Effect of Ramadan fasting in incidence of cerebral venous sinus thrombosis

Abstract

Dear editor, Cerebral venous sinus thrombosis (CVST) is regarded more common in Iran and other middle-eastern countries. 1,2 As recommended in Islam, sustained fasting in Ramadan is obligatory for all healthy adults. Muslim women are exempted from fasting during menstrual days. 3 Since there are some controversies on the association of Ramadan fasting and CVST, researchers have felt a gap. So they conducted a cross-sectional study to evaluate whether fasting in Ramadan month would increase the incidence of CVST. 3,4 This is a retrospective cross-sectional study done in Namazi Hospital affiliated with Shiraz University of Medical Sciences in Iran from 2009 to 2015. This is a high-volume referral center for stroke in southern Iran. All patients with any cerebrovascular disease (CVD), ischemic or hemorrhagic/arterial or venous, were enrolled in a data set. The ratio of CVST to all CVD patients was calculated in Ramadan and in all other lunar months. Overall, 13,094 CVD patients and 332 CVST patients were recruited in seven consecutive years. A total of 38 CVST and 942 CVD patients were admitted in Ramadan while fasting and 294 CVST and 12,152 CVD patients were admitted in other lunar months. CVST illustrated a significant increase in Ramadan compared to the rest of the year (p value ¼ 0.029) and people were 1.4 times more likely to develop CVST in this month. The CVST-CVD ratio in Ramadan and other months was estimated to be 0.4 and 0.02, respectively (p value ¼ 0.05). This increase in the risk of CVST in Ramadan can be explained by the effect of dehydration and hyperviscosity. Some women take oral contraceptive pills (OCPs) to prevent menstruation during Ramadan fasting which may have an adjuvant effect. 5 In the first week of fasting, dehydration occurred in Muslims 6 which led to hyperviscosity and can be an

Changes in trend of cerebral venous sinus thrombosis

“…It is common that Iranian women misuse oral contraceptive pills (OCP) in order to delay their menstruation during religious ceremonies such as Haj and fasting month of Ramadan. 5 , 6 Although not significant, OCP use has declined among our patients with CVST. The increasing frequency of thrombophilia can be attributed to more complete diagnostic work-ups in the recent years.…”

Dehydration and Headache

“…Dehydration is a risk factor for thrombosis, particularly cerebral venous sinus thrombosis (CVST) which can present as a thunderclap-onset headache. A 7-year retrospective cross-sectional study was conducted in Iran and found higher prevalence of CVST during the months of Ramadan compared to the other months in the lunar calendar [ 25 ]. The authors suspect this is due to elevated blood viscosity from dehydration during the months of Ramadan [ 25 ].…”

“…A 7-year retrospective cross-sectional study was conducted in Iran and found higher prevalence of CVST during the months of Ramadan compared to the other months in the lunar calendar [ 25 ]. The authors suspect this is due to elevated blood viscosity from dehydration during the months of Ramadan [ 25 ]. High estrogen states such as pregnancy or combined hormonal contraceptive use can also increase the risk of thrombosis [ 25 , 26 ].…”

“…The authors suspect this is due to elevated blood viscosity from dehydration during the months of Ramadan [ 25 ]. High estrogen states such as pregnancy or combined hormonal contraceptive use can also increase the risk of thrombosis [ 25 , 26 ]. In a retrospective analysis of 22 women with CVST during pregnancy or the postpartum period, dehydration was a predisposing factor during pregnancy.…”

The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review

“…Increased blood viscosity is a secondary effect of dehydration that may increase the risk of thrombosis and, thereby, the risk of stroke [15][16][17]. Javanmardi, Safari [18] reported that cerebral venous sinus thrombosis increased during Ramadan due to dehydration.…”