P5085 - Stalled Bowels, Strained Hearts: Constipation as a Hidden Risk Factor Independently Predicts Major Cardiovascular Events

Sushrut Ingawale, MD, DNB, MBBS¹, Raj H. Patel, MD², Ruchir Paladiya, MBBS³, Pujitha Vallivedu Chennakesavulu, MD, MBBS⁴, Corinne Caissie, MD⁵, Simran Joshi, MD⁵, Shefali Mody, MBBS⁶, Marquise Soto, MD⁷, Akshay Sharma, MBBS⁸, Sunny Kumar, MD⁹, Akanksha Togra, MD¹⁰, Sneh Sonaiya, MD, MPH, MBA¹¹, Ayushi Shah, MBBS⁶, Suprabhat Giri, DM, MD, MBBS¹², Prabin Sharma, MD¹³
1Quinnipiac University - Frank H Netter MD School of Medicine, Bridgeport, CT; 2St. Mary Medical Center, Langhorne, PA; 3University of Connecticut School of Medicine, Farmington, CT; 4Quinnipiac University Frank H Netter School of Medicine/ St Vincent medical center, Bridgeport, CT; 5Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT; 6SUNY Upstate Medical University Hospital, Syracuse, NY; 7Massachusetts General Hospital, Chelsea, MA; 8Luminis Health Anne Arundel Medical Center, Annapolis, MD; 9Wright Center for Graduate Medical Education, Scranton, PA; 10Texas Tech University Health Sciences Center, El Paso, El Paso, TX; 11Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV; 12Kalinga Institute of Medical Sciences, Bhubaneshwar, Orissa, India; 13Quinnipiac University - St VIncent Medical Center, Bridgeport, CT

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 ICD-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 three MACE outcomes. Notably, constipation remained a significant predictor of HF (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.

Discussion: 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.

Disclosures:
Sushrut Ingawale indicated no relevant financial relationships.
Raj Patel indicated no relevant financial relationships.
Ruchir Paladiya indicated no relevant financial relationships.
Pujitha Vallivedu Chennakesavulu indicated no relevant financial relationships.
Corinne Caissie indicated no relevant financial relationships.
Simran Joshi indicated no relevant financial relationships.
Shefali Mody indicated no relevant financial relationships.
Marquise Soto indicated no relevant financial relationships.
Akshay Sharma indicated no relevant financial relationships.
Sunny Kumar indicated no relevant financial relationships.
Akanksha Togra indicated no relevant financial relationships.
Sneh Sonaiya indicated no relevant financial relationships.
Ayushi Shah indicated no relevant financial relationships.
Suprabhat Giri indicated no relevant financial relationships.
Prabin Sharma indicated no relevant financial relationships.

Sushrut Ingawale, MD, DNB, MBBS¹, Raj H. Patel, MD², Ruchir Paladiya, MBBS³, Pujitha Vallivedu Chennakesavulu, MD, MBBS⁴, Corinne Caissie, MD⁵, Simran Joshi, MD⁵, Shefali Mody, MBBS⁶, Marquise Soto, MD⁷, Akshay Sharma, MBBS⁸, Sunny Kumar, MD⁹, Akanksha Togra, MD¹⁰, Sneh Sonaiya, MD, MPH, MBA¹¹, Ayushi Shah, MBBS⁶, Suprabhat Giri, DM, MD, MBBS¹², Prabin Sharma, MD¹³. P5085 - Stalled Bowels, Strained Hearts: Constipation as a Hidden Risk Factor Independently Predicts Major Cardiovascular Events, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.