Is there any effect of Ramadan fasting on acute coronary heart disease events?
Introduction
One of the five fundamental rituals of Islam, the religion professed by over one billion people, is fasting during the month of Ramadan. Muslims neither eat nor drink anything from dawn till sunset [1]. The period in which the person fasts may vary depending on the geographic location of the country and the season of the year, and can be as long as 20 h/day. Following fasting, at sunset people usually eat a great meal, and worship for a long time, which requires some effort. Before dawn, men get a meal (sahoor) and perform the morning worship.
In coronary heart disease patients, Gumaa et al., based on clinical observations, reported an increase in complaints of angina pectoris during Ramadan [2]. In fact, Ramadan fasting has some probable negative effects on coronary heart disease patients; the obligation that the daily calorie intake has to be taken in one or two meals instead of three to five, is an effort. The obligation that a heavy physical worship is performed after a heavy meal, and after sahoor, which is before dawn in relatively cold weather, walking towards the mosque seems to be unwise for coronary heart disease patients. The other negative effects are that, during fasting patients cannot take any drugs, such as, coronary dilatator, antihypertensive, antiaggregant drugs or fast-reacting nitrites. The regimen of diabetic patients is also negatively affected by unfamiliar diet and restrictions on drug usage during fasting etc. [3], [4]. Moreover, during hot weather and in warm climates a higher possibility of haemoconcentration should also be considered.
A literature review revealed that the effects of fasting on complications of peptic ulcer and diabetes mellitus have been investigated but effects on coronary heart disease have remained uncertain [5], [6], [7]. We investigated whether Ramadan fasting has a negative effect on coronary heart disease patients.
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Materials and methods
Patients who were hospitalized at Hizir Emergency Center of Ankara Numune Hospital, which responds to 100 000 calls annually and is the most crowded emergency service in Ankara, were evaluated retrospectively between the years 1991 and 1997. Time periods corresponding to the month of Ramadan in the Gregorian calendar have been established, since the lunar (Mohammedan) calendar is 11–12 days shorter than the solar year. To reduce the effects originating from seasonal changes to a minimum, and to
Results
We evaluated all the patients hospitalized in the coronary care unit and emergency service of internal medicine between the years 1991 and 1997, during, after and before Ramadan, and 1655 of 5016 patients were found to have acute coronary heart disease events. Patients with acute coronary heart disease events and the ratios of these patients to all patients are shown in Table 2. In all the years of the study the ratios of the cases with acute coronary heart disease events to all patients were
Discussion
In this study, we do not exactly know the proportion of patients with acute coronary heart disease events who were fasting before admission to the hospital. A small proportion of the population in our country is not Muslim — 99.2% are Muslim. Although a significant proportion of Muslims may not follow all the Islamic principles, Ramadan fasting is the most popular ritual in our country. At least 66% of our population fast regularly during the month of Ramadan [8]. This observation is confirmed
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