S1204 Stalled Bowels, Strained Hearts: Constipation as a Hidden Risk Factor Independently Predicts Major Cardiovascular Events

Introduction: Constipation has long been considered a benign gastrointestinal symptom, yet emerging evidence suggests it may have systemic implications, including cardiovascular risk. We aimed to evaluate whether constipation is independently associated with major adverse cardiovascular events (MACE)—specifically acute coronary syndrome (ACS), ischemic stroke, and heart failure (HF)—using a large, nationally representative inpatient database. Methods: We analyzed the National Inpatient Sample (2016–2020) for adult hospitalizations. Patients were classified based on the presence of constipation using International Classification of Diseases-10 codes. MACE outcomes included ACS, ischemic stroke, and HF. Chi-square tests assessed unadjusted associations, and multivariable logistic regression evaluated adjusted odds, controlling for age, sex, race, income, insurance, hospital characteristics, and comorbidities including hypertension, diabetes, chronic lung disease, and heart failure. Discharge weights were applied for national estimates. Results: Among 31,834,508 weighted hospitalizations, 1,896,565 (5.96%) had documented constipation. The unadjusted prevalence of ACS, HF, and stroke in constipated vs non-constipated patients was 4.43% vs 6.31%, 6.45% vs 3.84%, and 3.99% vs 6.19%, respectively (all P < 0.0001). While raw proportions varied, adjusted models showed constipation was independently associated with increased odds of all 3 MACE outcomes. Notably, constipation remained a significant predictor of HF (odds ratio [OR] 1.42, 95% CI 1.41–1.43) and ACS (OR 1.23, 95% CI 1.22–1.25). Constipated patients also had longer hospital stays, higher costs, and increased in-hospital mortality. Conclusion: Constipation is a modifiable and often overlooked symptom. It is independently associated with increased risk of MACE in hospitalized patients, even after adjusting for known risk factors. These findings challenge the perception of constipation as a localized disorder and suggest it may serve as an early clinical marker of systemic vascular vulnerability. Recognizing and managing constipation may offer a novel opportunity for cardiovascular risk modification. Future research should explore whether proactive constipation management can improve cardiovascular outcomes.