Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 3, June 2021, pages 169-176

Association Between Constipation and Frailty Components in Patients Undergoing Late Phase II Cardiac Rehabilitation

Figure 1. The number of applicable items for functional constipation diagnosis criteria. Subjects were classified into constipation (n = 33, 32%) and non-constipation (n = 69, 68%) groups according to the Chronic Constipation Treatment Guidelines.

Figure 2. Comparison of constipation prevalence and complaint rates in patients undergoing late phase II cardiac rehabilitation.

Figure 3. Comparison of diagnostic criteria for functional constipation between the constipation and non-constipation groups.

**Table 1.** Clinical Characteristics of the Study Subjects
	All subjects (n = 102)	Constipation group (n = 33)	Non-constipation group (n = 69)	P value
Data are presented as the mean ± SD. CVD: cardiovascular disease; CR: cardiac rehabilitation; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FBS: fasting blood sugar; BNP: brain natriuretic peptide; NT-proBNP: N-terminal pro brain natriuretic peptide; GNRI: Geriatric Nutritional Risk Index; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium-channel blocker; OHA: oral hypoglycemic agent.
Age, years	62.7 ± 13.4	71.5 ± 11.2	58.5 ± 12.4	< 0.01
Male, n (%)	68 (67)	20 (61)	48 (70)	0.37
Body mass index, kg/m²	24.0 ± 4.4	22.8 ± 3.3	24.5 ± 4.7	0.03
Hypertension, n (%)	59 (58)	17 (51)	42 (61)	0.37
Diabetes mellitus, n (%)	12 (12)	3 (9)	10 (14)	0.44
Dyslipidemia, n (%)	30 (29)	12 (36)	18 (26)	0.28
Current smoking, n (%)	10 (18)	1 (6)	9 (23)	0.27
CVD at the beginning of CR, n (%)
Chronic heart failure	64 (63)	22 (67)	43 (62)	0.52
Aortic disease	22 (21)	8 (24)	14 (20)
Acute myocardial infarction	16 (16)	3 (9)	12 (18)
Atrial fibrillation	25 (25)	11 (33)	14 (20)	0.15
Laboratory data
Hemoglobin, g/dL	13.1 ± 2.0	12.3 ± 1.8	13.4 ± 2.0	< 0.01
Albumin, g/dL	3.8 ± 0.4	3.6 ± 0.4	3.9 ± 0.4	< 0.01
Creatinine, mg/dL	1.07 ± 0.56	1.23 ± 0.67	0.99 ± 0.49	0.04
eGFR, mL/min/1.73 m²	59.4 ± 20.6	50.7 ± 20.2	63.8 ± 19.3	< 0.01
Total cholesterol, mg/dL	174 ± 32	170 ± 33	175 ± 33	0.55
Triglyceride, mg/dL	118 ± 97	115 ± 65	120 ± 110	0.82
HDL-C, mg/dL	50 ± 12	50 ± 13	50 ± 12	0.96
LDL-C, mg/dL	99 ± 30	92 ± 27	104 ± 30	0.07
FBS, mg/dL	104 ± 27	98 ± 18	106 ± 30	0.15
Hemoglobin A1c, %	5.9 ± 0.7	5.8 ± 0.4	5.9 ± 0.8	0.85
BNP, pg/mL	290 ± 348	361 ± 478	242 ± 221	0.20
NT-proBNP, pg/mL	1,855 ± 3,122	3,069 ± 2,989	1,855 ± 3,122	0.23
GNRI	100.1 ± 12.3	97.1 ± 10.7	103.3 ± 12.8	0.03
Ejection fraction, %	51.0 ± 17.5	51.6 ± 18.1	50.8 ± 17.4	0.81
Medications, n (%)
ACE-I	33 (32)	10 (30)	23 (33)	0.75
ARB	37 (36)	12 (36)	25 (36)	0.98
β-blockers	87 (85)	28 (85)	59 (85)	0.93
CCB	28 (27)	6 (18)	22 (32)	0.14
Loop diuretic	66 (64)	23 (70)	43 (62)	0.46
Vasopressin antagonist	16 (16)	7 (21)	9 (13)	0.46
Potassium-sparing diuretic	39 (38)	11 (33)	28 (41)	0.48
Statin	39 (38)	14 (42)	25 (36)	0.54
OHA	8 (8)	2 (6)	6 (9)	0.64
Insulin	2 (2)	1 (3)	1 (1)	0.59
Sleeping pills	8 (8)	3 (9)	5 (7)	0.74
Proton pump inhibitor	69 (67)	22 (67)	47 (68)	0.88
Laxatives	31 (30)	16 (48)	15 (22)	< 0.01
Irritant laxative	18 (18)	11 (34)	7 (10)	< 0.01
Lubiprostone	4 (4)	4 (12)	0 (0)	< 0.01
Osmotic laxative	19 (19)	7 (21)	12 (17)	0.20
Herbal medicine	5 (5)	2 (6)	3 (4)	0.74

