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Cardiovascular disease (CVD) prevalence and mortality are rapidly increasing globally and the burden, especially of premature CVD death, is disproportionally felt in low-income and middle-income countries (LMIC).1 We know that most current armed conflicts and resultant population displacement occur in LMICs.2 There is also evidence that factors associated with increased CVD risk, such as tobacco and alcohol use, are heightened as people cope with conflict and the postconflict environment.1 3 Recent reviews have shown that intense emotion, especially bereavement, may trigger heart attacks, but most of these studies have been conducted in stable settings.4 So, although it may seem logical that CVD morbidity and mortality would increase in armed conflict settings, it is surprising that there is such limited evidence to date in this area.
The first published systematic review to examine current evidence on the association between armed conflict and CVD risk by Jawad et al is both timely and important.5 The authors sought to address the question: ’What is the association between armed conflict and CVD risk for civilians in LMICs, compared with civilians with less or no exposure to armed conflict?’ They reported on 65 quantitative studies (covering 23 armed conflicts), which included a comparator group or examined outcomes over time. The authors descriptively summarised the studies using harvest diagrams, grouping by risk factor, setting and date of publication. They found evidence that armed conflict is associated with overt illness, including increased coronary heart disease, cerebrovascular and endocrine diseases; and with an increase in CVD risk factors: blood pressure, lipids, alcohol and tobacco use. In addition, the added risk may become evident both during periods of active conflict and in the acute and chronic post conflict period.
The authors succeeded in clearly summarising the existing research. The main limitations of this review relate to the …
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