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Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study
Jens Sundbøll1, Szimonetta Komjáthiné Szépligeti2, Kasper Adelborg2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark jens.sundboll@clin.au.dk.
Insights
Constipation significantly increases the risk of cardiovascular diseases, particularly venous thromboembolism. This association is strongest in the first year post-diagnosis and with increased laxative use.
Area of Science:
- Cardiology
- Gastroenterology
- Epidemiology
Background:
- Constipation is a common condition with potential systemic implications.
- Previous research has suggested links between constipation and cardiovascular health, but comprehensive risk assessments are needed.
Purpose of the Study:
- To evaluate the association between constipation and the risk of major cardiovascular events.
- To compare cardiovascular disease incidence in patients with constipation versus the general population.
Main Methods:
- A population-based, matched cohort study was conducted using Danish health registries from 2004-2013.
- 83,239 patients diagnosed with constipation were matched to 832,384 individuals without constipation.
- Cox regression analysis was used to calculate comorbidity- and medication-adjusted hazard ratios for cardiovascular outcomes.
Main Results:
- Constipation was associated with increased risks of myocardial infarction, stroke, peripheral artery disease, atrial fibrillation/flutter, and heart failure.
- A particularly strong association was observed for venous thromboembolism (adjusted hazard ratio: 2.04), including splanchnic venous thrombosis (aHR: 4.23).
- These associations were most pronounced within the first year after constipation diagnosis and intensified with greater laxative prescription frequency.
Conclusions:
- Constipation is linked to a significantly elevated risk of multiple cardiovascular diseases.
- The findings highlight venous thromboembolism as a key concern in patients with constipation.
- Further research into the mechanisms and management strategies for cardiovascular risks associated with constipation is warranted.
Objectives:
To assess the risks of myocardial infarction, stroke, peripheral artery disease, venous thromboembolism, atrial fibrillation or atrial flutter and heart failure in patients with constipation compared with a general population cohort.
Design:
Population-based matched cohort study.
Setting:
All Danish hospitals and hospital outpatient clinics from 2004 to 2013.
Participants:
Patients with a constipation diagnosis matched on age, sex and calendar year to 10 individuals without constipation from the general population.
Main Outcomes Measures:
Comorbidity-adjusted and medication-adjusted hazard ratios (aHRs) for cardiovascular outcomes based on Cox regression analysis.
Results:
83 239 patients with constipation were matched to 832 384 individuals without constipation. The median age at constipation diagnosis was 46.5% and 41% were men. Constipation was strongly associated with venous thromboembolism (aHR 2.04, 95% CI 1.89 to 2.20), especially splanchnic venous thrombosis (4.23, 95% CI 2.45 to 7.31). Constipation was also associated with arterial events, including myocardial infarction (1.24, 95% CI 1.14 to 1.35), ischaemic stroke (1.50, 95% CI 1.41 to 1.60), haemorrhagic stroke (1.46, 95% CI 1.26 to 1.69), peripheral artery disease (1.34, 95% CI 1.20 to 1.50), atrial fibrillation or atrial flutter (1.27, 95% CI 1.20 to 1.34) and heart failure (1.52, 95% CI 1.42 to 1.62). The associations were strongest during the first year after the constipation diagnosis and strengthened with an increased number of laxative prescriptions.
Conclusions:
Constipation was associated with an increased risk of several cardiovascular diseases, in particular venous thromboembolism.
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