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Publications

Journal Article Ahead of print

PubMed: 42142094 DOI: 10.1016/j.jacasi.2026.01.035

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

JACC Asia

Authors: Yasushi Matsuzawa, Kenichi Tsujita, Takaomi Kessoku, Masaomi Gohbara, Masanobu Ishii, Taishi Nakamura, Hisaya Kondo, Tomohiro Yoshii, Ryusuke Sekii, Jin Kirigaya, Kengo Terasaka, Hidefumi Nakahashi, Eiichi Akiyama, Masaaki Konishi, Toshihiro Yamada, Yuichiro Arima, Shinsuke Hanatani, Seiji Takashio, Hiroki Usuku, Yasuhiro Izumiya, Eiichiro Yamamoto, Masami Kosuge, Kazuo Kimura, Kiyoshi Hibi

Affiliations

  • Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
  • Department of Palliative Medicine and Gastroenterology, International University of Health and Welfare Narita Hospital, Narita, Japan; Department of Gastroenterology, International University of Health and Welfare Graduate School of Medicine, Narita, Japan; Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan.
  • Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
  • Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Medical Information Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
  • Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan.
  • Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
  • Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; International Research Center for Medical Sciences (IRCMS), Kumamoto University, Kumamoto, Japan.
  • Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
  • Yokosuka City Hospital, Yokosuka, Japan.
  • Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.

Abstract

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.

MeSH

Hospitalization, Stroke, Laxatives, Acute Coronary Syndrome, Defecation