{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:54:23Z","timestamp":1791618863209,"version":"4.3.4"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis aimed to evaluate the association between constipation and risk of coronary heart disease (CHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched PubMed, Web of Science, and Cochrane Library until 28 February 2025. Published cohort studies reporting quantitative association measures for CHD in constipated vs. non-constipated individuals were included. The heterogeneity was assessed via the chi-square test based on Cochrane Q statistics.\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009&amp;gt;\u200950% or\n                      <jats:italic>Q<\/jats:italic>\n                      -test\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05 indicated substantial heterogeneity, warranting random-effects modeling; otherwise, fixed-effects models were implemented. Subgroup evaluations were conducted for study design type, region, category of CHD, follow-up duration, and gender.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies involving 283,070 constipation cases and 3,343,120 controls were analyzed. Constipation was associated with a 10% increased CHD risk [hazard ratio (HR]\u2009=\u2009).10, 95% confidence interval (CI): 1.05\u20131.15]. Statistical heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200942.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03) was observed in the present study. Subgroup analyses revealed a stronger association with myocardial infarction (HR\u2009=\u20091.14, 95% CI: 1.05\u20131.23). Notably, constipation showed no CHD risk elevation in women (HR\u2009=\u20091.04, 95% CI: 0.98\u20131.11), with reduced residual heterogeneity (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200930.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.177).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our meta-analysis identified a significant positive association between constipation and CHD risk, particularly myocardial infarction. These findings suggest that constipation may either accelerate the pathological processes underlying CHD or that both conditions share common etiological pathways, warranting further mechanistic and interventional studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1622801","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:32:23Z","timestamp":1764829943000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between constipation and risk of coronary heart disease: a systematic review and meta-analysis of cohort studies"],"prefix":"10.3389","volume":"12","author":[{"given":"Feng","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianjun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiwen","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaidi","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobin","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2361","DOI":"10.1016\/j.jacc.2022.11.005","article-title":"The global burden of cardiovascular diseases and risk: a compass for future health","volume":"80","author":"Vaduganathan","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"155","DOI":"10.23876\/j.krcp.24.174","article-title":"Constipation and risk of death and cardiovascular events in patients on hemodialysis","volume":"44","author":"Park","year":"2025","journal-title":"Kidney Res Clin Pract"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e031028","DOI":"10.1136\/bmjopen-2019-031028","article-title":"Bowel movement frequency and risks of major vascular and non-vascular diseases: a population-based cohort study among Chinese adults","volume":"10","author":"Yang","year":"2020","journal-title":"BMJ Open"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e037080","DOI":"10.1136\/bmjopen-2020-037080","article-title":"Constipation and risk of cardiovascular diseases: a Danish population-based matched cohort study","volume":"10","author":"Sundb\u00f8ll","year":"2020","journal-title":"BMJ Open"},{"key":"B6","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/j.atherosclerosis.2018.12.021","article-title":"Constipation and risk of death and cardiovascular events","volume":"281","author":"Sumida","year":"2019","journal-title":"Atherosclerosis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/S2468-1253(21)00111-4","article-title":"Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis","volume":"6","author":"Barberio","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1038\/ajg.2014.187","article-title":"American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation","volume":"109","author":"Ford","year":"2014","journal-title":"Am J Gastroenterol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"33005","DOI":"10.1038\/srep33005","article-title":"Associations of bowel movement frequency with risk of cardiovascular disease and mortality among us women","volume":"6","author":"Ma","year":"2016","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.annepidem.2022.09.002","article-title":"Association of abnormal bowel health with major chronic diseases and risk of mortality","volume":"75","author":"Peng","year":"2022","journal-title":"Ann Epidemiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"10943","DOI":"10.1038\/s41598-023-38068-y","article-title":"Association of constipation with increased risk of hypertension and cardiovascular events in elderly Australian patients","volume":"13","author":"Judkins","year":"2023","journal-title":"Sci Rep"},{"key":"B12","doi-asserted-by":"publisher","first-page":"H956","DOI":"10.1152\/ajpheart.00519.2024","article-title":"Constipation is associated with an increased risk of major adverse cardiac events in a UK population","volume":"327","author":"Zheng","year":"2024","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.amjmed.2011.03.026","article-title":"Constipation and risk of cardiovascular disease among postmenopausal women","volume":"124","author":"Salmoirago-Blotcher","year":"2011","journal-title":"Am J Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1177\/2050640614558476","article-title":"Chronic constipation and co-morbidities: a prospective population-based nested case-control study","volume":"4","author":"Choung","year":"2016","journal-title":"United Eur Gastroenterol J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.atherosclerosis.2016.01.007","article-title":"Defecation frequency and cardiovascular disease mortality