Cardiac contractility, central haemodynamics and blood pressure regulation during semistarvation

The Association between Acute Myocardial Infarction-Related Outcomes and the Ramadan Period: A Retrospective Population-Based Study

Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients.

Effects of Ramadan fasting on blood pressure in hypertensive patients

INTRODUCTION

During Ramadan, repeated cycles of fasting might contribute to changes in blood pressure among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are scarce and have provided inconclusive results.

AIM

To examine the effect of fasting on ambulatory blood pressure and heart rate in treated hypertensive subjects.

METHODS

The study prospectively recruited 60 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital of Tunis. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24 hour, awake and asleep systolic and diastolic blood pressure and 24 hour, awake and asleep heart rate.

RESULTS

We studied 40 women and 20 men; mean age was 58.4 years. 33% of the patients were diabetics, 42% dyslipidemics, 15% had coronaropathy. 45% of the patients were on monotherapy, 37% on dual therapy and 18% on a triple antihypertensive therapy. During Ramadan, 74% of the patients were taking the treatment once daily, 3% twice daily, and 23% three times per day. Average 24hour ambulatory blood pressure in the whole group was 129±17/74±10 mmHg before Ramadan and 128±17/73±9 mmHg during Ramadan (p>0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age, gender, medical history and lifestyle.

CONCLUSIONS

In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods.

Impact of Ramadan fasting on lipid profile and cardiovascular risk factors in patients with stable coronary artery disease

BACKGROUND

The effects of Ramadan fasting (RF) on cardiometabolic risk factors in patients with stable ischemic heart disease are not well known.

AIM

The aim of this study was to evaluate the impact of RF on lipid profile and cardiovascular risk factors in patients with a stable coronary heart disease.

METHODS

A prospective observational study carried out in the Cardiology department of Charles Nicolle Hospital (Tunisia). Eighty-four patients with a stable ischemic heart disease who intended to fast were enrolled during May 2020. Detailed clinical and biochemical assessments were performed before and after the holy month. Parameters of glycemic control, lipid profile, ultrasensitive C-reactive protein concentration (us-CRP) and homocysteine were performed before- and after- Ramadan (BR and AR, respectively).

RESULTS

Eighty-four patients including 79 males and 5 females, with a mean age of 57±7 years completed the study. Levels of cholesterol, triglycerides, low-density lipoprotein-cholesterol and apoprotein A were significantly improved AR fasting in comparison with their BR values. There was a significant decrease in blood fasting glucose, insulin level, Homeostasis model assessment of insulin resistance index and in us-CRP level.

CONCLUSION

In patients with stable ischemic heart disease, RF may be accompanied by an improvement of lipid profile and glycemic parameters without increase in coronary events.

The safety of Ramadan Fasting following Percutaneous Coronary Intervention

BACKGROUND

This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention.

METHODS

In our two centers' Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary Intervention before the first day of Ramadan. We advised the patients that recent Percutaneous Coronary Intervention could be a valid excuse for not fulfilling Ramadan Fasting. However, many patients intended to fast the following Ramadan, and we included them in the fasting Group I. We added the patients who decided not to fast the following Ramadan as a control Group II. We followed all the patients during Ramadan and for 6 months after Ramadan.

RESULTS

The demographic data of both groups and the complexity of the coronary anatomy showed no statistically significant difference. Group I (n = 153) showed a statistically significant difference in the incidence of Major Adverse Cardiac Events compared to Group II with a P value (0.005). The logistic multivariate regression analysis showed that the duration from index PCI till the start of RF, SYNTAX score > 22, and Complex procedure were independent predictors of Major Adverse Cardiac Events in the fasting Group I with {P = 0.001, OR (2.302), P = 0.026, OR (2.419), and P = 0.032 OR (1.952)}, respectively. Major Adverse Cardiac Events in Group I occurred mainly during Ramadan Fasting, with 19 patients having Major Adverse Cardiac Events during Ramadan and four patients during the remaining of the follow-up period. The Receiver Operating Characteristic curve analysis showed the decline of the incidence of Major Adverse Cardiac Events after 90 days from Percutaneous Coronary Intervention till the start of Ramadan Fasting with Sensitivity and specificity (90% and 65%), respectively.

