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Original research article
Impact of armed conflict on cardiovascular disease risk: a systematic review
  1. Mohammed Jawad1,
  2. Eszter P Vamos1,
  3. Muhammad Najim1,
  4. Bayard Roberts2,
  5. Christopher Millett1
  1. 1Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London, UK
  2. 2Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Mohammed Jawad, Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London W2 1PG, UK; mohammed.jawad06{at}


Objectives Prolonged armed conflict may constrain efforts to address non-communicable disease in some settings. We assessed the impact of armed conflict on cardiovascular disease (CVD) risk among civilians in low/middle-income countries (LMICs).

Methods In February 2019, we performed a systematic review searching Medline, Embase, PsychINFO, Global Health and Web of Science without language or date restrictions. We included adult, civilian populations in LMICs. Outcomes included CVDs and diabetes, and eight clinical and behavioural factors (blood pressure, blood glucose, lipids, tobacco, alcohol, body mass index, nutrition, physical activity). We systematically reanalysed data from original papers and presented them descriptively.

Results Sixty-five studies analysed 23 conflicts, and 66% were of low quality. We found some evidence that armed conflict is associated with an increased coronary heart disease, cerebrovascular and endocrine diseases, in addition to increased blood pressure, lipids, alcohol and tobacco use. These associations were more consistent for mortality from chronic ischaemic heart disease or unspecified heart disease, systolic blood pressure and tobacco use. Associations between armed conflict and other outcomes showed no change, or had mixed or uncertain evidence. We found no clear patterning by conflict type, length of follow-up and study quality, nor strong evidence for publication bias.

Conclusions Armed conflict may exacerbate CVDs and their risk factors, but the current literature is somewhat inconsistent. Postconflict reconstruction efforts should deliver low-resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality.

PROSPERO registration number CRD42017065722

  • cardiac risk factors and prevention
  • global health
  • systemic review

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  • Contributors Study conception and design: MJ, EPV, BR and CM. Acquisition of data: MJ and MN. Analysis and interpretation of data: MJ, MN and EPV. Drafting of manuscript: MJ. Critical revision: EPV, BR, MN and CM.

  • 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.

  • Data sharing statement All data are provided in the supplementary files.

  • Patient consent for publication Not required.

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