Take care of your heart during the Ramadan fasting period
While the broad spectrum of cardiac diseases requires specific attention on regular days, it is even more crucial during Ramadan.
The change in lifestyle — daily calorie intake via two meals, prolonged dehydration and alteration of medication schedule or sleep pattern changes — might affect patients with cardiovascular diseases. There are different types of cardiac diseases that need medications, including hypertension, heart failure, heart attack, coronary artery disease and irregular heart rhythm or thromboembolic events.
There are some general rules for patients to prevent cardiovascular events in during Ramadan, as categorised and described below:
Patient with hypertension: they are often on multiple anti-hypertensive drugs for controlling the blood pressure. Therefore, we advise that their blood pressure (BP) is reasonably well-controlled before the beginning of Ramadan.
There are several new combination tablets which can be taken once or twice daily that do not interfere with the fasting period. Furthermore, in patients who need diuretics (water pills) with high dose, it is preferable to take the pills in the evening to prevent prolonged dehydration that precipitates blood clots in vessels. However, patients with uncontrolled hypertension should strictly refrain from fasting. As for patients with coronary artery disease, those with chest pain and a history of heart attack who are able to perform normal activities can observe the fast safely, if they have normal heart function (ejection fraction by echocardiography). However, they should reduce their physical activity during the month.
Patients with history of previous revascularisation (stenting or bypass surgery) more than one year ago, and are able to perform routine activities, can observe the fast as long as they take all their medicines. However, strenuous physical activity should be avoided. But patients with a recent heart attack should refrain from observing the fast on strictly medical grounds.
In the case of patients with chronic heart failure: those with poor functioning of the heart, especially experiencing shortness of breath on exertion, should avoid fasting on medical grounds.
However, patients who are wellcontrolled and nearly symptomfree may fast after taking precautions. They should avoid over-eating after breaking the fast and eat in small helpings till the morning. Patients should take diuretics in the evening instead of the morning, so that proper hydration can be maintained.
Those patients on anticoagulation drugs (blood thinners) for arrhythmia or thrombotic vessels need to be careful, even though recent studies show that Ramadan fasting does not adversely affect the efficacy and safety of oral anticoagulation. However, it is advisable to get a blood test to evaluate how long the blood takes to clot before the start of Ramadan, to ensure that it is in the therapeutic range.
Therefore, we recommend that patients seek medical advice before Ramadan, so that their clinical status is assessed and medications can be adjusted.