CONCLUSIONS

We suggest that low-risk patients with a normal systolic function who underwent Percutaneous Coronary Intervention may safely fast Ramadan. At the same time, Ramadan Fasting during the first 3 months following the Percutaneous Coronary Intervention may not be safe.

Atrial Fibrillation in Middle Eastern Arabs and South Asians: Summary of Published Articles in the Arabian Gulf

Seven studies are summarized herein focusing on different aspects of Atrial fibrillation (AF) in two unique ethnicities for which there is very limited literature published before; Middle Eastern Arabs and South Asians, using data from a national registry of cardiovascular diseases in Qatar over a 20-years period (1991-2010). These studies shed light upon important aspects of AF presentations and outcomes in these two ethnicities, thereby enriching the world literature on AF. In the process, several novel observations were reported and new questions were raised that warrant further investigations.

Acute heart failure presentations and outcomes during the fasting month of Ramadan: an observational report from seven Middle Eastern countries

BACKGROUND

Fasting during the month of Ramadan is practiced by over 1.5 billion Muslims worldwide. It remains unclear, however, how this change in lifestyle affects heart failure, a condition that has reached epidemic dimensions. This study examined the effects of fasting in patients with acute heart failure (AHF) using data from a large multi-center heart failure registry.

METHODS AND RESULTS

Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multi-center study of consecutive patients hospitalized with AHF during February-November 2012. The study included 4,157 patients, of which 306 (7.4%) were hospitalized with AHF in the fasting month of Ramadan, while 3,851 patients (92.6%) were hospitalized in other days. Clinical characteristics, precipitating factors, management, and outcome were compared among the two groups. Patients admitted during Ramadan had significantly lower prevalence of symptoms and signs of volume overload compared to patients hospitalized in other months. Atrial arrhythmias were significantly less frequent and cholesterol levels were significantly lower in Ramadan. Hospitalization in Ramadan was not independently associated with increased immediate or 1-year mortality.

CONCLUSIONS

The current study represents the largest evaluation of the effects of fasting on AHF. It reports an improved volume status in fasting patients. There were also favorable effects on atrial arrhythmia and total cholesterol and no effects on immediate or long-term outcomes.

Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis

Over one billion Muslims worldwide fast during the month of Ramadan. Ramadan fasting brings about some changes in the daily lives of practicing Muslims, especially in their diet and sleep patterns, which are associated with the risk of cardiovascular diseases. Over the years, many original studies have made the effort to identify the possible impact of the Ramadan fast on cardiovascular diseases. This systematic review and meta-analysis is an attempt to present the summary of key findings from those articles and an appraisal of selected literature. A systematic search using keywords of “;Ramadan fasting” and “;cardiovascular diseases” was conducted in primary research article and gray-literature repositories, in combination with hand searching and snow balling. Fifteen studies were finally selected for data extraction on the outcomes of stroke, myocardial infarction, and congestive heart failure. The analysis revealed that the incidence of cardiovascular events during the Ramadan fast was similar to the nonfasting period. Ramadan fast is not associated with any change in incidence of acute cardiovascular disease.

Effect of Ramadan intermittent fasting on selective fitness profile parameters in young untrained Muslim men

Background

The present study was aimed at investigating the effects of sleep deprivation and dietary irregularities during Ramadan intermittent fasting (RIF) on selective fitness profile parameters in young untrained male Muslim individuals.

Methods

77 untrained Muslim men were recruited in the study. They were divided into the experimental group (EG; n=37, age: 22.62±1.77 years) and the control group (CG; n=40, age: 23.00±1.48 years). EG was undergoing RIF while CG abstained. Aerobic fitness, anaerobic capacity or high-intensity efforts (HIEs), agility, flexibility, vertical jump height and handgrip strength were measured on 8 separate occasions—15 days before RIF, 7 days before RIF, 1st day of RIF, 7th day of RIF, 15th day of RIF, 21st day of RIF, last day of RIF and 15 days after RIF.

Results

Aerobic fitness and HIE showed a significant difference (p<0.05) during RIF in EG. Agility and flexibility score showed a significant decrease in EG during RIF, whereas changes in the vertical jump score (VJT) and handgrip strength were statistically insignificant. Studied parameters showed an insignificant variation in CG during RIF. Aerobic fitness, HIEs, agility and flexibility showed a significant intergroup variation during different experimental trials.

