Associations between reflux esophagitis and the progression of coronary artery calcification: A cohort study

BACKGROUND: Reflux esophagitis (RE) and coronary heart disease (CHD) have common risk factors, including obesity and metabolic syndrome. This study aimed to evaluate the associations between RE and the future CHD risk. METHODS: This retrospective cohort study included 8,221 participants who were ≥20 years old, and who underwent esophagogastroduodenoscopy and coronary computed tomography (CT) scans during the same visit and subsequent CT scans between 2003 and 2013. RE was defined as the presence of at least Los Angeles classification grade A mucosal break. CT scan was used to determine the coronary artery calcium (CAC) scores. CAC progression was defined as an increase in the CAC score on a subsequent CT scan. RESULTS: RE was present in 984 (12.0%) participants. RE at baseline was associated with CAC progression (odds ratio [OR], 1.253; 95% confidence interval [CI], 1.088–1.444; P = 0.002), and this association persisted after adjusting the model for age, sex, smoking status, and alcohol consumption (OR, 1.175; 95% CI, 1.001–1.378; P = 0.048). This association disappeared when the model was further adjusted for body mass index, diastolic blood pressure, the presence of hypertension, glycated hemoglobin, low-density lipoprotein cholesterol, and triglycerides (OR, 1.088; 95% CI, 0.924–1.281; P = 0.311) which were selected using a stepwise selection procedure from several metabolic variables. CONCLUSIONS: Our results suggest that the presence of RE is closely associated with CHD, even though RE is not a direct risk factor for CHD. Metabolic factors may play roles in CAC progression in individuals with RE.