Constipation and risk of death and cardiovascular events

Abstract

Background and aims: Constipation is one of the most frequent symptoms encountered in daily clinical practice and is implicated in the development of atherosclerosis, potentially through altered gut microbiota. However, little is known about its association with incident cardiovascular events. Methods: In a nationally representative cohort of 3,359,653 U.S. veterans with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m 2 between October 1, 2004 and September 30, 2006 (baseline period), with follow-up through 2013, we examined the association of constipation status (absence or presence; defined using diagnostic codes and laxative use) and

Constipation in CKD

“…37 Impact on Clinical Outcomes Constipation has been increasingly recognized as a potentially serious condition, particularly in patients with ESRD receiving PD, affecting the mechanical properties of dialysis techniques and predisposing to bacterial intestinal translocation and eventual enteric peritonitis. 76 Although little attention has been paid to the clinical impact of constipation beyond its gastrointestinal complications (e.g., diverticulitis, perforation, and peritonitis), 6,103,104 recent studies have disclosed its independent associations with the risk of several clinical outcomes, such as Parkinson's disease, 105 ESRD, 14 CV disease, [15][16][17][18] and mortality. 18…”

“…Subsequently, using a cohort of 45,112 Japanese men and women aged 40 to 79 years, Honkura et al 17 reported that a lower defecation frequency was significantly associated with higher CV mortality (21% and 39% higher mortality for defecation frequency of 1 time every 2-3 days and #1 time every 4 days [vs. $1 time per day], respectively). In a recent large observational study of 3,359,653 US veterans with an eGFR $60 ml/min per 1.73 m 2 , Sumida et al 18 reported that patients with (vs. without) constipation had 11% and 19% higher incidence of coronary heart disease and ischemic stroke, respectively, and also experienced a 12% higher all-cause mortality.…”

“…Because gastrointestinal motility and gut microbiota are closely interrelated and exert reciprocal effects on each other, 9,10,106 constipation, one of the clinical forms of altered gut microbiota, 73,77,107,108 is thought to be involved in the pathogenesis of atherosclerosis partly through chronic inflammation induced by bacterial endotoxins 109 and/or gut metabolites (e.g., trimethylamine-N-oxide), 110 consequently contributing to adverse CV outcomes. Although the median follow-up period ranging from 6.7 to 13.3 years in the aforementioned 3 studies appears to be relatively short to evaluate a long-term effect of constipation on the outcomes, 15,17,18 given the chronic nature of this particular disease condition, it is possible that the patients identified as constipated had been exposed for a much longer time to these potential causative factors up to the time when the study follow-up was started. Some other factors, such as autonomic dysfunction, 111 increased blood serotonin levels, 112,113 and repeated Valsalva-like breath-holdings (a well-recognized cause of "defecation syncope"), 114 associated with constipation may also serve as potential explanations for the observed associations (Figure 3).…”

“…9,10 Constipation is usually perceived as a benign and often self-limited or treatable condition, 11 but its chronic, multiple symptoms negatively affect patients' quality of life and may impose a considerable social and economic burden. 12,13 Furthermore, recent evidence also has revealed that constipation is independently associated with adverse clinical outcomes such as CKD progression, CV events, and mortality, [14][15][16][17][18] which, in turn, suggests that constipation could potentially serve as a new therapeutic target for these outcomes. The advent of new drug classes for constipation, some of which shows unique renoprotective properties with improvement of gut microbiota, [19][20][21] has further expanded the potential of constipation management as a novel therapeutic strategy for diseases related to altered gut microbiota like CKD.…”

Use of Concentrated Aloe Vera Juice Fe-Rox for Management of Functional Constipation

“…В среднем около 2% людей на Земле страдают запорами, заболеваемость в среднем составляет примерно 1% в год [1]. Только треть принимающих слабительные препараты делают это по рекомендации врача, остальные -по совету знакомых, без выбора, случайно [2].…”