fasting and acute coronary syndromes

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Heart. 2004 June; 90(6): 695–696.
doi: 10.1136/hrt.2003.012526.
PMCID: PMC1768280
A population based study of Ramadan fasting and acute coronary syndromes
J Al Suwaidi,1 A Bener,2 A Suliman,1 R Hajar,1 A M Salam,1 M T Numan,1 and H A Al Binali1
1Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Hamad Medical Corporation, Doha, State of Qatar
2Department of Biostatistics and Epidemiology, Hamad General Hospital and Hamad Medical Corporation
Correspondence to:
J Al Suwaidi
Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation and Hamad General Hospital, PO Box 3050, Doha, State of Qatar;
Accepted September 25, 2003.
Keywords: coronary heart disease, myocardial infarction, unstable angina
Sustained fasting over a period is a feature of several of the world’s great religions. One of the five fundamental rituals of Islam is fasting during the month of Ramadan. Muslims neither eat nor drink anything from dawn until sunset. Fasting may have negative effects on cardiac patients because of the limited time allowed for food intake and the heavy physical worship that is performed after a heavy meal, as well as the inability to take any medications during fasting, which may be essential for the patients.1
Despite the fact that most clinicians worldwide treat Muslim patients, data on the incidence of patients presenting with acute coronary syndromes (ACS) in relation to fasting during Ramadan are lacking. Hence, the purpose of this study is to investigate whether Ramadan fasting has a negative effect on the incidence of presentation with ACS such as acute myocardial infarction (AMI) and unstable angina (UA).
This study was based at Hamad General Hospital, Doha, Qatar, which is the only tertiary care centre in the country and so all patients with ACS are treated here. The Hamad General Hospital cardiology database was used for this study; this database comprises data collected from all patients admitted to the cardiology department at the hospital since January 1991. Data were collected from the clinical records by the patients’ physicians at the time of the patients’ hospital discharge according to predefined criteria for each data point. We focused our study only on Qatari patients because it is a stable population and avoids the bias in the fluctuation of the expatriate population in the country. Furthermore, more than 95% of Qatari adults regularly practise fasting. The study was approved by the institution review board.
With the described database, all patients presenting with ACS from the year 1991 to 2001 were identified. Age, sex, risk factors including smoking, hypertension, hypercholesterolaemia, diabetes, pre-existing coronary heart disease, in-hospital mortality and morbidity, as well as acute medical care provided were analysed.
Periods corresponding to the month of Ramadan in the Gregorian calendar have been established, since the lunar calendar is 11–12 days shorter than the solar year. To reduce the effects originating from seasonal changes to a minimum and to use the data as a control, we evaluated patients for one month before, during, and one month after Ramadan by going back and forward from the period of Ramadan (29–30 days) in a particular year.
Data are expressed as mean and standard deviation of the mean. One way analysis of variance (ANOVA) t test, χ2 test, and Fisher’s exact test were used for statistical analysis. A probability value of p <>

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