Ramadan Fasting (RF) is considered one of the pillars of Islam. RF includes refraining from any form of ingestion into the body from dawn until Sunset. RF is mandatory for all adult Muslims except for patients with medical disorders that exclude them from fasting. Although physicians always exempt patients with illnesses from this religious obligation, many continue with fasting for spiritual reasons, and they strictly organize their prescription timetable to outfit RF. The metabolic and clinical effects of RF have been previously studied systematically . Most of the studies suggested that RF is safe in stable patients with Coronary Artery Disease (CAD).
RF reduced the proinflammatory markers significantly 4 weeks after Ramadan, denoting a potential long-term beneficial RF role on proinflammatory markers .
Thrombogenicity, aggravated by dehydration, plays a critical role in favoring late stent thrombosis . Many cardiologists advise patients with recent Percutaneous Cardiac Intervention (PCI) to avoid fasting because of potential dehydration, which may increase the risk of stent thrombosis. Although there are no consensus guidelines, it looks sensible to advise patients with myocardial infarction, unstable angina (UA), or recent revascularization to avoid RF.
In tow center Prospective Cohort Study, that followed 303 patients whom underwent Percutaneous Coronary intervention, 160 continue fasting , it concluded that that RF during the hot and extended fasting hours in the summertime may not be safe during the first 3 months following the PCI in patients with high SYNTAX (score > 22) and who had a complex PCI procedure. They suggest that low-risk patients with a normal systolic function who underwent PCI may safely fast Ramadan.
Meanwhile the trend of cardiologists in Iraq differs widely between different centers regarding stable patients with elective procedures, but patients with urgent ones there near agreement to prevent them from fasting until 1 month after Myocardial infarction.