Cardiovascular Risk Assessment by SCORE2 Predicts Risk for Colorectal Neoplasia and Tumor-Related Mortality

Abstract

Objectives: The European Society of Cardiology endorsed SCORE2 to assess cardiovascular risk. The aim of this observational, retrospective study was to assess whether SCORE2 is associated with colorectal neoplasia in an asymptomatic screening population. Further, we evaluated if SCORE2 predicts tumor-related mortality. Methods: We included 3408 asymptomatic patients who underwent a screening colonoscopy. We calculated SCORE2 for each participant and stratified patients according to their predicted 10-year risk of cardiovascular disease: SCORE2 0−4.9%, SCORE2 5−9.9%, and SCORE2 ≥ 10%. We assessed the association between SCORE2 as a continuous variable, the presence of colorectal neoplasia using multilevel logistic regression, and SCORE2 and mortality using Cox regression. Results: In total, 1537 patients had a SCORE2 of 0−4.9%, 1235 a SCORE2 of 5−9.9%, and 636 a SCORE2 ≥ 10%. The respective rates of colorectal neoplasia were 20%, 37%, and 44%. SCORE2 was associated with the presence of any (OR 1.11 95%CI 1.09−1.12; p < 0.001) and advanced colorectal neoplasia (OR 1.06 95%CI 1.08−1.13; p < 0.001) in univariate analysis. After multivariable adjustment (age, sex, family history, and metabolic syndrome) a higher SCORE2 remained associated with higher odds for any (aOR 1.04 95%CI 1.02−1.06; p = 0.001) and advanced (aOR 1.06 95%CI 1.03−1.10; p < 0.001) colorectal neoplasia. SCORE2 was associated with both all-cause (HR 1.11 95%CI 1.09−1.14; p < 0.001) and tumor-related mortality (HR 1.10 95%CI 1.05−1.14; p < 0.001). Conclusions: We found that SCORE2 is associated with the presence of colorectal neoplasia. Clinicians could kill two birds with one stone calculating SCORE2. In patients with a high SCORE2, screening colonoscopy aside from cardiovascular risk mitigation could improve outcomes.

Keywords: cancer screening; colorectal adenoma and carcinoma; primary prevention; risk assessment; risk score.

Figure 1

Predicted risk for any colorectal neoplasia based on the SCORE2 obtained by univariable multilevel logistic regression, using the year of inclusion as random effect and the SCORE2 as continuous variable as fixed effect.

Figure 2

Predicted risk for any advanced colorectal neoplasia based on the SCORE2 obtained by univariable multilevel logistic regression, using the year of inclusion as random effect and the SCORE2 as continuous variable as fixed effect.

Figure 3

Sensitivity analyses stratifying the presence of the primary endpoint (any colorectal neoplasia) according to patient-specific baseline characteristics (stratified for sex, age (in categories), BMI (in categories according to the World Health Organization), smoking status, metabolic syndrome, and positive family history). For the sensitivity analyses, model-1 was fitted with SCORE2 as continuous variable as independent variable and any colorectal neoplasia as dependent variable in the strata. Abbreviations: BMI: body mass index; CI: confidence interval; and OR: odds ratio.

Figure 4

Sensitivity analyses stratifying the presence of the primary endpoint (any colorectal neoplasia) according to patient-specific baseline characteristics (stratified for sex, age (in categories), BMI (in categories according to the World Health Organization), smoking status, metabolic syndrome, and positive family history). For the sensitivity analyses, model-1 was fitted with SCORE2 as continuous variable as independent variable and advanced colorectal neoplasia as dependent variable in the strata. We plotted the OR and 95%CI. Abbreviations: BMI: body mass index; CI: confidence interval; and OR: odds ratio.

Figure 5

Survival data for all-cause mortality in the three SCORE2 strata. The all-cause mortality was 7% over a median follow-up of 2768 days. In the Cox regression model, SCORE2 was associated with all-cause (HR 1.11 95%CI 1.09–1.14; p < 0.001) mortality. Abbreviations: CI: confidence interval; and HR: hazard ratio.