The effect of Ramadan fasting on circadian variation of Turkish patients with acute myocardial infarction

Abstract

A b s t r a c tIntroduction: The mechanisms of circadian variation in cardiovascular events are not clear. Aim: Evaluation of the effect of Ramadan fasting on circadian variation of acute ST-elevation myocardial infarction (STEMI) in Turkish patients.Material and methods: This comparative cross-sectional study included 151 consecutive patients with acute STEMI. The time of onset of STEMI was determined by the attending physician on the basis of patients' self-reports. The patients were divided into two group based on the history of fasting. The standard hourly profile of the onset of STEMI was obtained over a 24-h period. Patients were then categorized into four 6-hour increments according to the time that the symptoms began (00:00-05:59; 06:00-11:59; 12:00-17:59 and 18:00-23:59 h).Results: In all study participants, the highest incidence of STEMI was between 12.00 and 18.00; the odds ratio was 2.77 (95% CI: 2.63-2.92, p < 0.001). In the non-fasting group, the highest incidence of STEMI occurred between 06:00 and 12:00 A.M. The highest incidence of AMI occurred between 12.00 A.M. and 18.00 in patients with fasting; the odds ratio was 2.70 (95% CI: 2.51-2.91, p < 0.001). There were significant differences between fasting and non-fasting groups regarding circadian variation of STEMI (p < 0.001).Conclusions: There are significant changes in the circadian variation of patients with STEMI in relation to Ramadan fasting.

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

“…Table 2 shows the five studies, which reported the incidence of MI during Ramadan and other months, as well as the fasting status. Almansori and Cherif,[ 13 ] Turker et al,[ 14 ] and Al Suwaidi et al[ 11 ] studied the effect of the fasting status on the risk of MI hospitalization. Al Suwaidi et al studying 1019 consecutive acute coronary disease patients admitted to a general hospital in the span of 9 months (including a Ramadan month) reported a higher relative risk for MI in the nonfasting group.…”

“…[ 13 ] In their study of 151 consecutive Turkish patients with ST-elevation MI (STEMI) during the Ramadan months of 2010 and 2011, Turker et al reported that higher proportions of the STEMI occurred during the nonfasting state. [ 14 ] Baseline hemodynamics (heart rate, systolic-diastolic blood pressure, etc.) and biomedical profiles (hemoglobin, creatinine, total cholesterol, etc.)…”

“…were reported to be similar between fasting and nonfasting groups. [ 13 14 ] The use of medications such as aspirin, Beta-blockers, and angiotensin-converting enzyme inhibitors were also the same between the two groups. [ 13 ]…”

“…Researchers also focused on evaluating the impact of Ramadan fasting on the circadian pattern of MI. [ 11 14 ] Al Suwaidi et al reported that there were significant differences (p = 0.002) between the fasting and nonfasting groups with respect to the time when the symptoms of AMI began. The symptoms of fasting patients were less likely to start between 5 am and 8 am but more likely between 5 pm and 6 pm and between 3 am and 4 am, which correspond to the time of the meals for fasting patients.…”

“…[ 11 ] In their study, Turker et al reported that there were significant differences between fasting and nonfasting groups regarding circadian variation of STEMI (p< 0.001). [ 14 ] The highest incidence of STEMI among the fasting group was between 12 am and 6 pm, whereas the highest incidence of STEMI in the nonfasting group occurred between 6 am and 12 am. [ 14 ]…”