Conclusions

The present investigation revealed that RIF had adverse effects on aerobic fitness, HIEs, agility and flexibility of young untrained Muslims of Kolkata, India. VJT, waist-hip ratio and handgrip strength were not affected by RIF in the studied population. Mild but statistically insignificant reduction in body mass was also reflected after the mid-Ramadan week.

Ramadan fast in patients with coronary artery disease

Background:

Fasting during the month of Ramadan is of vital significance amongst Muslims; however, little is known about the effects of this kind of fasting on patients with coronary artery disease (CAD).

Objectives:

This nonrandomized prospective observational pilot study was designed to investigate the effects of Ramadan fast on the symptoms of CAD.

Patients and Methods:

Patients with documented CAD were consecutively (nonrandomized) included in the study, and those with heart failure (ejection fraction < 50%), renal failure, gout, and insulin-treated diabetes were excluded. Patients had the choice of fasting during Ramadan if they so wished and to break their fast as soon as symptoms such as dyspnea and chest pain occurred (fasting group) or not fasting (control group).

Results:

A total of 148 patients completed the study. Mean (mean ± SD) age of the patients was 61.5 ± 11.7 years and 50% were male. Finally, 66 patients (44.6%) accomplished Ramadan fast with an average of 22.27 ± 10.46 days of fasting. Occurrence of chest pain was not significantly different between the fasting and non-fasting groups (4 out of 66 [6.1%] vs. 8 out of 82 [9.8%] respectively; P = 0.42). In addition, patients who fasted during Ramadan did not experience a higher frequency of a combined endpoint of chest pain and dyspnea (4 out of 66 cases in the fasting group [6.1%] vs. 11 out of 82 in non-fasting group [13.4%]; P = 0.14).

Conclusions:

In the present study, the patients with CAD were able to observe Ramadan fast safely and their combined endpoint of chest pain and dyspnea was not significantly different from that of the non-fasting ones. We would suggest that patients with CAD and normal left ventricular function could fast during Ramadan.

Effects of Ramadan on physical capacities of North African boys fasting for the first time

INTRODUCTION

Most of the literature related to the effects of Ramadan fasting on physical performance has focused on adults, and only three studies have examined its impact on children's physical performance.

AIMS

To examine the effects of Ramadan fasting on first-time fasting boys' performance in short-term explosive exercises [vertical and horizontal jump tests (VJT and HJT), 20-m and 30-m sprints and medicine-ball throw (MBT)], as well as in sub-maximal endurance [6-min walking distance (6MWD) measured during the 6-min walk test (6MWT)].

METHODS

Eighteen Tunisian boys [mean±standard deviation (SD) of age and body mass (BM): 11.9±0.8 y and 55.4±18.2 kg, respectively] were included. The experimental design comprised four testing phases: 2-weeks before Ramadan (BR), the end of the second week (R2) and the fourth week (R4) of Ramadan, and 10-12 days after the end of Ramadan (AR). At each phase, boys performed two test sessions in the afternoon (15:00-17:00 h) interrupted by 48 h of recovery (first test session: BM, VJT, HJT, and 20-m and 30-m sprint tests; second session: MBT and 6MWT). The study was conducted during the summer of 2012 from July 5 to August 29.

RESULTS

6MWDs (m) were significantly shorter during R2 (652±101) and R4 (595±123) compared to BR (697±86) and came back to baseline values AR. BM (kg) mean±SD did not significantly change during R2 (52±15) and during R4 (53±15) compared to BR (55±17), and short-term explosive performances were unchanged throughout the study.

CONCLUSION

In non-athletic children, first-ever Ramadan fasting impairs sub-maximal aerobic capacity but has no effect on BM or short-term explosive performance.

Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature

BACKGROUND

Fasting during the month of Ramadan is a religious obligation that is practiced by millions of people around the world yet there is no clear scientific consensus on its effects on cardiovascular disease. This study was performed to inform physicians as well as patients of evidence based recommendations on this subject.

AIM

The study was undertaken to assess: (1) any alteration in the incidence of acute cardiac illness during Ramadan fasting; (2) whether fasting during the month of Ramadan alters the clinical status of patients with stable cardiac disease; and (3) the impact of Ramadan fasting on cardiovascular risk factors in normal subjects, in patients with stable cardiac disease, metabolic syndrome, dyslipidemia, type 2 diabetes and systemic hypertension.

STUDY DESIGN

Systematic review of the literature.

METHOD

A Medline search of the English literature published between January 1980 and September 2012.

