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Ramadan fasting: recommendations for patients with cardiovascular disease
  1. Abid Mohammed Akhtar1,
  2. Nazim Ghouri2,3,
  3. C. Anwar A Chahal1,4,5,
  4. Riyaz Patel1,6,
  5. Fabrizio Ricci7,8,9,
  6. Naveed Sattar2,
  7. Salman Waqar10,
  8. Mohammed Yunus Khanji1,11,12,13
  1. 1 Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
  2. 2 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  3. 3 Department of Diabetes and Endocrinology, Queen Elizabeth University Hospital, Glasgow, UK
  4. 4 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 Department of Medicine, Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  6. 6 Institute of Cardiovascular Sciences, University College London, London, UK
  7. 7 Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, University of Gabriele d'Annunzio Chieti and Pescara, Chieti Scalo, Abruzzo, Italy
  8. 8 Department of Clinical Sciences, Lund University, Malmö, Sweden
  9. 9 Department of Cardiology, Casa di Cura Villa Serena, Pescara, Italy
  10. 10 Nuffield Department of Primary care Health Sciences, University of Oxford, Oxford, UK
  11. 11 NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
  12. 12 Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, UK
  13. 13 Department of Cardiovascular Disease Prevention and Proactive Care, UCLPartners, London, UK
  1. Correspondence to Dr Mohammed Yunus Khanji, Department of Cardiology, Newham Univeristy Hospital, Barts Health NHS Trust, London E13 8SL, UK; m.khanji{at}; Dr Abid Mohammed Akhtar; mohammed.akhtar{at}


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.

  • heart failure
  • coronary artery disease
  • hypertension
  • global health
  • education
  • medical

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  • Contributors All the authors have been significantly involved in the conception and design of the narrative review, the acquisition and interpretation of data, drafting the work and revising it. Final approval of the version published has been given by all authors. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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