If you search for the words “constipation” and “heart attack” on Google, you will remember the name of Elvis Presley. Elvis had a problem of constipation for a long time and it is believed that he had to strain a lot to pass stools, which led to his fatal heart attack.
We don't know what really happened to the so-called King of Rock and Roll in 1977. There are probably several factors that contributed to his death, and this theory is one of them.
But after this famous case, researchers became keenly interested in the link between constipation and heart attack risk.
This includes a recent study by Australian researchers, which used data from thousands of people.
Is there a connection between constipation and heart attack?
Studies done on large populations show that constipation is associated with an increased risk of heart attack.
For example, an Australian study included more than 540,000 people over the age of 60 who were hospitalized for a variety of illnesses. It found that patients with constipation had a higher risk of high blood pressure, heart attack, and stroke than non-constipated patients of the same age.
The study, which involved more than 900,000 people from hospitals and hospital outpatient clinics in Denmark, also found that people with constipation had a higher risk of heart attack and stroke.
However, it was unclear whether this link between constipation and an increased risk of heart attack and stroke would also hold true for healthy people outside hospital.
These Australian and Danish studies also did not take into account the effects of medications used to treat high blood pressure (hypertension), which can make you constipated.
What do you think about this new study?
A recent international study conducted by researchers at Monash University found a link between constipation and an increased risk of heart attack, stroke and cardiac arrest in the general population.
The researchers analyzed data from the UK Biobank, a database of health information on nearly half a million people in the United Kingdom.
Researchers identified more than 23,000 cases of constipation and examined the effect of medications to treat high blood pressure, which can cause constipation.
People with constipation (identified through medical records or questionnaires) are twice as likely to have a heart attack, stroke, or cardiac arrest than those without constipation.
The researchers found a strong link between high blood pressure and constipation. People with high blood pressure who also had constipation had a 34% higher risk of developing major heart disease than those with high blood pressure alone.
The study only looked at data from people of European descent. However, there are good reasons to believe that the link between constipation and heart attacks applies to other populations as well.
A Japanese study looked at more than 45,000 men and women from the general population. It found that those who had a bowel movement once every two to three days had a higher risk of dying from heart disease than those who had a bowel movement less than once a day.
How can constipation cause heart attack?
Chronic constipation can cause excessive straining while passing stools. This can cause breathing difficulties and increase blood pressure.
A Japanese study of ten elderly people found that blood pressure was high just before a bowel movement and continued to rise during the bowel movement. This increase in blood pressure lasted for up to an hour afterward, which was not seen in younger Japanese people.
One theory is that older people have stiffer blood vessels because of atherosclerosis (thickening or hardening of the arteries due to a buildup of plaque) and other age-related changes. So their high blood pressure may persist for a while after the stress. But younger people's blood pressure returns to normal more quickly because their blood vessels are more flexible.
As blood pressure rises, the risk of heart disease increases. The risk of developing heart disease doubles when systolic blood pressure (the top number in your blood pressure reading) permanently rises by 20 mmHg (millimeters of mercury, a standard measure of blood pressure).
Straining to pass stools has been shown to increase systolic blood pressure by up to 70 mmHg. This increase is only temporary, but continued straining in chronic constipation may increase the risk of heart attack.
Some people with chronic constipation may have impaired function of the vagus nerve, which controls a variety of bodily functions, including digestion, heart rate, and breathing.
This impaired function can cause abnormalities in heart rhythm and the flight-fight response can become overly active. As a result, blood pressure can rise.
Another interesting area of research examines imbalances in gut bacteria in people with constipation.
This imbalance, known as dysbiosis, can cause microorganisms and other substances to cross the gut barrier into the bloodstream and activate an immune response. As a result, mild inflammation in the blood circulation can occur and the arteries may harden, increasing the risk of heart attack.
This latest study also explored the genetic links between constipation and heart disease. Researchers found that genetic factors are similar for both constipation and heart disease.
What can we do about it?
About 19% of the global population aged 60 years or older suffer from constipation. Therefore, a large portion of the population has an increased risk of heart disease due to poor bowel health.
Dietary changes (especially increasing the amount of fiber in the diet), increasing physical activity, ensuring adequate hydration, and managing chronic constipation using medications if needed are all important ways to improve bowel function and help reduce the risk of heart disease.