Gallstone Disease and the Risk of Cardiovascular Disease

Cameron J Fairfield, Stephen J Wigmore, Ewen M Harrison, Cameron J Fairfield, Stephen J Wigmore, Ewen M Harrison

Abstract

Gallstone disease (GD) is one of the most common presentations to surgical units worldwide and shares several risk factors with cardiovascular disease (CVD). CVD remains the most common cause of death worldwide and results in considerable economic burden. Recent observational studies have demonstrated an association between GD and CVD with some studies demonstrating a stronger association with cholecystectomy. We present the findings of a meta-analysis assessing the relationship between GD and CVD. A total of fourteen cohort studies with over 1.2 million participants were included. The pooled hazard ratio (HR, 95% confidence interval [CI]) for association with GD from a random-effects model is 1.23 (95%CI: 1.16-1.30) for fatal and non-fatal CVD events. The association was present in females and males. Three studies report the relationship between cholecystectomy and CVD with a pooled HR of 1.41 (95%CI: 1.21-1.64) which compares to a HR of 1.30 (95%CI: 1.07-1.58) when cholecystectomy is excluded although confounding may influence this result. Our meta-analysis demonstrates a significant relationship between GD and CVD events which is present in both sexes. Further research is needed to assess the influence of cholecystectomy on this association.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow chart of study selection process
Figure 2
Figure 2
Forest plot demonstrating relationship between GD and CVD. Squares and horizontal lines represent individual studies with 95% confidence intervals. Area of squares is proportional to study weighting in random effects meta-analysis. Diamond (blue) represents pooled HR from meta-analysis with 95% CI. Reference line (black) represents hazard ratio of 1.00 (no association between GD and CVD). Summary line (red) represents summary estimate and demonstrates increased risk of CVD with GD (23%).
Figure 3
Figure 3
Forest plot demonstrating relationship between GD and CVD stratified by sex. Blue diamonds represent pooled summary estimate with 95% CI for each subgroup and overall pooled estimate for both groups combined.
Figure 4
Figure 4
Funnel plot with pseudo-95% confidence limits. Circles represent identified studies. Log-transformed adjusted HR plotted against inverse standard error of log-transformed HR.

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