Le risque du syndrome coronarien aigu au mois de Ramadan.
Mots-clés :
Le Jeûne, Syndrome coronarien aigu, Urgence, Humains, prévalence, Islam, Tunisie, épidémiologie, Religion, études prospectives, évaluation du risque, facteurs de risqueRésumé
Introduction : les données sur l’effet de Ramadan (R) sur la pathologie coronaire sont rares et controversées. L’objectif de notre étude était d’étudier l’influence du mois de Ramadan sur la prévalence du syndrome coronarien aigue chez la population consultant pour douleur thoracique non traumatique. Méthodes : Il s’agit d’une étude prospective, réalisée au service des urgences CHU Fattouma Bourguiba de Monastir, pendant les 3 mois avant, pendant et après Ramadan de 2012 à 2014. Nous avons inclus tous les patients présentant une douleur thoracique non traumatique pendant la période d’étude. Les données ont été recueillies sur un formulaire standardisé. Le test de chi 2 d’homogénéité, le test d’ANOVA, le test de Kruskal-wallis ont été réalisé au seuil de signification de 5%. Le modèle de régression logistique binaire a été utilisé pour l’analyse multivariée. Résultats : durant les 9 mois d’étude, nous avons inclus 765 consultants pour douleur thoracique. La prévalence du SCA, parmi les adultes souffrant de douleur thoracique non traumatique, était de 17 % un mois avant R, de 22 % pendant R et de 28 % un mois après R (p=0.007). Selon les résultats de l’analyse multivariée, le risque de SCA n’est pas majoré au mois de R et est amplifié durant Shawal pour toute la population (OR=2; p=0.001). En analyse en sous groupes, la période de R était associé à une amplification du risque chez les hommes âgés de plus de 55 ans et les femmes de plus de 65 ans (OR: 2.1; p = 0.020) et auprès des sujets hypertendus ((OR: 2.4, p = 0.007). Le jeun de R et la « rupture » du jeun à shawal, n’étaient pas associés à une augmentation du risque parmi les sujets n’ayant aucun facteurs de risque.
Conclusion : Nous avons pu démontrer que le risque de SCA n’est pas majoré au mois de Ramadan que chez les sujets âgés et ceux présentant une hypertension. La majoration du risque à shawwal peut être expliquée par la levée inadéquate de la restriction alimentaire.
Téléchargements
Références
http://www.who.int/gho/countries/tun/en/ Consulté le 05/01/2015.
Saidi O, Ben Mansour N, O'Flaherty M, Capewell S, Critchley JA, Ben Romdhane H. Analyzing Recent Coronary Heart Disease Mortality Trends in Tunisia between 1997 and 2009. PLoS One. 2013; 8: 63202. 2013; 8:63202.
Baccouche H, Sriha Belguith A, Boubaker H, Grissa MH, Bouida W, Beltaief K, et al. Acute coronary syndrome among patients with chest pain: Prevalence, incidence and risk factors. International Journal of Cardiology 2016 (214) 531-535.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Association Heart Disease and Stroke Statistics-2014 Update: A Report From the American Heart Association. Circulation. 2014;129:28-292
www.ins.nat.tn Consulté le 05/01/2015.
Braunwald E, Antman EM, Beasley JW Califf RM, Cheitlin MD, Hochman JS et al. Guideline for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article. J Am Coll Cardiol. 2002;40:1366-74.
Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2011;104:365-72.
Chamsi-Pasha H, Ahmed WH, Al-Shaibi KF. The cardiac patient during Ramadan and Hajj. J Saudi Heart Assoc 2014;26:212-5.
Bener A, Hamad A, Fares A, Al-Sayed HM, Al-Suwaidi J. Is there any effect of Ramadan fasting on stroke incidence? Singapore Med J. 2006;47:404-8.
Reilly T, Waterhouse J. Altered sleep-wake cycles and food intake: The Ramadan model. Physiology and Behavior 2007;90 : 219-28.
Esen Ö, Akçakoyun M, Açar G, Bulut M, Alızade E, Kargin R et al. Acute sleep deprivation is associated with increased atrial electromechanical delay in healthy young adults. Pacing Clin Electrophysiol 2011;34: 1645-51.
Casiero D, Frishman WH. Cardiovascular complications of eating disorders. Cardiol Rev 2006;14: 227-31.
Salam AM, AlBinali HA, Salim I, Singh R, Asaad N, Al-Qahtani A, Al-Suwaidi J. Impact of religious fasting on the burden of atrial fibrillation: A population-based study. Int J Cardiol. 2013;168:3042-3.
Temizhan A, Dönderici O, Ouz D, Demirbas B. Is there any effect of Ramadan fasting on acute coronary heart disease events? Int J Cardiol 1999;70:149-53.
Al Suwaidi J, Bener A, Sulaiman A, AlBinali HA, Salam AM. A population based study of Ramadan fasting and acute coronory syndromes (1991 - 2001). Heart 2004; 90:695-6.
Al Suwaidi J, Bener A, AlBinali H, Numan MT. Does hospitalisation for congestive heart failure occur more frequently in Ramadan: a population based study (1991 - 2001). Int J Cardiol 2004; 96:217-21.
Nematy M, Alinezhad-Namaghi M , Mahdavi Rashed M , Mozhdehifard M, Sania Sajjadi S , Akhlaghi S, Sabery M et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutrition Journal. 2012;11:69. doi:10.1186/1475-2891-11-69.