Table 1. Clinical Characteristics of the Study Subjects

All subjects (n = 102)

Constipation group (n = 33)

Non-constipation group (n = 69)

P value

Data are presented as the mean ± SD. CVD: cardiovascular disease; CR: cardiac rehabilitation; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; FBS: fasting blood sugar; BNP: brain natriuretic peptide; NT-proBNP: N-terminal pro brain natriuretic peptide; GNRI: Geriatric Nutritional Risk Index; ACE-I: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; CCB: calcium-channel blocker; OHA: oral hypoglycemic agent.

Age, years

62.7 ± 13.4

71.5 ± 11.2

58.5 ± 12.4

< 0.01

Male, n (%)

68 (67)

20 (61)

48 (70)

0.37

Body mass index, kg/m²

24.0 ± 4.4

22.8 ± 3.3

24.5 ± 4.7

0.03

Hypertension, n (%)

59 (58)

17 (51)

42 (61)

0.37

Diabetes mellitus, n (%)

12 (12)

3 (9)

10 (14)

0.44

Dyslipidemia, n (%)

30 (29)

12 (36)

18 (26)

0.28

Current smoking, n (%)

10 (18)

1 (6)

9 (23)

0.27

CVD at the beginning of CR, n (%)

Chronic heart failure

64 (63)

22 (67)

43 (62)

0.52

Aortic disease

22 (21)

8 (24)

14 (20)

Acute myocardial infarction

16 (16)

3 (9)

12 (18)

Atrial fibrillation

25 (25)

11 (33)

14 (20)

0.15

Laboratory data

Hemoglobin, g/dL

13.1 ± 2.0

12.3 ± 1.8

13.4 ± 2.0

< 0.01

Albumin, g/dL

3.8 ± 0.4

3.6 ± 0.4

3.9 ± 0.4

< 0.01

Creatinine, mg/dL

1.07 ± 0.56

1.23 ± 0.67

0.99 ± 0.49

0.04

eGFR, mL/min/1.73 m²

59.4 ± 20.6

50.7 ± 20.2

63.8 ± 19.3

< 0.01

Total cholesterol, mg/dL

174 ± 32

170 ± 33

175 ± 33

0.55

Triglyceride, mg/dL

118 ± 97

115 ± 65

120 ± 110

0.82

HDL-C, mg/dL

50 ± 12

50 ± 13

50 ± 12

0.96

LDL-C, mg/dL

99 ± 30

92 ± 27

104 ± 30

0.07

FBS, mg/dL

104 ± 27

98 ± 18

106 ± 30

0.15

Hemoglobin A1c, %

5.9 ± 0.7

5.8 ± 0.4

5.9 ± 0.8

0.85

BNP, pg/mL

290 ± 348

361 ± 478

242 ± 221

0.20

NT-proBNP, pg/mL

1,855 ± 3,122

3,069 ± 2,989

1,855 ± 3,122

0.23

GNRI

100.1 ± 12.3

97.1 ± 10.7

103.3 ± 12.8

0.03

Ejection fraction, %

51.0 ± 17.5

51.6 ± 18.1

50.8 ± 17.4

0.81

Medications, n (%)

