Defecation Patterns and Cardiovascular Outcomes in Acute Coronary Syndrome

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.