Constipation and Incident Cardiovascular Disease: A Nationwide, Real-World Cohort Study.

Background: The association of constipation with incident cardiovascular disease (CVD) has been suggested; however, there are few studies including general population and assessing whether constipation can improve the predictive performance for future CVD.

Objectives: This study aims to quantify the association of constipation with the risk and attribution of developing CVD using a nationwide epidemiological database in Japan.

Methods: In 1,516,763 individuals without prior CVD from the DeSC database between April 2014 and November 2022, constipation was defined by International Classification of Diseases-10th revision code before the initial health checkup. We assessed the association of constipation with incident CVDs including myocardial infarction (MI), angina pectoris, stroke, heart failure (HF), atrial fibrillation (AF), and a composite of them using multivariable Cox models.

Results: Constipation was observed in 186,448 individuals (12.3%), showing a significant association with composite and each CVD, particularly with HF (HR: 1.30; 95% CI: 1.29-1.32 and HR: 1.32; 95% CI: 1.29-1.34, respectively). Followed by hypertension, constipation was the second highest population attributable fractions for the composite CVD, stroke, HF, and AF. Adding constipation to the established risk factors showed a modest but significant improvement in the prediction for the CVDs (net reclassification improvement for composite CVD: 0.122; 95% CI: 0.116-0.127; P < 0.001).

Conclusions: In individuals without prior CVD, constipation was associated with incident CVDs including myocardial infarction, angina pectoris, stroke, HF, and AF. Constipation may be promising for the prediction of future CVD other than established risk factors, suggesting the importance of constipation not just as a quality-of-life issue but as a potential cardiovascular risk in the general population.