Constipation and Risk of Cardiovascular Events in Menopausal Women

Introduction: Complaints of constipation are common in Western societies, accounting for 2.5 million-physician visits/year in the US. Constipation is associated with age, female gender, diabetes, lack of physical activity, and poor intake of dietary fiber. Since some of the former are risk factors for cardiovascular (CV) disease, we hypothesized that constipation may be associated with increased risk of CV events. Methods: We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women’s Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire and rated as none, mild, moderate, severe. Baseline associations between constipation and risk factors for CV disease were determined using cross-tabulations and chi-square statistics. Estimates of the risk of CV events (cumulative end-point including mortality for coronary heart disease, MI, angina, PTCA, CABG, stroke and TIA) in the different constipation categories (vs. no constipation) were derived from Cox proportional hazard regression models. CV outcomes were centrally validated. Results: The analysis included 76,870 women. Mean follow-up was 6.4 years (max. 9.3). Constipation was associated with age, race, smoking, diabetes, high cholesterol, family history of MI, hypertension, obesity, lack of physical activity, low fiber intake, and depression (all p\u3c0.001). Women with moderate and severe constipation had a higher number of CV events (14.7 and 18.9/1000 person-years, respectively, vs. 9.6/1000 person-years in the no constipation group) and a higher risk of CV events (unadjusted HR, moderate vs. none: 1.53; CI: 1.39, 1.68); severe vs. none: HR: 1.97; CI: 1.66, 2.33). After adjustment for demographics, risk factors for CHD, dietary factors, medications and depression, women reporting moderate constipation still had a higher risk of CV events (HR:1.13; CI: 1.03,1.24) as did women with severe constipation (HR 1.28; CI: 1.08,1.53). Conclusion: Moderate and severe constipation appear to be independently associated with an increased risk of CV events in menopausal women. Since constipation is easily assessed, it may be helpful in identifying women at risk, in whom preventive screening for coronary risk factors may be indicated