Effect of Ramadan fasting in incidence of cerebral venous sinus thrombosis

Abstract

Dear editor,

Cerebral venous sinus thrombosis (CVST) is regarded more common in Iran and other middle-eastern countries.^1,2 As recommended in Islam, sustained fasting in Ramadan is obligatory for all healthy adults. Muslim women are exempted from fasting during menstrual days.³ Since there are some controversies on the association of Ramadan fasting and CVST, researchers have felt a gap. So they conducted a cross-sectional study to evaluate whether fasting in Ramadan month would increase the incidence of CVST.^3,4

This is a retrospective cross-sectional study done in Namazi Hospital affiliated with Shiraz University of Medical Sciences in Iran from 2009 to 2015. This is a high-volume referral center for stroke in southern Iran.

All patients with any cerebrovascular disease (CVD), ischemic or hemorrhagic/arterial or venous, were enrolled in a data set. The ratio of CVST to all CVD patients was calculated in Ramadan and in all other lunar months.

Overall, 13,094 CVD patients and 332 CVST patients were recruited in seven consecutive years. A total of 38 CVST and 942 CVD patients were admitted in Ramadan while fasting and 294 CVST and 12,152 CVD patients were admitted in other lunar months. CVST illustrated a significant increase in Ramadan compared to the rest of the year (p value = 0.029) and people were 1.4 times more likely to develop CVST in this month. The CVST–CVD ratio in Ramadan and other months was estimated to be 0.4 and 0.02, respectively (p value = 0.05). This increase in the risk of CVST in Ramadan can be explained by the effect of dehydration and hyperviscosity. Some women take oral contraceptive pills (OCPs) to prevent menstruation during Ramadan fasting which may have an adjuvant effect.⁵

In the first week of fasting, dehydration occurred in Muslims⁶ which led to hyperviscosity and can be an important risk factor for developing CVST. This study is presented to highlight the higher incidence of CVST in Ramadan. Relevant education about the importance of water intake and the adverse effect of OCPs should be provided for the fasting Muslim people.

References

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