Defecation Patterns and Cardiovascular Outcomes in Acute Coronary Syndrome: The Influence of Stimulant Laxative Use.

BACKGROUND

Appropriate defecation patterns may be important for the prevention of recurrent cardiovascular events.

OBJECTIVES

This study aimed to investigate the association of defecation patterns and laxative use during hospitalization with future cardiovascular events in patients with acute coronary syndrome (ACS).

METHODS

This 2-center retrospective observational study included 1,817 patients hospitalized for ACS. In addition to: 1) "average daily defecation frequency," we comprehensively evaluated the following abnormal defecation patterns; 2) "% of nondefecation days;" 3) "consecutive nondefecation days;" and 4) "maximum daily defecation frequency." Cutoff values were determined using maximization of the log-rank statistic. The primary outcome was a composite of all-cause mortality, myocardial infarction, ischemic stroke, and hemorrhagic stroke. Laxatives were categorized into stimulant and nonstimulant types, and their associations with defecation patterns and cardiovascular outcomes were assessed.

RESULTS

During a median follow-up of 48 months (IQR: 29-74 months), 375 of 1,817 patients (20.6 [95% CI: 18.8-22.6]%) developed the primary outcome. Frequent nondefecation days (adjusted HR for ≥33.8%: 1.549; 95% CI: 1.217-1.971; P < 0.001)-corresponding to at least 1 nondefecation day every 3 days-and high maximum daily defecation-frequency (adjusted HR for ≥5 times/d: 1.803; 95% CI: 1.273-2.554; P < 0.001) were significant predictors. Those with reduced defecation frequency more often used stimulant laxative, which was independently associated with the primary outcome (adjusted HR: 1.285; 95% CI: 1.003-1.646; P = 0.047).

CONCLUSIONS

Abnormal defecation patterns and stimulant laxative use during ACS hospitalization were independent factors associated with an increased risk of future cardiovascular events.