	MR+Q	100%	CAP
Cha JM, 2011^Citation38	Korea	2006–2009	192	56 (Median)	115 (59.9)	AD, AN	MR	NR	CAP
Yun KE, 2018^Citation32	Korea	2010–2011	4859	41.0±7.0	4354 (89.6)	AD, HRA	MR+Q	100%	CACS
Choi SH, 2015^Citation33	Korea	2009–2014	398	56.8 ± 8.1	290 (72.9)	AD	MR+Q	NR	CACS
Yang MH, 2013^Citation39	Korea	2006–2009	3092	52.5±7.1	2807 (91.1)	AD	MR	100%	CACS
Kim, HB, 2014^Citation40	Korea	2007–2010	1637	51.7 ± 9.5	981 (59.9)	AD	MR	NR	CACS
Lee YJ, 2019^a^Citation41	Korea	2006–2017	754	52.6^b	544 (72.1)	AD	MR+Q	≥95%	CACS
Lee JY, 2013^Citation42	Korea	2010	3144	50.5± 7.8	2068 (65.8)	AD, AN	MR+Q	100%	FRS
Niederseer D, 2018^Citation43	Austria	2010–2014	1990	58.7 ± 9.7	982 (49.4)	AD, AN	MR+Q	NR	FRS
Basyigit S, 2015^Citation28	Turkey	2014	235	60.3±12.6	126 (53.0)	AD, AN	MR+Q	100%	FRS

Notes: ^aIt is a retrospective follow-up study, and all the other studies are cross-sectional; ^bSD was not reported; ^cDetected by colonoscopies in all included studies; ^d100% cecum intubation rate: participants with failure of cecum intubation were excluded; NR, not reported; studies mentioned that colonoscopies were extended to cecum in the methods section, but did not reported the success rate of cecum intubation.

Abbreviations: ABI, ankle-brachial index; AD; colorectal adenoma; AN, advanced colorectal neoplasia; CACS, coronary artery calcium score; CAP, carotid artery plaque; CVD, cardiovascular disease; FRS, Framingham risk score; HRA, high risk adenoma; MR, medical records; NR, not reported; Q, questionnaires; SD, standard deviation.

Table 2 Risk of Bias and Applicability Judgements in QUADAS-2

Study	Risk of Bias				Applicability Concerns			Total
	Patient Selection	Index Test	Reference Standard	Flow and Timing	Patient Selection	Index Test	Reference Standard
Yamaji Y, 2014^Citation29	√	√	√	√	√	√	√	7
Kim J, 2019^Citation30	√	√	√	√	√	√	√	7
Kim H, 2018^Citation31	?	√	√	√	?	√	√	5
Cha JM, 2011^Citation38	√	√	√	√	√	√	√	7
Yun KE, 2018^Citation32	√	√	√	√	√	√	√	7
Choi SH, 2015^Citation33	√	√	√	√	√	√	√	7
Yang MH, 2013^Citation39	√	√	√	√	√	√	√	7
Kim, HB, 2014^Citation40	√	√	√	√	√	√	√	7
Lee YJ, 2019^Citation41	√	√	√	√	√	√	√	7
Lee JY, 2013^Citation42	√	√	√	√	√	√	√	7
Niederseer D, 2018^Citation43	√	√	√	√	√	√	√	7
Basyigit S, 2015^Citation28	√	√	√	√	√	√	√	7
Total	11	12	12	12	11	12	12

Notes: “_”, High risk; “√”, Low Risk; “?”, Unclear Risk.

Table 3 Details of the CVD Risk Assessment Methods in the Included Studies About Relation of CVD Risk to Colorectal Neoplasia

