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The William Harvey Research Institute - Barts and The London

Ramadan fasting: recommendations for patients with cardiovascular disease

A new publication led by cardiologists and researchers at the Barts Heart Centre and Queen Mary University of London has developed a framework for triaging and where possible, facilitating safe fasting in patients with cardiovascular disease.

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Ramadan fasting is one of the five fundamental pillars of Islam and is observed by most of the 1.8 billion Muslims around the world. It lasts for one month based on the lunar calendar year and involves abstention from any food or drink from dawn to sunset. Although general exemptions for Ramadan fasting exist for those within those limiting medical conditions, recommendations on ‘safe’ fasting for patients with cardiovascular disease are lacking. Given the relatively high prevalence of cardiovascular diseases within some Muslim communities, the lack of guidance for this group of patients was an unmet need.

The new guidance document, published in the science journal Heart, addresses this issue. In collaboration with the British Islamic Medical Association (BIMA), an international group of experts helped to produce a consensus document that healthcare professionals can use when advising and managing patients with different cardiovascular conditions, who may wish to fast in Ramadan.

Senior author Dr Mohammed Khanji said: “Using expert consensus and any available evidence in the literature, we risk stratified patients. For those in the ‘low-moderate risk’ group it is generally safe to fast, provided their medications and clinical conditions allow. The ‘high’ or ‘very high risk’ groups would generally be advised not to fast or at least be advised to consider safe alternatives such as non-consecutive fasts or fasting shorter days e.g. during winter.”

“Patients who are fasting should be educated well before the start of Ramadan on the potential risks (including the risk of dehydration, fluid overload, and terminating the fast if they become unwell) and reviewed after Ramadan to reassess their risk status and condition.”

Future studies in this area should help clarify the benefits and risks of fasting in this group of patients and refinement of this novel document.

Further information