Association between constipation and risk of cardiovascular or all-cause mortality: a meta-analysis

Abstract

Background: Constipation, characterized by infrequent bowel movements or difficulty with defecation, is a common gastrointestinal disorder. This meta-analysis aimed to evaluate the association between constipation and the risks of cardiovascular and all-cause mortality. Methods: A systematic search of PubMed, Embase and Web of Science was conducted through 6 August 2025, to identify longitudinal observational studies examining the association between constipation and mortality. Pooled adjusted hazard ratios (HR) with 95% confidence intervals (CI) were calculated using random-effects models to account for substantial clinical heterogeneity in constipation definitions across studies. Results: Thirteen studies (14 articles) involving 3,710,453 participants were included. Pooled analyses revealed a significant association between constipation and all-cause mortality across different populations: a HR of 1.10 (95% CI 1.02–1.19) for the general population, 1.40 (95% CI 1.16–4.68) for patients with chronic kidney disease (CKD), and 1.85 (95% CI 1.28–2.67) for patients with heart failure. Conversely, no significant associations were observed for cardiovascular mortality in either the general population (HR 1.19; 95% CI 0.99–1.45) or CKD patients (HR 1.33; 95% CI 0.83–2.13). Conclusions: Constipation is independently associated with an increased risk of all-cause mortality, particularly in patients with chronic conditions such as CKD and heart failure. However, standardized measurement protocols and validation across diverse cohorts are necessary to clarify its prognostic significance.