Association Between Aortic Valve Diseases and the Risk of Colorectal Polyps and Cancer: A Real-World Cohort Study Using a Global Collaborative Network

Aims This study aimed to examine the association between aortic valve diseases and the subsequent development of colorectal neoplasia. Specifically, we evaluated whether patients with aortic stenosis (AS) or aortic regurgitation (AR) had higher risks of developing colorectal polyps, benign colorectal polyps, or colorectal cancer compared with echocardiography-confirmed individuals without valvular disease. By leveraging a large real-world dataset from a global collaborative network, we sought to clarify potential links between valvular pathology, systemic inflammation, and colorectal tumorigenesis. Methods We conducted a retrospective cohort study using the TriNetX Global Collaborative Network. Adults aged 18 years or older who underwent echocardiography between January 1, 2015 and January 1, 2020 were included. Two exposure cohorts, aortic stenosis (AS) and aortic regurgitation (AR), were compared with echocardiography-confirmed controls without valvular disease. Patients with inflammatory bowel disease, acute abdomen, prior colectomy, or preexisting colorectal neoplasia were excluded. The outcomes included incident colorectal polyp, benign polyp, and colorectal cancer. Propensity score matching in a 1:1 ratio was performed to balance demographics, comorbidities, and lifestyle factors. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95 percent confidence intervals (CIs). Results After matching, 250,255 patients with AS and 254,023 with AR were analyzed, each matched to an equal number of controls. In the AS cohort, risks were significantly higher for colorectal polyp (HR 1.21; 95% CI 1.17–1.24; p<0.0001), benign polyp (HR 1.19; 95% CI 1.16–1.22; p<0.0005), and colorectal cancer (HR 1.20; 95% CI 1.13–1.29; p=0.0008). Similarly, in the AR cohort, risks were elevated for colorectal polyp (HR 1.17; 95% CI 1.14–1.21; p<0.0001), benign polyp (HR 1.21; 95% CI 1.18–1.24; p=0.0083), and colorectal cancer (HR 1.07; 95% CI 1.00–1.15; p=0.034). Kaplan–Meier analysis showed consistently lower event-free survival among AS and AR groups compared with controls (log-rank p<0.001 for most outcomes). Conclusions Both aortic stenosis and aortic regurgitation were associated with increased risks of colorectal polyps and malignancy, suggesting potential shared inflammatory or hemodynamic mechanisms linking valvular disease and colorectal neoplasia. Further studies integrating molecular and hemodynamic parameters are warranted to elucidate causal pathways. Article published online: 06 June 2026 © 2026. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany