Background & Objectives: Constipation, characterized by infrequent bowel movements and related symptoms, is increasingly recognized as a potential predictor for cardiovascular diseases (CVD), including myocardial infarction, atrial fibrillation, peripheral artery disease, stroke, heart failure, and major adverse cardiac events (MACE). This literature review aims to evaluate the current evidence linking constipation with cardiovascular outcomes, understand potential underlying mechanisms, and identify gaps requiring further research. Methodology: A comprehensive review was conducted, analyzing observational cohort studies, population-based studies, Mendelian randomization studies, systematic reviews, and meta-analyses. These studies were evaluated for their findings, methodological strengths, limitations, and adjustments for confounding factors. Results: Several studies revealed significant associations between constipation and cardiovascular outcomes. A Danish cohort study (n = 83,239) demonstrated increased risks for myocardial infarction (1.24-fold), atrial fibrillation (aHR 1.27), peripheral artery disease (aHR 1.34), and heart failure (aHR 1.52) in patients with constipation. A systematic review and meta-analysis reported a 41% increased stroke risk, particularly ischemic stroke (50% higher). Additionally, analysis of the UK Biobank data indicated a significant association between constipation and increased risk of MACE. Proposed mechanisms include gut dysbiosis, systemic inflammation, vagal nerve stimulation, increased intra-abdominal pressure, and medication-related electrolyte disturbances. Conclusion: Constipation is associated with increased cardiovascular risk, implicating potential mechanisms such as gut microbiota alterations, inflammation, and physiological stress during bowel movements. Despite robust observational associations, establishing causality remains essential, necessitating future Mendelian randomization and clinical intervention studies. Enhanced understanding and targeted management strategies may significantly impact cardiovascular outcomes, particularly in high-risk populations such as elderly individuals, diabetics, and patients with existing heart failure.
Diaz, S., Bittar, K., Hashmi, M.F. and Mendez, M.D. (2023) Constipation. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513291/
Bharucha, A.E. and Lacy, B.E. (2020) Mechanisms, Evaluation, and Management of Chronic Constipation. Gastroenterology , 158, 1232-1249.e3. https://doi.org/10.1053/j.gastro.2019.12.034
Dennison, C., Prasad, M., Lloyd, A., Bhattacharyya, S.K., Dhawan, R. and Coyne, K. (2005) The Health-Related Quality of Life and Economic Burden of Constipation. PharmacoEconomics , 23, 461-476. https://doi.org/10.2165/00019053-200523050-00006
Sundbøll, J., Szépligeti, S.K., Adelborg, K., Szentkúti, P., Gregersen, H. and Sørensen, H.T. (2020) Constipation and Risk of Cardiovascular Diseases: A Danish Population-Based Matched Cohort Study. BMJ Open , 10, e037080. https://doi.org/10.1136/bmjopen-2020-037080
Sumida, K., Molnar, M.Z., Potukuchi, P.K., Thomas, F., Lu, J.L., Yamagata, K., et al . (2019) Constipation and Risk of Death and Cardiovascular Events. Atherosclerosis , 281, 114-120. https://doi.org/10.1016/j.atherosclerosis.2018.12.021
Zheng, T., Camargo Tavares, L., D’Amato, M. and Marques, F.Z. (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 , 327, H956-H964. https://doi.org/10.1152/ajpheart.00519.2024
Peng, Y., Liu, F., Qiao, Y., Wang, P., Ma, B., Li, L., et al . (2022) Association of Abnormal Bowel Health with Major Chronic Diseases and Risk of Mortality. Annals of Epidemiology , 75, 39-46. https://doi.org/10.1016/j.annepidem.2022.09.002
Sharma, A., Rao, S.S.C., Kearns, K., Orleck, K.D. and Waldman, S.A. (2021) Review Article: Diagnosis, Management and Patient Perspectives of the Spectrum of Constipation Disorders. Alimentary Pharmacology & Therapeutics , 53, 1250-1267. https://doi.org/10.1111/apt.16369
Bouras, E. and Vazquez-Roque, M. (2015) Epidemiology and Management of Chronic Constipation in Elderly Patients. Clinical Interventions in Aging , 10, 919-930. https://doi.org/10.2147/cia.s54304
Forootan, M., Bagheri, N. and Darvishi, M. (2018) Chronic Constipation. Medicine , 97, e10631. https://doi.org/10.1097/md.0000000000010631
Talley, N.J., Jones, M., Nuyts, G. and Dubois, D. (2003) Risk Factors for Chronic Constipation Based on a General Practice Sample. American Journal of Gastroenterology , 98, 1107-1111. https://doi.org/10.1111/j.1572-0241.2003.07465.x
Peripheral Heart Disease
Bowel Dysfunction
Major Adverse Cardiac Events
Mace
Gut Microbiota
Intra-Abdominal Pressure
Electrolyte Imbalance
Short Chain Fatty Acids
Simren, M., Palsson, O.S. and Whitehead, W.E. (2017) Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Current Gastroenterology Reports , 19, 15. https://doi.org/10.1007/s11894-017-0554-0
Dong, Q., Chen, D., Zhang, Y., Xu, Y., Yan, L. and Jiang, J. (2023) Constipation and Cardiovascular Disease: A Two-Sample Mendelian Randomization Analysis. Frontiers in Cardiovascular Medicine , 10, Article ID: 1080982. https://doi.org/10.3389/fcvm.2023.1080982
Suenghataiphorn, T., Yanpiset, P., Xanthavanij, N., Srikulmontri, T., Thiravetyan, B., Tribuddharat, N., et al . (2024) Increased Risk of Stroke in Constipation Patients: Systematic Review and Meta-Analysis. Journal of Clinical Gastroenterology . https://doi.org/10.1097/mcg.0000000000002127
Du, W., Yang, S., Zhou, H., Wu, Y., Cai, Y., Meng, H., et al . (2023) The Association between Constipation and Stroke Based on the NHANES and Mendelian Randomization Study. Frontiers in Neuroscience , 17, Article ID: 1276032. https://doi.org/10.3389/fnins.2023.1276032
Ishiyama, Y., Hoshide, S., Mizuno, H. and Kario, K. (2019) Constipation-Induced Pressor Effects as Triggers for Cardiovascular Events. The Journal of Clinical Hypertension , 21, 421-425. https://doi.org/10.1111/jch.13489
Threapleton, D.E., Greenwood, D.C., Evans, C.E.L., Cleghorn, C.L., Nykjaer, C., Woodhead, C., et al . (2013) Dietary Fibre Intake and Risk of Cardiovascular Disease: Systematic Review and Meta-Analysis. BMJ , 347, f6879. https://doi.org/10.1136/bmj.f6879
Wang, J.Y., Hart, S.L., Lee, J., Berian, J.R., McCrea, G.L. and Varma, M.G. (2009) A Valid and Reliable Measure of Constipation-Related Quality of Life. Diseases of the Colon & Rectum , 52, 1434-1442. https://doi.org/10.1007/dcr.0b013e3181a51196
Judkins, C.P., Wang, Y., Jelinic, M., Bobik, A., Vinh, A., Sobey, C.G., et al . (2023) Association of Constipation with Increased Risk of Hypertension and Cardiovascular Events in Elderly Australian Patients. Scientific Reports , 13, Article No. 10943. https://doi.org/10.1038/s41598-023-38068-y
Yan, Q., Zhai, W., Yang, C., Li, Z., Mao, L., Zhao, M., et al . (2021) The Relationship among Physical Activity, Intestinal Flora, and Cardiovascular Disease. Cardiovascular Therapeutics , 2021, Article ID: 3364418. https://doi.org/10.1155/2021/3364418
Sun, T., Song, B. and Li, B. (2025) Gut Microbiota and Atrial Cardiomyopathy. Frontiers in Cardiovascular Medicine , 12, Article ID: 1541278. https://doi.org/10.3389/fcvm.2025.1541278
Li, N., Wang, L., Li, L., Yang, M., Wang, Q., Bai, X., et al . (2023) The Correlation between Gut Microbiome and Atrial Fibrillation: Pathophysiology and Therapeutic Perspectives. Military Medical Research , 10, Article No. 51. https://doi.org/10.1186/s40779-023-00489-1
Ito, H., Ito, K., Tanaka, M., Hokamura, M., Tanaka, M., Kusano, E., et al . (2022) Constipation Is a Frequent Problem Associated with Vascular Complications in Patients with Type 2 Diabetes: A Cross-Sectional Study. Internal Medicine ( Tokyo , Japan ), 61, 1309-1317. https://doi.org/10.2169/internalmedicine.7676-21
Evans, B.R., Yerly, A., van der Vorst, E.P.C., Baumgartner, I., Bernhard, S.M., Schindewolf, M., et al . (2022) Inflammatory Mediators in Atherosclerotic Vascular Remodeling. Frontiers in Cardiovascular Medicine , 9, Article ID: 868934. https://doi.org/10.3389/fcvm.2022.868934
Ordookhanian, C., Barseghian, C., Amidon, R.F. and Kaloostian, P. (2022) Intricate Connection among the Valsalva Maneuver, Gastrointestinal Tract, and Hemodynamics: A Rare Case Presentation. Cureus , 14, e24474. https://doi.org/10.7759/cureus.24474
Ishida, T., Kawada, K., Jobu, K., Hamada, T., Kubo, T., Okazaki, M., et al . (2025) Impact of Comorbid Constipation on the Survival of Patients with Heart Failure: A Multicenter, Prospective Cohort Study Conducted in Japan. Frontiers in Cardiovascular Medicine , 11, Article ID: 1470216. https://doi.org/10.3389/fcvm.2024.1470216
Namiuchi, S., Tanita, A., Sunamura, S., Onodera, K., Ogata, T., Noda, K., et al . (2023) Effect of Constipation on Readmission for Heart Failure in Patients with Acute Heart Failure. ESC Heart Failure , 11, 819-825. https://doi.org/10.1002/ehf2.14650
Eiraku, K., Uozumi, Y., Hieda, M., Maruyama, T. and Nomura, H. (2022) A Senile Case of Heart Failure Associated with Hypermagnesemia Induced by Magnesium-containing Laxative Agent. Geriatrics & Gerontology International , 22, 897-899. https://doi.org/10.1111/ggi.14478
Li, X., Wen, H., Ke, J. and Zhao, D. (2024) Association of Constipation with All-Cause Mortality among Individuals with Type 2 Diabetes: A Retrospective Cohort Study. Journal of Diabetes Investigation , 16, 501-509. https://doi.org/10.1111/jdi.14375
Itano, S., Honda, Y., Kubo, E., Yamada, Y., Ikenoue, T. and Kimachi, M. (2020) P1440 Association between the Use of Drugs for Constipation and Mortality in Hemodialysis Patients; from Japan-Dialysis Outcomes and Practice Patterns Study (J-DOPPS). Nephrology Dialysis Transplantation , 35, gfaa142.P1440. https://doi.org/10.1093/ndt/gfaa142.p1440
Nesci, A., Carnuccio, C., Ruggieri, V., D’Alessandro, A., Di Giorgio, A., Santoro, L., et al . (2023) Gut Microbiota and Cardiovascular Disease: Evidence on the Metabolic and Inflammatory Background of a Complex Relationship. International Journal of Molecular Sciences , 24, Article No. 9087. https://doi.org/10.3390/ijms24109087
Martel, J., Chang, S., Ko, Y., Hwang, T., Young, J.D. and Ojcius, D.M. (2022) Gut Barrier Disruption and Chronic Disease. Trends in Endocrinology & Metabolism , 33, 247-265. https://doi.org/10.1016/j.tem.2022.01.002
Sandys, O. and te Velde, A. (2022) Raising the Alarm: Environmental Factors in the Onset and Maintenance of Chronic (Low-Grade) Inflammation in the Gastrointestinal Tract. Digestive Diseases and Sciences , 67, 4355-4368. https://doi.org/10.1007/s10620-021-07327-1
Zhang, Y., Song, F., Yang, M., Chen, C., Cui, J., Xing, M., et al . (2024) Gastrointestinal Dysmotility Predisposes to Colitis through Regulation of Gut Microbial Composition and Linoleic Acid Metabolism. Advanced Science , 11, e2306297. https://doi.org/10.1002/advs.202306297
Cooke, W.H., Reynolds, B.V., Yandl, M.G., Carter, J.R., Tahvanainen, K.U.O. and Kuusela, T.A. (2002) Effects of Exercise Training on Cardiovagal and Sympathetic Responses to Valsalva’s Maneuver. Medicine & Science in Sports & Exercise , 34, 928-935. https://doi.org/10.1097/00005768-200206000-00004
Hotta, H., Lazar, J., Orman, R., Koizumi, K., Shiba, K., Kamran, H., et al . (2009) Vagus Nerve Stimulation-Induced Bradyarrhythmias in Rats. Autonomic Neuroscience : Basic & Clinical , 151, 98-105. https://doi.org/10.1016/j.autneu.2009.07.008
Thompson, G.W., Levett, J.M., Miller, S.M., Hill, M.R.S., Meffert, W.G., Kolata, R.J., et al . (1998) Bradycardia Induced by Intravascular versus Direct Stimulation of the Vagus Nerve. The Annals of Thoracic Surgery , 65, 637-642. https://doi.org/10.1016/s0003-4975(97)01351-9
Kollai, M., Koizumi, K., Yamashita, H. and Brooks, C.M. (1978) Study of Cardiac Sympathetic and Vagal Efferent Activity during Reflex Responses Produced by Stretch of the Atria. Brain Research , 150, 519-532. https://doi.org/10.1016/0006-8993(78)90817-x
Mehra, R., Chung, M.K., Olshansky, B., Dobrev, D., Jackson, C.L., Kundel, V., et al . (2022) Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults: Mechanistic Insights and Clinical Implications: A Scientific Statement from the American Heart Association. Circulation , 146, e119-e136. https://doi.org/10.1161/cir.0000000000001082
Shen, M.J. and Zipes, D.P. (2014) Role of the Autonomic Nervous System in Modulating Cardiac Arrhythmias. Circulation Research , 114, 1004-1021. https://doi.org/10.1161/circresaha.113.302549
Arcieri, T.R. and Meizoso, J.P. (2025) Intraabdominal Hypertension and Abdominal Compartment Syndrome—What You Need to Know. Journal of Trauma and Acute Care Surgery . https://doi.org/10.1097/ta.0000000000004603
Persichini, R., Lai, C., Teboul, J., Adda, I., Guérin, L. and Monnet, X. (2022) Venous Return and Mean Systemic Filling Pressure: Physiology and Clinical Applications. Critical Care , 26, Article No. 150. https://doi.org/10.1186/s13054-022-04024-x
Xu, X., He, Z., Shan, Y., Mao, Q., Feng, J. and Gao, G. (2021) Intra-Abdominal Pressure Measurements in Neurocritical Patients. Journal of Visualized Experiments . https://doi.org/10.3791/62557
Depauw, P.R.A.M., Groen, R.J.M., Van Loon, J., Peul, W.C., Malbrain, M.L.N.G. and De Waele, J.J. (2019) The Significance of Intra-Abdominal Pressure in Neurosurgery and Neurological Diseases: A Narrative Review and a Conceptual Proposal. Acta Neurochirurgica , 161, 855-864. https://doi.org/10.1007/s00701-019-03868-7
Dreesen, P., Schoutteten, M.K., Vande Velde, N., Kaminski, I., Heylen, L., De Moor, B., et al . (2020) Increased Intra-Abdominal Pressure during Laparoscopic Pneumoperitoneum Enhances Albuminuria via Renal Venous Congestion, Illustrating Pathophysiological Aspects of High Output Preeclampsia. Journal of Clinical Medicine , 9, 487. https://doi.org/10.3390/jcm9020487
Montorfano, L., Dip, F., Lo Menzo, E., Agrawal, N., Phillips, E.H., Liang, H., et al . (2022) The Role of Cushing’s Reflex and the Vasopressin-Mediated Oligoanuric Response to Intracranial Hypertension in Patients with Abdominal Compartment Syndrome. Surgery , 171, 399-404. https://doi.org/10.1016/j.surg.2021.08.046
Cavaliere, F., Cina, A., Biasucci, D., Costa, R., Soave, M., Gargaruti, R., et al . (2011) Sonographic Assessment of Abdominal Vein Dimensional and Hemodynamic Changes Induced in Human Volunteers by a Model of Abdominal Hypertension. Critical Care Medicine , 39, 344-348. https://doi.org/10.1097/ccm.0b013e3181ffe0d2
Tazmini, K., Frisk, M., Lewalle, A., Laasmaa, M., Morotti, S., Lipsett, D.B., et al . (2020) Hypokalemia Promotes Arrhythmia by Distinct Mechanisms in Atrial and Ventricular Myocytes. Circulation Research , 126, 889-906. https://doi.org/10.1161/circresaha.119.315641
Skogestad, J. and Aronsen, J.M. (2018) Hypokalemia-Induced Arrhythmias and Heart Failure: New Insights and Implications for Therapy. Frontiers in Physiology , 9, Article No. 1500. https://doi.org/10.3389/fphys.2018.01500
Aronsen, J.M., Skogestad, J., Lewalle, A., Louch, W.E., Hougen, K., Stokke, M.K., et al . (2014) Hypokalaemia Induces Ca 2+ Overload and Ca 2+ Waves in Ventricular Myocytes by Reducing Na + ,K + -ATPase α 2 Activity. The Journal of Physiology , 593, 1509-1521. https://doi.org/10.1113/jphysiol.2014.279893
Osadchii, O.E. (2010) Mechanisms of Hypokalemia-Induced Ventricular Arrhythmogenicity. Fundamental & Clinical Pharmacology , 24, 547-559. https://doi.org/10.1111/j.1472-8206.2010.00835.x
Sandau, K.E., Funk, M., Auerbach, A., Barsness, G.W., Blum, K., Cvach, M., et al . (2017) Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement from the American Heart Association. Circulation , 136, e273-e344. https://doi.org/10.1161/cir.0000000000000527
Salmoirago-Blotcher, E., Crawford, S., Jackson, E., Ockene, J. and Ockene, I. (2011) Constipation and Risk of Cardiovascular Disease among Postmenopausal Women. The American Journal of Medicine , 124, 714-723. https://doi.org/10.1016/j.amjmed.2011.03.026
Soliman, G.A. (2019) Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients , 11, Article No. 1155. https://doi.org/10.3390/nu11051155
Alahmari, L.A. (2024) Dietary Fiber Influence on Overall Health, with an Emphasis on CVD, Diabetes, Obesity, Colon Cancer, and Inflammation. Frontiers in Nutrition , 11, Article ID: 1510564. https://doi.org/10.3389/fnut.2024.1510564
Ağagündüz, D., Şahin, T.Ö., Yılmaz, B., Ekenci, K.D., Duyar Özer, Ş. and Capasso, R. (2022) Cruciferous Vegetables and Their Bioactive Metabolites: From Prevention to Novel Therapies of Colorectal Cancer. Evidence - Based Complementary and Alternative Medicine , 2022, Article ID: 1534083. https://doi.org/10.1155/2022/1534083
Anti, M., Pignataro, G., Armuzzi, A., et al . (1998) Water Supplementation Enhances the Effect of High-Fiber Diet on Stool Frequency and Laxative Consumption in Adult Patients with Functional Constipation. Hepato - Gastroenterology , 45, 727-732. https://pubmed.ncbi.nlm.nih.gov/9684123/
Bashir, A. and Sizar, O. (2024) Laxatives. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK537246/
Castro, D. and Sharma, S. (2025) Hypokalemia. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK482465/
Astudillo, A.A. and Mayrovitz, H.N. (2021) The Gut Microbiome and Cardiovascular Disease. Cureus , 13, e14519. https://doi.org/10.7759/cureus.14519
Muchtar, N.J., Helianthi, D.R. and Nareswari, I. (2020) Effectiveness of Acupuncture for Management in a Hospitalized Geriatric Patient with Constipation. Medical Acupuncture , 32, 116-120. https://doi.org/10.1089/acu.2019.1401