Constipation in Cardiac Patients: an Underestimated Risk Factor and Therapy Challenges (Literature review)

Chronic constipation, traditionally considered as a functional gastrointestinal disorder, is increasingly recognized as a clinically significant cardiovascular risk factor. The current epidemiological studies and meta-analyses demonstrate a consistent association between constipation and an increased risk of major adverse cardiovascular events, heart failure, ischemic stroke, venous thromboembolism, and all-cause mortality, particularly in patients with preexisting cardiovascular disease. Pathophysiological mechanisms of this association include acute hemodynamic stress during straining, chronic systemic inflammation, intestinal dysbiosis, impaired trimethylamine-N-oxide metabolism, decreased short-chain fatty acid production, and increased intestinal permeability. Of particular interest is the role of the “gut–heart” axis, as well as the potential pleiotropic nature of shared genetic and autonomic mechanisms. In the context of current recommendations of the World Gastroenterology Organization (2025), lactulose is considered not only as an effective osmotic laxative, but also as a prebiotic capable of influencing key links in the pathogenesis of cardiovascular complications which are associated with chronic constipation. Chronic constipation is an underappreciated but potentially modifiable cardiovascular risk factor that requires active detection in patients with a cardiac profile. A comprehensive approach to correcting intestinal function, taking into account the impact on the intestinal microbiota and systemic inflammation, may be important for improving the prognosis. Lactulose, due to the combination of osmotic and prebiotic action, is a promising therapeutic agent in the management of cardiac patients with constipation, which justifies the feasibility of further prospective studies.