ACE-I

33 (32)

10 (30)

23 (33)

0.75

ARB

37 (36)

12 (36)

25 (36)

0.98

β-blockers

87 (85)

28 (85)

59 (85)

0.93

CCB

28 (27)

6 (18)

22 (32)

0.14

Loop diuretic

66 (64)

23 (70)

43 (62)

0.46

Vasopressin antagonist

16 (16)

7 (21)

9 (13)

0.46

Potassium-sparing diuretic

39 (38)

11 (33)

28 (41)

0.48

Statin

39 (38)

14 (42)

25 (36)

0.54

OHA

8 (8)

2 (6)

6 (9)

0.64

Insulin

2 (2)

1 (3)

1 (1)

0.59

Sleeping pills

8 (8)

3 (9)

5 (7)

0.74

Proton pump inhibitor

69 (67)

22 (67)

47 (68)

0.88

Laxatives

31 (30)

16 (48)

15 (22)

< 0.01

Irritant laxative

18 (18)

11 (34)

7 (10)

< 0.01

Lubiprostone

4 (4)

4 (12)

0 (0)

< 0.01

Osmotic laxative

19 (19)

7 (21)

12 (17)

0.20

Herbal medicine

5 (5)

2 (6)

3 (4)

0.74

**Table 2.** Comparison of Frailty Components Between the Constipation and Non-Constipation Groups
	All subjects (n = 102)	Constipation group (n = 33)	Non-constipation group (n = 69)	P value
Data are presented as the mean ± SD.
Kihon checklist score
Activities of daily living	0.80 ± 1.16	1.09 ± 1.55	0.68 ± 0.91	0.09
Physical function	1.21 ± 1.26	1.60 ± 1.24	1.04 ± 1.22	0.03
Nutritional status	0.60 ± 0.60	1.09 ± 0.94	0.71 ± 0.94	0.05
Oral function	0.82 ± 0.95	0.63 ± 0.60	0.61 ± 0.62	0.83
Social activities of daily living	0.40 ± 0.56	0.58 ± 0.56	0.31 ± 0.55	0.03
Cognitive function	0.35 ± 0.60	0.48 ± 0.66	0.30 ± 0.57	0.16
Depressive mood	1.89 ± 1.74	2.67 ± 1.57	1.53 ± 1.70	< 0.01
Total score	6.02 ± 4.20	8.15 ± 4.24	5.20 ± 3.87	< 0.01
Prevalence of frailty
Frailty, n (%)	35 (34)	18 (55)	17 (25)	0.01
Pre-frailty, n (%)	35 (34)	10 (30)	25 (36)
Non-frailty, n (%)	32 (32)	5 (15)	27 (39)

Table 2. Comparison of Frailty Components Between the Constipation and Non-Constipation Groups

All subjects (n = 102)

Constipation group (n = 33)

Non-constipation group (n = 69)

P value

Data are presented as the mean ± SD.

Kihon checklist score

Activities of daily living

0.80 ± 1.16

1.09 ± 1.55

0.68 ± 0.91

0.09

Physical function

1.21 ± 1.26

1.60 ± 1.24

1.04 ± 1.22

0.03

Nutritional status

0.60 ± 0.60

1.09 ± 0.94

0.71 ± 0.94

0.05

Oral function

0.82 ± 0.95

0.63 ± 0.60

0.61 ± 0.62

0.83

Social activities of daily living

0.40 ± 0.56

0.58 ± 0.56

0.31 ± 0.55

0.03

Cognitive function

0.35 ± 0.60

0.48 ± 0.66

0.30 ± 0.57

0.16

Depressive mood

1.89 ± 1.74

2.67 ± 1.57

1.53 ± 1.70

< 0.01

Total score

6.02 ± 4.20

8.15 ± 4.24

5.20 ± 3.87

< 0.01

Prevalence of frailty

Frailty, n (%)

35 (34)

18 (55)

17 (25)

0.01

Pre-frailty, n (%)

35 (34)

10 (30)

25 (36)

Non-frailty, n (%)

32 (32)

5 (15)

27 (39)