Constipation and risk of death and cardiovascular events

Keiichi Sumida, M. Molnár, Praveen K. Potukuchi, Fridtjof Thomas, Jun Ling Lu, Kunihiro Yamagata, Kamyar Kalantar-Zadeh, Csaba P. Kovesdy

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and aims: Constipation is one of the most frequent symptoms encountered in daily clinical practice and is implicated in the development of atherosclerosis, potentially through altered gut microbiota. However, little is known about its association with incident cardiovascular events. Methods: In a nationally representative cohort of 3,359,653 US veterans with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 between October 1, 2004 and September 30, 2006 (baseline period), with follow-up through 2013, we examined the association of constipation status (absence or presence; defined using diagnostic codes and laxative use) and laxative use (none, one, or ≥2 types of laxatives) with all-cause mortality, incident coronary heart disease (CHD), and incident ischemic stroke. Results: Among 3,359,653 patients, 237,855 (7.1%) were identified as having constipation. After multivariable adjustments for demographics, prevalent comorbidities, medications, and socioeconomic status, patients with (versus without) constipation had 12% higher all-cause mortality (hazard ratio [HR], 1.12; 95% CI, 1.11–1.13), 11% higher incidence of CHD (HR, 1.11; 95% CI, 1.08–1.14), and 19% higher incidence of ischemic stroke (HR, 1.19; 95% CI, 1.15–1.22). Patients with one and ≥2 (versus none) types of laxatives experienced a similarly higher risk of all-cause mortality (HRs [95% CI], 1.15 [1.13–1.16] and 1.14 [1.12–1.15], respectively), incident CHD (HRs [95% CI], 1.11 [1.07–1.15] and 1.10 [1.05–1.15], respectively) and incident ischemic stroke (HRs [95% CI], 1.19 [1.14–1.23] and 1.21 [1.16–1.26], respectively). Conclusions: Constipation status and laxative use are independently associated with higher risk of all-cause mortality and incident CHD and ischemic stroke.

Original languageEnglish
Pages (from-to)114-120
Number of pages7
JournalAtherosclerosis
Volume281
DOIs
Publication statusPublished - Feb 1 2019

Fingerprint

Laxatives
Constipation
Coronary Disease
Stroke
Mortality
Status Epilepticus
Incidence
Veterans
Glomerular Filtration Rate
Social Class
Comorbidity
Atherosclerosis
Demography

Keywords

  • Constipation
  • Coronary heart disease
  • Laxatives
  • Mortality
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sumida, K., Molnár, M., Potukuchi, P. K., Thomas, F., Lu, J. L., Yamagata, K., ... Kovesdy, C. P. (2019). Constipation and risk of death and cardiovascular events. Atherosclerosis, 281, 114-120. https://doi.org/10.1016/j.atherosclerosis.2018.12.021

Constipation and risk of death and cardiovascular events. / Sumida, Keiichi; Molnár, M.; Potukuchi, Praveen K.; Thomas, Fridtjof; Lu, Jun Ling; Yamagata, Kunihiro; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.

In: Atherosclerosis, Vol. 281, 01.02.2019, p. 114-120.

Research output: Contribution to journalArticle

Sumida, K, Molnár, M, Potukuchi, PK, Thomas, F, Lu, JL, Yamagata, K, Kalantar-Zadeh, K & Kovesdy, CP 2019, 'Constipation and risk of death and cardiovascular events', Atherosclerosis, vol. 281, pp. 114-120. https://doi.org/10.1016/j.atherosclerosis.2018.12.021
Sumida, Keiichi ; Molnár, M. ; Potukuchi, Praveen K. ; Thomas, Fridtjof ; Lu, Jun Ling ; Yamagata, Kunihiro ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba P. / Constipation and risk of death and cardiovascular events. In: Atherosclerosis. 2019 ; Vol. 281. pp. 114-120.
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abstract = "Background and aims: Constipation is one of the most frequent symptoms encountered in daily clinical practice and is implicated in the development of atherosclerosis, potentially through altered gut microbiota. However, little is known about its association with incident cardiovascular events. Methods: In a nationally representative cohort of 3,359,653 US veterans with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 between October 1, 2004 and September 30, 2006 (baseline period), with follow-up through 2013, we examined the association of constipation status (absence or presence; defined using diagnostic codes and laxative use) and laxative use (none, one, or ≥2 types of laxatives) with all-cause mortality, incident coronary heart disease (CHD), and incident ischemic stroke. Results: Among 3,359,653 patients, 237,855 (7.1{\%}) were identified as having constipation. After multivariable adjustments for demographics, prevalent comorbidities, medications, and socioeconomic status, patients with (versus without) constipation had 12{\%} higher all-cause mortality (hazard ratio [HR], 1.12; 95{\%} CI, 1.11–1.13), 11{\%} higher incidence of CHD (HR, 1.11; 95{\%} CI, 1.08–1.14), and 19{\%} higher incidence of ischemic stroke (HR, 1.19; 95{\%} CI, 1.15–1.22). Patients with one and ≥2 (versus none) types of laxatives experienced a similarly higher risk of all-cause mortality (HRs [95{\%} CI], 1.15 [1.13–1.16] and 1.14 [1.12–1.15], respectively), incident CHD (HRs [95{\%} CI], 1.11 [1.07–1.15] and 1.10 [1.05–1.15], respectively) and incident ischemic stroke (HRs [95{\%} CI], 1.19 [1.14–1.23] and 1.21 [1.16–1.26], respectively). Conclusions: Constipation status and laxative use are independently associated with higher risk of all-cause mortality and incident CHD and ischemic stroke.",
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AU - Molnár, M.

