In a large study of post-menopausal women, constipation was associated with all the major risk factors for cardiovascular events. However, constipation was not an independent risk factor nor was there a causal relationship with constipation and cardiovascular disease. The study, published in the American Journal of Medicine, was derived from a survey of more than 70,000 women in the Women’s Health Initiative.
Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.
It is difficult to interpret this study. The degree of constipation was self-reported and limited to the previous four weeks. Was severe constipation a marker for poor health (or health habits) in general? Does severe constipation trigger some inflammatory event, leading to cardiovascular disease? Could there be intestinal bacterial overgrowth (there have been studies associating infections and coronary heart disease)? Because of the particular population studied, women who are postmenopausal, mostly white, and educated beyond high school, these results may not be generalizable to younger age groups and less educated women and men.
Amer J Medicine, 124:8; 714-723, August 2011
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