RESULTS

The incidence of acute cardiac illness during Ramadan fasting was similar to non-fasting days, although the timing of symptom onset may be different, with significant increase in events during the period of 'breaking fast' when compared to non-fasting days. The majority of patients with stable cardiac illness can undergo Ramadan fasting without any clinical deterioration. Body mass index, lipid profile, and blood pressure showed significant improvement in normal healthy subjects, patients with stable cardiac illness, metabolic syndrome, dyslipidemia and hypertension during Ramadan fasting. The lipid profile of diabetic patients deteriorated significantly during Ramadan fasting.

CONCLUSIONS

Ramadan fasting is not associated with any change in incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising. Diabetic patients should be carefully monitored during Ramadan fasting.

The effect of ramadan fasting on physical performances, mood state and perceived exertion in young footballers

Purpose

This study was designed to assess the effects of Ramadan fasting on the profile of mood state and perceived exertion in young soccer players and aerobic and anaerobic performances during the Yo-Yo, repeated sprint ability (RSA) and the Wingate tests.

Methods

Twenty junior male soccer players completed the Yo-Yo, the RSA, and the Wingate tests on three different occasions: one-week before Ramadan (BR), the second week (SWR) and the fourth week (ER) of Ramadan. The total distance (TD) covered and the estimated maximal aerobic velocity (MAV) during the Yo-Yo test were recorded. During the RSA test, peak power (PP) during each sprint, the percentage of decrement of PP (PD) and total work (Wtotal) were calculated. During the Wingate test, peak (P_peak) and mean (P_mean) powers and fatigue index (FI) were recorded.

Results

TD and MAV (P=0.01) during the Yo-Yo test and PP (P=0.01, P=0.004, P=0.001, P=0.01, P=0.03 for sprints 1, 2, 3, 4, and 5, respectively) and Wtotal (P=0.02) during the RSA test were significantly higher during BR than ER. Furthermore, muscle fatigue during the RSA test increased significantly from BR to ER (P=0.01). P_peak and P_mean during the Wingate test decreased significantly from BR to SWR and ER (P<0.0005). FI was higher during SWR (P=0.001) and ER (P<0.0005) than BR. In addition, rating of perceived exertion scores and fatigue estimated by the profile of mood state questionnaire were higher during Ramadan in comparison with BR.

Conclusions

The present study suggests that both aerobic and anaerobic performances during the Yo-Yo, the RSA and the Wingate tests were affected by Ramadan fasting in young soccer players.

The effect of the Ramadan fast on physical performance and dietary habits in adolescent soccer players

The purpose of this study was to examine the effect of the Ramadan fast on performance capacities, dietary habits, and the daily behavioral patterns in adolescent (14-16-year-old) soccer players. Nineteen male players performed a series of fitness tests before and at the end of Ramadan fast. Caloric intake, physical activity pattern and sleep habits were evaluated during the week before the Ramadan fast and during the last week of the Ramadan fast. The fast resulted in a significant reduction in aerobic capacity [3,000 m run time (mean +/- SD): 812.8 +/- 73.3 s vs. 819.9 +/- 73.4 s, P < 0.001], speed endurance (Sum 6 x 40 m run time: 46.36 +/- 1.36 s vs. 46.73 +/- 1.31 s, P < 0.001, and performance decrement: 9.0 +/- 1.5% vs. 9.5 +/- 1.7%, P < 0.05), and jumping performance (44.8 +/- 4.5 cm vs. 44.0 +/- 4.5 cm, P < 0.05), but had no significant effect on sprint performance (7.38 +/- 0.25 s vs. 7.40 +/- 0.26 s, P = 0.20) or agility (4 x 10 m shuttle run time: 9.53 +/- 0.35 s vs. 9.55 +/- 0.37 s, P = 0.26). Daily intense physical activity was significantly reduced during Ramadan (6.4 +/- 0.2 h/week vs. 4.5 +/- 0.1 h/week, P < 0.005). There were no significant differences in total caloric intake (3,012 +/- 412 kcal/day vs. 3240 +/- 348 kcal/day, P = 0.39) or total daily sleeping hours (8.6 +/- 0.7 h/day vs. 8.6 +/- 0.5 h/day, P = 0.80) between Ramadan and a regular month. The results indicate that Ramadan fasting can lead to a significant decrease in athletic performance capacities. The decrease in performance does not necessarily relate to changes in caloric intake and sleeping hours during the fast.

