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Armed conflict exacerbates CVD risk
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Prolonged armed conflict raises the risk for CVD and related risk factors among civilians living in low- and middle-income countries. However, evidence on this association remains limited, researchers reported in Heart.
Based on their research, Mohammed Jawad, MBBS, MPH, and colleagues recommended that “postconflict reconstruction efforts should deliver low-resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality.”
Jawad and colleagues performed a systematic review of existing literature that assessed the impact of armed conflict on CVD risk among civilians in low- to middle-income countries.
“Part of my research was looking at the health effects of armed conflict beyond casualties and injuries on the battlefield. One area that is often overlooked in the conflict literature is its effect on heart disease,” Jawad, PhD candidate at the Public Health Policy and Evaluation Unit at Imperial College London, told Cardiology Today. “We decided to address this knowledge gap with our review because an increasing number of conflicts are affecting countries, often low- and middle-income countries, with a high burden of heart disease. Also, we are seeing a lot more low-intensity but protracted armed conflicts, so we wondered whether living in a conflict zone for long periods of time would be an independent risk factor for heart disease or its major risk factors.”
The current systematic review focused on 65 studies that analyzed 23 conflicts in low- to middle-income countries. Outcomes evaluated in these studies included CVD and diabetes, as well as clinical and behavioral factors such as BP, blood glucose, lipids, tobacco use, alcohol use, BMI, nutrition and physical activity.
The researchers determined that, in the studies included in the review, armed conflict was associated with CHD, cerebrovascular disease and endocrine disorders in this population. Moreover, civilians living in areas of armed conflict exhibited increases in BP and lipids and greater use of alcohol and tobacco. Civilians in these areas also had higher risk for mortality related to chronic ischemic heart disease or unspecified heart disease.
“We believe we’re the first research group to bring together and summarize all of the evidence” on CVD risk among civilians living in areas of armed conflict in low- and middle-income countries,” Jawad told Cardiology Today. “We found a number of instances where armed conflict was associated with increased heart disease risk, particularly with respect to coronary heart diseases, stroke [and] diabetes. We also found more consistent evidence that armed conflict was associated with increased blood pressure and tobacco use.”
However, 66% of studies were deemed to be of low quality, according to the researchers. Jawad said the results did not change when the researchers restricted the analysis to higher-quality studies.
Jawad also told Cardiology Today there was an absence of research from the Middle East and among refugees in general.
The researchers observed “no clear patterns” for conflict type, length of follow-up, study quality or evidence of publication bias in this systematic review.
Looking ahead, Jawad said, “as clinicians and researchers, we can make better use of routinely collected clinical data to analyze the effects of events such as armed conflicts. There is a growing interest in this field and much advocacy can be done with minimal research cost.”
He noted that the findings of this review are relevant for clinicians who work in conflict-affected countries.
“We think that given the burden of heart disease is likely to be high in conflict-affected countries, primary care should be the center of heart disease prevention and treatment,” Jawad said. “Generalist doctors should be trained to deliver health care to prevent heart disease, and there are a number of cheap and effective ways of doing so when resources are thin,” Jawad told Cardiology Today. – by Earl Holland Jr.
For more information: Mohammed Jawad, MBBS, MPH, can be reached at Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London W2 1PG, UK; email: mohammed.jawad06@imperial.ac.uk; Twitter: @mojawad606.
Disclosures: The authors report no relevant financial disclosures.
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