in Japan: the Ohsaki cohort study","volume":"246","author":"Honkura","year":"2016","journal-title":"Atherosclerosis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"242","DOI":"10.2188\/jea.JE20150123","article-title":"Bowel movement frequency, laxative use, and mortality from coronary heart disease and stroke among Japanese men and women: the Japan collaborative cohort (JACC) study","volume":"26","author":"Kubota","year":"2016","journal-title":"J Epidemiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"951","DOI":"10.1016\/j.jacc.2012.02.082","article-title":"Obstructive coronary atherosclerosis and ischemic heart disease: an elusive link!","volume":"60","author":"Marzilli","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1161\/CIR.0b013e3182009701","article-title":"Heart disease and stroke statistics\u20132011 update: a report from the American Heart Association","volume":"123","author":"Roger","year":"2011","journal-title":"Circulation"},{"key":"B19","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s11886-016-0705-1","article-title":"Intracoronary imaging in the detection of vulnerable plaques","volume":"18","author":"Batty","year":"2016","journal-title":"Curr Cardiol Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"3481","DOI":"10.1161\/CIRCULATIONAHA.105.537878","article-title":"Pathophysiology of coronary artery disease","volume":"111","author":"Libby","year":"2005","journal-title":"Circulation"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e596","DOI":"10.1161\/CIR.0000000000000678","article-title":"2019 ACC\/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"140","author":"Arnett","year":"2019","journal-title":"Circulation"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2980","DOI":"10.1016\/j.jacc.2020.11.021","article-title":"The global burden of cardiovascular diseases and risks: a compass for global action","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.3390\/jcm10081738","article-title":"Current overview on clinical management of chronic constipation","author":"W\u0142odarczyk","year":"2021","journal-title":"J Clin Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1080\/17474124.2020.1781617","article-title":"An overview of interventions for constipation in adults","volume":"14","author":"Daniali","year":"2020","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"86","DOI":"10.5694\/mja18.00241","article-title":"Chronic idiopathic constipation in adults: epidemiology, pathophysiology, diagnosis and clinical management","volume":"209","author":"Black","year":"2018","journal-title":"Med J Aust"},{"key":"B26","doi-asserted-by":"publisher","first-page":"12465","DOI":"10.3390\/ijms252212465","article-title":"The gut-heart axis: molecular perspectives and implications for myocardial infarction","volume":"25","author":"Rivera","year":"2024","journal-title":"Int J Mol Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"7073","DOI":"10.3390\/jcm11237073","article-title":"A combination of xyloglucan, pea protein and chia seed ameliorates intestinal barrier integrity and mucosa functionality in a rat model of constipation-predominant irritable bowel syndrome","volume":"11","author":"Filippone","year":"2022","journal-title":"J Clin Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.cca.2020.04.037","article-title":"Butyrate-producing bacteria and the gut-heart axis in atherosclerosis","volume":"507","author":"Chen","year":"2020","journal-title":"Clin Chim Acta"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1056\/NEJMoa1109400","article-title":"Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk","volume":"368","author":"Tang","year":"2013","journal-title":"N Engl J Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/nature09922","article-title":"Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease","volume":"472","author":"Wang","year":"2011","journal-title":"Nature"},{"key":"B31","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1038\/nm.3145","article-title":"Intestinal microbiota metabolism of l-carnitine, a nutrient in red meat, promotes atherosclerosis","volume":"19","author":"Koeth","year":"2013","journal-title":"Nat Med"},{"key":"B32","first-page":"1854","article-title":"Physiologic and psychologic characteristics of an elderly population with chronic constipation","volume":"88","author":"Merkel","year":"1993","journal-title":"Am J Gastroenterol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1111\/jch.13489","article-title":"Constipation-induced pressor effects as triggers for cardiovascular events","volume":"21","author":"Ishiyama","year":"2019","journal-title":"J Clin Hypertens"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1038\/ajg.2009.683","article-title":"Mucosal serotonin signaling is altered in chronic constipation but not in opiate-induced constipation","volume":"105","author":"Costedio","year":"2010","journal-title":"Am J Gastroenterol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.lab.2004.03.014","article-title":"The ratio of plasma to whole-blood serotonin may be a novel marker of atherosclerotic cardiovascular disease","volume":"144","author":"Hara","year":"2004","journal-title":"J Lab Clin Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1161\/01.CIR.100.5.483","article-title":"Serotonin is associated with coronary artery disease and cardiac events","volume":"100","author":"Vikenes","year":"1999","journal-title":"Circulation"},{"key":"B37","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1007\/s10620-022-07590-w","article-title":"Recto-anal pressures in constipated men and women undergoing high-resolution anorectal manometry","volume":"68","author":"Prichard","year":"2023","journal-title":"Dig Dis Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1097\/DCR.0b013e31822cb5c2","article-title":"Prevalence and pathophysiology of functional constipation among women in Catalonia, Spain","volume":"54","author":"Ribas","year":"2011","journal-title":"Dis Colon Rectum"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1622801\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:32:24Z","timestamp":1764829944000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1622801\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,4]]},"references-count":38,"alternative-id":["10.3389\/fcvm.2025.1622801"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1622801","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,4]]},"article-number":"1622801"}}