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Constipation and Heart Disease

The Link between constipation & CVD

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First published: 11. Jan.2025

Overview

Constipation is a pervasive gastrointestinal disorder that affects between 14 and 20% of the population. It has a higher prevalence among older people and women.

A series of studies in different populations, using a large number of patients, have revealed a strong link between constipation, heart disease, and death due to cardiovascular disease (CVD). This article examines some of these studies and the possible mechanisms by which constipation causes CVD.

In this Article (Index)

gut and heart drawn side by side
The gut, constipation, and heart disease. A. Whittall

Science: constipation and heart disease

A series of recent studies investigating the association between constipation and heart disease.

Australia

A study in Australia (1) analyzed the data from over 541,000 hospitalized patients aged 60 and over, comparing information from constipated with a control group of non-constipated patients to investigate the association between constipation and cardiovascular disease.

This study concluded that "constipation is linked to an increased risk of hypertension and cardiovascular events... constipation was positively associated with myocardial infarction, stroke and all cardiovascular events."

Constipated patients had almost twice the risk for hypertension (96% risk increase).
Compared to patients with neither constipation nor hypertension, constipated patients had a 58% higher risk of cardiovascular events which for constipated patients with hypertension was 7.5 times higher (653%) than in the control group.

Take-home point

Constipation increases the risk of hypertension, and both combined increase the risk of cardiovascular events.

Japan

The Ohaki cohort took data from 45,112 subjects followed over 13.3 years. (2)

Compared with those who moved their bowels once a day or more, overall death from heart disease was "significantly higher" among those who did so once every 2 to 3 days (risk increase of 21%) and once every 4 days (risk increase of 39%).

The authors concluded that "A lower defecation frequency was associated with risk of CVD mortality."

Take-home point

Constipation increases mortality due to heart disease.

American Veterans

A study followed over 237,000 constipated U.S. Veterans from 2004 to 2013 investigating the association of constipation and laxative use with heart disease and all-cause mortality.

7.1% of the 3.3 million veterans who were screened suffered from constipation, representing 237,855 patients. The study revealed that:

  • Constipation and laxative use are associated with a higher risk of mortality.
  • Both were also associated with a higher incidence of coronary heart disease (11% risk increase) and stroke (19% risk increase).
  • 12% higher all-cause mortality
  • Those using one or more laxatives compared to those using none also had a higher risk of all-cause mortality (15%), heart disease (11%), and ischemic stroke (20%).

Take-home point

Constipation and high laxative use are linked to heart disease and all-cause mortality.

Denmark

The Danish cohort study analyzed data from all Danish hospitals from 2004 to 2013 and it tracked over 83,000 patients with constipation comparing them with individuals that didn't suffer from constipation. (4)

It found "an increased risk of several cardiovascular disease" among the constipated patients that "strengthened with an increased number of laxative prescriptions."

  • Over twice the risk (104%) of venous thromboembolism.
  • Over four times the risk (323%) of splanchnic venous thrombosis.
  • 24% increased risk of arterial events, including myocardial infarction.
  • 50% for ischaemic stroke, and 46% for hemorrhagic stroke.
  • 34% for peripheral artery disease.
  • 27% for atrial fibrillation or atrial flutter.
  • 52% for heart failure

Take-home point

Constipation and laxative use increase the risk of cardiovascular events.

man holding belly, in pain
Constipation affects 20% of the world's population.

UK Study

This study analyzed 408,354 participants of the UK Biobank, which includes healthcare and genetic information. (5); it corroborated the findings of previous studies and also found a genetic risk factor.

Constipation, compared to those with regular bowel movements was associated with a 115% increased risk for a major adverse cardiac event, a 172% increase in the risk of heart failure, a 136% risk increase for ischemic stroke, and a 62% risk increase for acute coronary syndrome.

Just like the Australian study, it found that hypertension plus constipation increased the risk of a major adverse cardiac event 1,7 times and the risk of death by 34%.

Genetics

The UK Biobank study showed a link between genetic factors, constipation, and heart disease: "Constipation shares up to 27% of genetic risk factors with individual MACE" (major adverse cardiac events) (5)

Take-home point

Constipation and heart disease share genetic risk factors.

How does constipation cause heart disease?

Each of the studies mentioned in the previous section speculates on the link between constipation and heart disease and suggests explanations connecting the two of them.

Hypertension

Older adults tend to have higher blood pressure and are more constipated than the younger population which also has lower blood pressure levels.

Constipated patients tend to be hypertensive and the combination of both has been shown to increase the risk of cardiovascular events. (1),(5)

Lack of water intake can cause dehydration which can harden the stool causing constipation, lower levels of hydration alter the levels of sodium in the body which triggers an increase in blood pressure.

Inflammation due to "leaky gut"

Constipation causes changes in the gut microbiota a process called dysbiosis. This affects the lining of the gut allowing microbes and their waste products (metabolites) to enter the bloodstream which activates the immune system and provokes inflammation. Low-grade inflammation is a risk factor for cardiovascular disease as it leads to an increase in blood pressure.

The gut microbes also produce short-chain fatty acids (SCFAs) that have a positive effect on blood pressure and the contraction of the colon. An alteration in the gut microbiome reduces these beneficial effects.

Vagus Nerve

The autonomic nervous system regulates the gut and cardiovascular functions with the vagus nerve playing an important role as it carries signals between the brain, heart, and digestive system.

A low vagal tone has been observed in subjects with inflammation, gut dysbiosis, and high blood pressure. Low vagal tone also reduces gut motility, slowing transit time and constipation.

References and Further Reading

(1) Judkins, C.P., Wang, Y., Jelinic, M. et al., (2023). Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients. Sci Rep 13, 10943 (2023). https://doi.org/10.1038/s41598-023-38068-y

(2) Honkura, K. et al., (2016). Defecation frequency and cardiovascular disease mortality in Japan: The Ohsaki cohort study. Atherosclerosis 246, 251–256

(3) Sumida, K. et al., (2019). Constipation and risk of death and cardiovascular events. Atherosclerosis 281, 114–120

(4) Sundbøll J, Szépligeti SK, Adelborg K, et al., (2020). Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study. BMJ Open 2020;10:e037080. doi: 10.1136/bmjopen-2020-037080

(5) Tenghao Zheng, Leticia Camargo Tavares, Mauro D’Amato, and Francine Z. Marques, (2024). Constipation is associated with an increased risk of major adverse cardiac events in a UK population. American Journal of Physiology-Heart and Circulatory Physiology 2024 327:4, H956-H964

About this Article

Constipation and Heart Disease, A. Whittall

©2025 Fit-and-Well.com. First Published: 11.Jan.2025. Update scheduled for 11.Jan.2028. https://www.fit-and-well.com/fitness/constipation-and-heart-disease.html

Tags: heart, constipation, fiber, health

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