Impact of Ramadan on demographics and frequencies of disease-related visits in the emergency department

Summary The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non-Ramadan months (chi(2) test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes-related conditions in Ramadan was significantly lower than in pre- and post-Ramadan months (59.91 +/- 14.60 and 62.11 +/- 14.61, respectively) (Mann-Whitney U-test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Does hospitalization for congestive heart failure occur more frequently in Ramadan: a population-based study (1991–2001)

OBJECTIVE

Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is essentially a radical change in lifestyle for the period of one lunar month, so it is important to see the response of congestive heart failure patients to this change. Our objective in this study is to investigate whether Ramadan fasting has any effect on the number of hospitalization for congestive heart failure (CHF) in a geographically defined population.

METHODS

We conducted a retrospective review of clinical data study on all Qatari patients in Qatar for a period of 10 years (January 1991 through December 2001) who were hospitalized with heart failure. Patients were divided according to the time of presentation in relation to the month of Ramadan, 1 month before, during and 1 month after Ramadan. The number of hospitalization for CHF in various time periods was analyzed. The age of presentation, gender, cardiovascular risk factor profiles (smoking status, hypertension, hypercholesterolemia, diabetes, pre-existing coronary heart disease) and outcome were analyzed.

RESULTS

Of the 20,856 patients treated during the 10-year period, 8446 of them were Qataris with 5095 males and 3351 females. Overall, 2160 Qatari patients were hospitalized for CHF and their mean age and standard deviation was 64.2 +/- 11.5 years, 52.4% were hypertensives, 18.5% had hypercholestrolemia, 17.7% were current smokers and 56.5% were diabetics. The overall mortality was 9.7%. The number of hospitalization for CHF was not significantly different in Ramadan (208 cases) when compared to a month before Ramadan (182 cases) and a month after Ramadan (198 cases); p > 0.37). There was no significant difference found in the baseline clinical characteristics or mortality (11.5%, 7.7% and 9.6%, respectively; p > 0.43) in patients presenting in various time periods.

CONCLUSION

This population-based study demonstrates that no significant difference was found in number of hospitalization for CHF while fasting in Ramadan when compared to the non-fasting months.

Biphasic changes in heart performance with food restriction in rats

To examine effects of food restriction resembling very-low-calorie dieting on heart performance, normal rats were fed 25% of ad libitum food intake for 14 days. Although heart weight decreased (P < 0.05) after 5 days, left ventricular systolic pressure as well as rates of pressure development and fall were increased (P < 0.05) at 7 days and decreased (P < 0.05) after 14 days. Systolic and diastolic blood pressures were also increased from 5 to 7 days and decreased after 14 days. The increased hemodynamic performance of heart was associated with a raised plasma norepinephrine concentration, which peaked at day 7 of food restriction; epinephrine concentration was increased (P < 0.05) also at day 7. An increased catecholamine synthesis was indicated by the raised (P < 0.05) plasma dopamine beta-hydroxylase activity at 3 days, but this was decreased (P < 0. 05) at 14 days. The concentration of dopamine in the heart was increased (P < 0.05) at 2-14 days, of norepinephrine at 7-14 days, and of epinephrine at 10 and 14 days. Food restriction thus appears initially to be associated with an enhanced catecholamine influence on the heart and is followed by a depressed cardiac performance.

Is there any effect of Ramadan fasting on acute coronary heart disease events?

OBJECTIVE

We investigated whether Ramadan fasting, which concerns billions of Muslims in the world, has a negative effect on coronary heart disease patients.

METHODS

Patients who were hospitalized at Emergency Center of Ankara Numune Hospital were evaluated retrospectively between the years 1991 and 1997. Patients with acute coronary heart disease events, who were hospitalized and those who died of this disease within the period of before, during, and after Ramadan were evaluated and the ratio of these cases in the total number of patients was determined along with mortality rates.

RESULTS

In all the years of the study the number of cases with acute coronary heart disease events was significantly lower in Ramadan than before or after Ramadan (P=0.03). But, the ratio of this population to all patients was not statistically significant between the periods (P>0.05). In conclusion, we speculate that Ramadan fasting does not increase acute coronary heart disease events. We believe that further prospective studies should provide an opportunity to examine the relation of fasting to coronary events.