Study	Categories^b	Outcome	OR	[95% CI]
Yamaji Y, 2014^Citation29	Abnormal ABI	AD	1.76	[0.55, 5.63]
	Abnormal ABI	AN	13.0	[2.69, 62.7]
Kim J, 2019^Citation30	CAP: Yes	AD	1.24	[1.08, 1.43]
	CAP: Yes	HRA	1.35	[1.10, 1.65]
Kim H, 2018^Citation31	CAP: Yes	AD	1.70	[1.04, 2.76]
Cha JM, 2011^Citation38	CAP: Yes	AD	1.35	[0.68, 2.68]
	CAP: Yes	AN	3.10	[0.83, 11.67]
Yun KE, 2018^Citation32	CACS: >0	AD	1.37	[1.09, 1.70]
	CACS: 1–100	AD	1.26	[1.00, 1.60]
	CACS: >100	AD	2.07	[1.31, 3.26]
	CACS: >0	HRA	1.98	[1.23, 3.19]
	CACS: 1–100	HRA	1.90	[1.15, 3.13]
	CACS: >100	HRA	2.54	[1.10, 5.89]
Choi SH, 2015^Citation33	CACS: >0	AD	1.66	[1.05, 2.64]
	CACS: 1–100	AD	1.80	[1.06, 3.03]
	CACS: >100	AD	1.95	[1.05, 3.63]
Yang MH,2013^Citation39	CACS: >0	AD	1.35	[1.12, 1.61]
Kim, HB, 2014^Citation40	CACS: 1–17	AD	1.44	[0.91, 2.33]
	CACS: 18–105	AD	1.88	[1.15, 3.01]
	CACS: ≥106	AD	3.61	[2.23, 5.74]
Lee YJ, 2019^a^Citation41	CACS: >0	AD	HR: 1.29	[0.80, 2.08]
Lee JY, 2013^Citation42	FRS: Intermediate	AD	1.66	[1.34, 2.05]
	FRS: High	AD	2.26	[1.53, 3.35]
	FRS: Intermediate	AN	1.26	[0.85, 1.87]
	FRS: High	AN	3.31	[1.94, 5.65]
Niederseer D, 2018^Citation43	FRS: Intermediate	AD	2.34	[1.89, 2.89]
	FRS: High	AD	2.69	[1.47, 4.90]
	FRS: Intermediate	AN	2.93	[1.82, 4.71]
	FRS: High	AN	2.86	[0.84, 9.71]
Basyigit S, 2015^Citation28	FRS: Intermediate	AD	2.89	[1.52, 5.49]
	FRS: High	AD	1.74	[0.64, 4.12]
	FRS: Intermediate	AN	0.04	[0.09, 2.01]
	FRS: High	AN	4.12	[1.36, 12.52]

Notes: ^aIn participants without adenoma, CACS>0 at baseline (compared to CACS=0) increased the risk of colorectal adenoma at follow-up colonoscopy (HR, 1.29, 95% CI, 0.80, 2.08). ^bThe lowest level was defined as reference.

Abbreviations: ABI, ankle-brachial index; AD, colorectal adenoma; AN, advanced colorectal neoplasia; CACS, coronary artery calcium score; CAP, carotid artery plaque; FRS, Framingham risk score; HRA, high risk adenoma; HR, hazard ratio; OR, odds ratio; CI, confidence interval.

Table 4 Meta-Analysis of Odds Ratios for Different CVD Risk Assessment Tools

Study	CVD Risk Assessment	Categories^a	Outcome	OR (95% CI)
^Citation30,Citation31,Citation38	CAP	Yes vs. No	AD	1.27 (1.12, 1.45)
^Citation32,Citation33,Citation39,Citation40	CACS	CACS: >0 vs. CACS=0	AD	1.42 (1.24, 1.61)
^Citation32,Citation33	CACS	CACS: 1–100 vs. CACS=0	AD	1.34 (1.08, 1.66)
^Citation32,Citation33	CACS	CACS: >100 vs. CACS=0	AD	2.03 (1.40, 2.93)
^Citation28,Citation42,Citation43	FRS	Intermediate vs. Low risk	AD	2.09 (1.55, 2.83)
^Citation28,Citation42,Citation43	FRS	High vs. low risk	AD	2.30 (1.69, 3.13)
^Citation28,Citation42,Citation43	FRS	Intermediate vs. Low risk	AN	0.71 (0.19, 2.73)
^Citation28,Citation42,Citation43	FRS	High vs. low risk	AN	3.36 (2.15, 5.27)

Note: ^aThe lowest level was defined as reference.

Abbreviations: AD, colorectal adenoma; AN, advanced colorectal neoplasia; CACS, coronary artery calcium score; CAP, carotid artery plaque; CVD, cardiovascular disease; FRS, Framingham risk score; OR, odds ratio; CI, confidence interval.

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