Ramadan fasting and cardiovascular disease — Newham University recommendations

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Expert consensus says Muslim patients at high cardiovascular risk should not observe strict fasting during Ramadan, writes MedicalBrief.

While recommendations on ‘safeʼ fasting exist for patients with some chronic conditions, such as diabetes mellitus, guidance for patients with cardiovascular disease is lacking, according to a study in Heart.

Ramadan fasting is observed by most of the 1.8 billion Muslims worldwide, and lasts for one month per the lunar calendar year. It is the abstention from any food and drink from dawn to sunset.

The article was submitted to the Department of Cardiology, Newham University Hospital in London by a team which reviewed the literature to help healthcare professionals educate, discuss and manage patients with cardiovascular conditions, who were considering fasting.

Studies on the safety of Ramadan fasting in patients with cardiac disease are sparse, observational, of small sample size and have short follow-up.

Study details

Ramadan fasting: recommendations for patients with cardiovascular disease

Department of Cardiology, Newham University Hospital, Barts Health NHS Trust

Abid Mohammed Akhtar, Nazim Ghouri,, C. Anwar A. Chahal, Riyaz Patel,, Fabrizio Ricci,Naveed Sattar, Salman Waqar, Mohammed Yunus Khanji

Published 28 May in Heart

Abstract
Ramadan fasting is observed by most of the 1.8 billion Muslims around the world. It lasts for 1 month per the lunar calendar year and is the abstention from any food and drink from dawn to sunset. While recommendations on ‘safe’ fasting exist for patients with some chronic conditions, such as diabetes mellitus, guidance for patients with cardiovascular disease is lacking.

We reviewed the literature to help healthcare professionals educate, discuss and manage patients with cardiovascular conditions, who are considering fasting. Studies on the safety of Ramadan fasting in patients with cardiac disease are sparse, observational, of small sample size and have short follow-up.

Using expert consensus and a recognised framework, we risk stratified patients into ‘low or moderate risk’, for example, stable angina or non-severe heart failure; ‘high risk’, for example, poorly controlled arrhythmias or recent myocardial infarction; and ‘very high risk’, for example, advanced heart failure. The ‘low-moderate risk’ group may fast, provided their medications and clinical conditions allow. The ‘high’ or ‘very high risk’ groups should not fast and may consider safe alternatives such as non-consecutive fasts or fasting shorter days, for example, during winter.

All patients who are fasting should be educated before Ramadan on their risk and management (including the risk of dehydration, fluid overload and terminating the fast if they become unwell) and reviewed after Ramadan to reassess their risk status and condition. Further studies to clarify the benefits and risks of fasting on the cardiovascular system in patients with different cardiovascular conditions should help refine these recommendations.

 

Full Heart study (Restricted access)

 

See also from the MedicalBrief archives:

 

Full Heart study (Restricted access)

 

Intermittent fasting may help people live longer

 

Fasting may boost metabolic activity, slow ageing


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