The association between gallstones and cardiovascular disease: evidence from the latest NHANES data

Background Gallstones and cardiovascular diseases (CVD) are two highly prevalent conditions worldwide. However, the association between gallstones and CVD in the U.S. population remains insufficiently explored. Methods This cross-sectional study analyzed 13,047 U.S. adults from the 2017–2020 and 2021–2023 National Health and Nutrition Examination Survey cycles. Binary multivariable weighted logistic regression was used to assess the associations between gallstones and total CVD, as well as congestive heart failure (CHF), coronary heart disease (CHD), angina pectoris (AP), and myocardial infarction (MI). Subgroup and interaction analyses further clarified the relationship between diseases across different subgroups. Mediation analysis was conducted to investigate the mediating effect of total cholesterol in the above associations. Results The study population included 1,406 gallstone carriers and 1,178 CVD cases at baseline. Except for CHF and MI, gallstones were significantly positively associated with total CVD (OR 2.364, 95% CI 1.782–3.137), CHD (OR 1.916, 95% CI 1.189–3.086), and AP (OR 4.398, 95% CI 2.848–6.794), independent of common cardiovascular risk factors. The association between gallstones and AP was the strongest. Subgroup analysis showed that the relationship between gallstones and increased cardiovascular risk remained across different subgroups. Moreover, mediation analysis indicated that total cholesterol partially mediated these associations. Conclusions Patients with gallstones have an increased risk of cardiovascular diseases, and this association is independent of traditional cardiovascular risk factors. Abnormal lipid metabolism may be a key mechanism mediating this relationship. This study highlights the importance of monitoring cardiovascular events in gallstone patients and provides valuable insights for the prevention of CVD.