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Living in a war zone is badociated with an increased risk of heart attack and stroke in civilians, even years after the end of the conflict, a study found.
The results come from the first systematic badysis of the effects of armed conflict on the risk of heart disease, conducted by researchers at Imperial College London and the London School of Hygiene & Tropical Medicine.
In the journal, published in the journal HeartThe team has rebadyzed data from a number of studies on the badociations between armed conflict and the health of civilian adults living in armed conflict in low-income or low-income countries. intermediary, particularly in Syria, Lebanon, Bosnia, Croatia, Palestine and Colombia. and Sudan.
They found that conflicts were badociated with a host of negative health consequences for civilians, including an increased risk of coronary heart disease, stroke, diabetes, increased blood pressure and cholesterol, and increased consumption of alcohol and tobacco.
Beyond the immediate impacts of conflict, such as blast injuries, infectious diseases or malnutrition, researchers cite long-term risks to the health of civilians, which may be due to multiple factors, including disruptions in health services, thus exposing them to an increased risk of heart disease. medium to long term.
The team said the findings could help inform international health policy in preventing heart disease in politically unstable countries where conflict is occurring or likely to occur. They also offer recommendations, including prioritizing primary health care during and after conflict, and training health professionals to focus on the cheapest and most effective ways to prevent heart disease, such as prescribing generic rather than branded drugs and helping to quit smoking.
"This is the first such review to examine the links between armed conflict and the risk of heart disease among civilians," said the study's lead author, Dr. Mohammed Jawad, of the # 39; School of Public Health of Imperial. "Due to the nature of the war, the data is often scarce and fragmented, but our study shows evidence of a link between armed conflict and the increase in deaths from heart disease and stroke. to a stroke. "
During the last review, the team conducted a literature search of scientific research trawl libraries to review a total of 65 studies of 23 armed conflicts. The studies included in the review focused on cardiovascular diseases and their risk factors. In addition to prevalence and mortality rates, they also reviewed data from studies of cholesterol levels and blood pressure, as well as behavioral data on alcohol and tobacco use.
In one example, researchers included studies on the causes of death before and after the invasion of Iraq by the United States in 2003. The data collected from household surveys have showed that the death rate from heart attack or stroke had increased significantly from 147.9 per 100,000 population before the invasion to 228.8 per 100,000 after the invasion. In a similar study, heart disease was the leading cause of about half of non-violent deaths committed during the invasion of Iraq by the United States.
The review did not clearly identify the mechanisms underlying the findings, but these may be complex and numerous.
According to the researchers, an armed conflict could have an impact on chronic diseases via two main mechanisms: first, the direct effects of living in a conflict zone can increase stress and anxiety, resulting in an increase in blood pressure and worsening risk behaviors such as alcohol consumption over alcohol and smoking more.
Second, the destruction of health systems can eliminate screening programs, reduce patient access to hospitals and health-care workers, reduce the availability of drugs and make regular medications – such as statins or insulin – less priority for people in conflict.
Professor Christopher Millett, professor of public health at the Imperial and senior author of the newspaper, said: "The experience of an armed conflict, that it is about" For example, specific traumatic events or forced displacements in your home seem to expose the civilian population to an increase in blood pressure, and tobacco use, alcohol consumption, and smoking are well-established risk factors for individuals. Even if civilians wish and are able to seek health care during an armed conflict, their access is often limited due to the closure of hospitals, roadblocks, lack of drugs, etc. "
Overall, they found evidence that the conflict is badociated with an increase in coronary artery disease, cerebrovascular disease (CVA) and endocrine diseases (such as diabetes). There was also evidence of increased consumption of alcohol and tobacco during and after conflict.
Researchers suggest that community-based health care models (where people have access to services in general medical clinics) may be better positioned to perform interventions, such as screening for underlying health conditions, prescription preventive medications (such as statins) or the implementation of smoking cessation and alcohol reduction programs. in conflict and post-conflict situations. They added that training of health professionals in the affected regions should be a priority, enabling them to implement prevention and control measures for cardiovascular disease at the end of the conflict.
Dr. Jawad pointed out that the results are limited, with two-thirds of the 65 included studies being of "poor quality" and this may be due in part to the nature of data collection during conflict – civil and health services failing. register deaths or their causes. However, the results of the studies were largely consistent when the researchers limited their badysis to higher quality studies. They add that there is no evidence of links between armed conflict and other health problems, but more elaborate studies might be useful.
The review also revealed a number of gaps in the literature, including a lack of studies on the Middle East or refugees. Refugees in particular are exposed to a "double burden" – the impact of the armed conflict itself and the impact of forced migration as a result of armed conflict – so it is important to better understand how wars affect the risk of different diseases.
Dr. Jawad added, "As conflicts become longer and longer, new challenges have to be addressed to measure the impact on public health, and further research in this area is urgently needed to confirm the badociations we have. found and helped governments and health agencies reduce the burden of heart disease in civilians during and in the months and years after wars. "
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The researchers receive funding from the Medical Research Council and the National Institute for Health Research.
"The impact of armed conflict on the risk of cardiovascular disease: a systematic review" by Mohammed Jawad etc. al. is published in Heart.
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