Islamic fasting: cardiovascular disease perspective

ABSTRACT

Introduction

Ramadan is a month of obligatory fasting observed by the majority of 2 billion Muslims living around the globe. The guidelines for ‘risk-free’ fasting exist for chronic diseases, including diabetes mellitus, but recommendations for cardiovascular disease (CVD) patients are deficient due to the paucity of literature.

Areas Covered

Databases were screened to find relevant studies for an evidence-based consensus regarding the risk stratification and management of CVD. Using practical guidelines of the European Society of Cardiology (ESC), we categorized patients into low-, moderate-, and high-risk categories and proposed a pre-Ramadan checklist for the assessment of cardiac patients before fasting. Regular moderate-intensity exercise is recommended for most cardiac patients, which has been demonstrated to provide an anti-inflammatory and antioxidant effect that improves immune function.

Expert opinion

In Ramadan, many physiological changes occur during fasting, which brings about a balanced metabolic homeostasis of the body. In addition, Ramadan fasting is a nonpharmacologic means of decreasing CV risk factors. As Islam exempts Muslims from fasting if they are unwell; therefore, patients with the acute coronary syndrome (ACS), advanced heart failure (HF), recent percutaneous coronary intervention (PCI), or cardiac surgery should avoid fasting.

KEYWORDS:

• intermittent fasting
• ischemic heart disease
• heart failure
• ramadan fasting

Article highlights

• With an increasing prevalence of cardiovascular diseases in Muslims, clinicians are likely to encounter questions about the suitability of observing fast

• Ramadan diurnal intermittent fasting and caloric restriction regimens have shown to have general health-beneficial and disease-preventing effects on the body

• Fasting allows the production of new white blood cells, it necessitates glucose and fat consumption, and activates stem cells to regenerate new cells in the immune system

• Ramadan fasting modulates the immune system for better regulation of insulin, cholesterol, and other metabolic hormones necessary for the homeostasis of the body

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.