A meta-analysis of seven studies found adults with a history of gallstone disease had a 23 percent increased risk of coronary heart disease.

The association was stronger for participants who were not obese, not diabetic or normotensive. At baseline, none of the participants had cancer or cardiovascular disease.

Lead researcher Yan Zheng, MD, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues published their results online in Arteriosclerosis, Thrombosis and Vascular Biology on Aug. 18.

In the Western hemisphere, an estimated 5 percent to 25 percent of adults have gallstone disease, which the researchers noted has been linked to obesity, diabetes, metabolic syndrome and other cardiovascular risk factors.

The researchers identified more than 200,000 participants who enrolled in the Nurses’ Health Study from 1980 to 2010, the Nurses’ Health Study II from 1989 to 2011 and the Health Professionals Follow-up Study from 1986 to 2010.

At baseline, 3.3 percent of men and 6.2 percent of women had a history of gallstone disease. Adults with a history of gallstone disease were more likely to be older, current smokers, regular aspirin users, less physically active, to consume less alcohol, to have a higher body mass index and to have a history of hypertension, diabetes, or hypercholesterolemia.

During the follow up period, there were 21,265 incident coronary heart disease cases. The crude incidence rates of coronary heart disease were nearly double among participants with gallstone disease.

After adjusting for multiple variables, participants with a history of gallstone disease had an 11 percent, 15 percent and 33 percent increased risk of coronary heart disease in the three studies compared with those without a history of gallstone disease.

The researchers then evaluated data from four prospective studies and combined it with the three previously mentioned studies. In all, they assessed 842,553 participants and 51,123 incident cases of coronary heart disease. They found that participants with gallstone disease had a 23 percent increased risk of coronary heart disease.

The researchers acknowledged that the study does not prove a causal relationship between gallstone disease and coronary heart disease, but they mentioned the results could be important in clinical practice. They also mentioned that they did not measure insulin resistance or nonalcoholic fatty liver disease and that participants self-reported whether they had gallstone disease, which could have been limitations of the study.

“Our results suggest that patients with gallstone disease should be monitored closely based on a careful assessment of both gallstone and heart disease risk factors,” Lu Qi, MD, PhD, a study senior author and professor of epidemiology from Tulane University in New Orleans, Louisiana, said in a news release. “Preventing gallstone disease may also benefit heart health.”