Leiper JB, Molla AM. Effects on health of fluid restriction during fasting in Ramadan. Eur J Clin Nutr. 2003;57 Suppl 2:S30-8.
Salahuddin M, Sayed Ashfak AH, Syed SR, Badaam KM. Effect of Ramadan Fasting on Body Weight, and Biochemical Parameters in Middle Aged Hypertensive Subjects: An Observational Trial. J Clin Diagn Res. 2014;8:16-8.
Perk G, Ghanem J, Aamar S, Ben-Ishay D, Bursztyn M. The effect of the fast of Ramadan on ambulatory blood pressure in treated hypertensives. J Hum Hypertens 2001;15:723-5.
Ural E, Kozdag G, Kilic T, Ural D, Sahin T, Celebi O, et al. The effect of Ramadan fasting on ambulatory blood pressure in hypertensive patients using combination drug therapy. J Hum Hypertens 2008;3:208-10.
Mousavi M, Mirkarimi S, Rahmani G, Hosseinzadeh E, Salahi N. Ramadan fast in patients with coronary artery disease. Iran Red Crescent Med J. 2014;16:7887.
Chamsi-Pasha H, Ahmed WH. The effect of fasting in Ramadan on patients with heart disease. Saudi Med J 2004;25(1):47-51.
Al Suwaidi J, Zubaid M, Al-Mahmeed WA, Al-Rashdan I, Amin H, et al. Impact of fasting in Ramadan in patients with cardiac disease. Saudi Med J 2005;26: 1579-83.
Khafaji HA, Bener A, Osman M, Al Merri A, Al Suwaidi J. The impact of diurnal fasting during Ramadan on the lipid profile, hs-CRP, and serum leptin in stable cardiac patients. Vasc Health Risk Manag. 2012; 8:7-14.
Bener A, Derbala MF, Al-Kaabi S, Taryam LO, Al-Ameri MM, Al-Muraikhi NM, et al. Frequency of peptic ulcer disease during and after Ramadan in a United Arab Emirates hospital. East Mediterr Health J. 2006;12 :105-11.
Aksungar FB, Eren A, Ure S, Teskin O, Ates G. Effects of intermittent fasting on serum lipid levels, coagulation status and plasma homocysteine levels. Ann Nutr Metab. 2005; 49:77-82.
Nematy M, Alinezhad-Namaghi M, Rashed MM, Mozhdehifard M, Sajjadi SS, Akhlaghi S, et al. Effects of Ramadan fasting on cardiovascular risk factors: a prospective observational study. Nutr J. 2012; 11: 69.
Faris MA, Hussein RN, Al-Kurd RA, Al-Fararjeh MA, Bustanji YK, Mohammad MK. Impact of Ramadan intermittent fasting on oxidative stress measured by urinary 15-f(2t)-isoprostane. J Nutr Metab. 2012: 802924.
Shehab A, Abdulle A, El Issa A, Al Suwaidi J, Nagelkerke N. Favorable changes in lipid profile: the effects of fasting after Ramadan. PLoS One 2012;7:47615.
Kul S, Savaş E, Oztürk ZA, KaradaÄŸ G. Does Ramadan Fasting Alter Body Weight and Blood Lipids and Fasting Blood Glucose in a Healthy Population? A Meta-analysis. J Relig Health. 2014;53:929-42.
Baccouche H, Hellara I, Khochtali I, Grissa MH, Boubaker H, Beltaief K et al. Ramadan fasting effects on metabolic parameters in elderly persons with cardiovascular risk factors. Journal of Aging Research and Clinical Practice. 2014 ; 3 :200-5.
Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J. 2006;47:409-14.
Barkia A, Mohamed K, Smaoui M, Zouari N, Hammami M, Nasri M. Change of diet, plasma lipids, lipoproteins, and fatty acids during Ramadan: a controversial association of the considered Ramadan model with atherosclerosis risk. J Health Popul Nutr. 2011; 29:486-93.
Bahijri S, Borai A, Ajabnoor G, Abdul Khaliq A, AlQassas I, Al-Shehri D, Chrousos G. Relative metabolic stability, but disrupted circadian cortisol secretion during the fasting month of Ramadan. PLoS One. 2013; 8:60917.
Khatib FA, Shafagoj YA. Metabolic alterations as a result of Ramadan fasting in non-insulin-dependent diabetes mellitus patients in relation to food intake. Saudi Med J 2004 ; 25: 1858-63.
Khaled BM, Bendahmane M, Belbraouet S. Ramadan fasting induces modifications of certain serum components in obese women with type 2 diabetes. Saudi Med J 2006 ;27: 23-26.
Yarahmadi Sh, Larijani B, Bastanhagh MH, Pajouhi M, Baradar Jalili R, et al. Metabolic and clinical effects of Ramadan fasting in patients with type II diabetes. J Coll Physicians Surg Pak 2003 ;13: 329-32.
Benaji B, Mounib N, Roky R, Aadil N, Houti IE, Moussamih S et al. Diabetes and Ramadan: Review of the literature. Diabetes Research and Clinical Practice. 2006; 73: 117-25.
Hankir A, Hankir M, Zaman R. Should Ramadan be prescribed after Christmas? Obesity in the healthcare profession and the health benefits of fasting. BMJ Case Rep.2014.
Salim I, Al Suwaidi J, Ghadban W, Al kilani H, Salam AM. Impact of religious Ramadan fasting on cardiovascular disease: a systematic review of the literature. Curr Med Res Opin 2013 ;29 :343-54.