AU - Potukuchi, Praveen K.

AU - Thomas, Fridtjof

AU - Lu, Jun Ling

AU - Yamagata, Kunihiro

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba P.

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N2 - Background and aims: Constipation is one of the most frequent symptoms encountered in daily clinical practice and is implicated in the development of atherosclerosis, potentially through altered gut microbiota. However, little is known about its association with incident cardiovascular events. Methods: In a nationally representative cohort of 3,359,653 US veterans with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 between October 1, 2004 and September 30, 2006 (baseline period), with follow-up through 2013, we examined the association of constipation status (absence or presence; defined using diagnostic codes and laxative use) and laxative use (none, one, or ≥2 types of laxatives) with all-cause mortality, incident coronary heart disease (CHD), and incident ischemic stroke. Results: Among 3,359,653 patients, 237,855 (7.1%) were identified as having constipation. After multivariable adjustments for demographics, prevalent comorbidities, medications, and socioeconomic status, patients with (versus without) constipation had 12% higher all-cause mortality (hazard ratio [HR], 1.12; 95% CI, 1.11–1.13), 11% higher incidence of CHD (HR, 1.11; 95% CI, 1.08–1.14), and 19% higher incidence of ischemic stroke (HR, 1.19; 95% CI, 1.15–1.22). Patients with one and ≥2 (versus none) types of laxatives experienced a similarly higher risk of all-cause mortality (HRs [95% CI], 1.15 [1.13–1.16] and 1.14 [1.12–1.15], respectively), incident CHD (HRs [95% CI], 1.11 [1.07–1.15] and 1.10 [1.05–1.15], respectively) and incident ischemic stroke (HRs [95% CI], 1.19 [1.14–1.23] and 1.21 [1.16–1.26], respectively). Conclusions: Constipation status and laxative use are independently associated with higher risk of all-cause mortality and incident CHD and ischemic stroke.

AB - Background and aims: Constipation is one of the most frequent symptoms encountered in daily clinical practice and is implicated in the development of atherosclerosis, potentially through altered gut microbiota. However, little is known about its association with incident cardiovascular events. Methods: In a nationally representative cohort of 3,359,653 US veterans with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 between October 1, 2004 and September 30, 2006 (baseline period), with follow-up through 2013, we examined the association of constipation status (absence or presence; defined using diagnostic codes and laxative use) and laxative use (none, one, or ≥2 types of laxatives) with all-cause mortality, incident coronary heart disease (CHD), and incident ischemic stroke. Results: Among 3,359,653 patients, 237,855 (7.1%) were identified as having constipation. After multivariable adjustments for demographics, prevalent comorbidities, medications, and socioeconomic status, patients with (versus without) constipation had 12% higher all-cause mortality (hazard ratio [HR], 1.12; 95% CI, 1.11–1.13), 11% higher incidence of CHD (HR, 1.11; 95% CI, 1.08–1.14), and 19% higher incidence of ischemic stroke (HR, 1.19; 95% CI, 1.15–1.22). Patients with one and ≥2 (versus none) types of laxatives experienced a similarly higher risk of all-cause mortality (HRs [95% CI], 1.15 [1.13–1.16] and 1.14 [1.12–1.15], respectively), incident CHD (HRs [95% CI], 1.11 [1.07–1.15] and 1.10 [1.05–1.15], respectively) and incident ischemic stroke (HRs [95% CI], 1.19 [1.14–1.23] and 1.21 [1.16–1.26], respectively). Conclusions: Constipation status and laxative use are independently associated with higher risk of all-cause mortality and incident CHD and ischemic stroke.

KW - Constipation

KW - Coronary heart disease

KW - Laxatives

KW - Mortality

KW - Stroke

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