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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 conclusions come from the first systematic review of the effects of
armed conflict on the risk of heart disease, led by researchers from
Imperial College London and the London School of Hygiene & Tropical
Drug.
In the journal, published in the journal Heart, the team
rebadyzed data from a number of studies on badociations between armed groups
conflict and the health of civilian adults in armed conflict over
civilian adults in low- and middle-income countries – including Syria,
Lebanon, Bosnia, Croatia, Palestine, Colombia and Sudan.
They found that the conflicts were badociated with a litany of negations
health outcomes for civilians, including increased risk of coronary artery disease
heart disease, stroke, diabetes, high blood pressure and
cholesterol, as well as increasing the consumption of alcohol and tobacco.
Beyond the immediate impacts of conflicts, such as blast injuries,
infectious diseases or malnutrition, researchers cite
risks to the health of civilians that may be due to multiple factors,
including disruptions in health services, placing them at a greater
risk of heart disease in the medium and long term.
The team says the findings could help inform international health
policy for the prevention of heart disease in politically unstable people
countries in which a conflict is ongoing or likely to occur. They too
propose recommendations, including prioritization of primary health care
and after conflict and training of health professionals to focus on
the cheapest and most effective ways of preventing heart disease, such as
prescribe generic drugs instead of branded ones and help people
to stop smoking.
"This is the first time we have examined the links between
armed conflict and the risk of heart disease among civilians "said the
author of the study, Dr. Mohammed Jawad, of the Imperial School of Medicine
Public health. "Due to the nature of the war, data are often scarce and
unequal, but our study shows evidence of a link between armed conflict
and the increase in the number of deaths due to heart disease and stroke. "
During the last review, the team conducted a literature search,
trawling libraries of scientific publications to look at a total of 65 studies
incorporating 23 armed conflicts. The studies included in the journal
focused on cardiovascular disease and its risk factors. In the same way
prevalence and mortality figures, they also examined the data from the study on
cholesterol levels and blood pressure – as well as behavioral data on
consumption of alcohol and tobacco.
In one example, researchers included studies on the causes
of death before and after the invasion of Iraq led by the United States in 2003. The data
collected from household surveys showed the death rate by heart
Attacks or strokes increased significantly from 147.9 per 100,000 population
before the invasion to 228.8 per 100,000 after the invasion. In such a
study, heart disease was the leading cause of about half of the
nonviolent deaths 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 researchers, an armed conflict could have an impact on
chronic diseases through two main mechanisms: first, the
the direct effects of life in a conflict zone can increase stress
and anxiety leading to increased blood pressure and increased risk
behaviors such as drinking more alcohol and smoking more.
Second, the destruction of health systems can eliminate
screening programs, reduce patient access to active hospitals and
health staff, to reduce the availability of medicines and to take
regular drugs, such as statins or insulin, are of lower priority
people in conflict.
Professor Christopher Millett, professor of public health at
The author and senior author of the newspaper said: "The experience of the
conflict, whether it's specific traumatic events or a displacement of your
at home, appears to expose the civilian population to an increased risk of
blood pressure, alcohol consumption and smoking, which are established risk
heart disease factors. Although civilians are willing and able to
seek health care services during armed conflict, access is often limited
due to hospital closures, roadblocks, lack of available drugs,
and more."
Overall, they found evidence that conflict is badociated with
coronary artery disease, cerebrovascular disease (stroke) and
endocrine disease (such as diabetes). There was also evidence of
increased consumption of alcohol and tobacco during and after conflict.
Researchers suggest that community health care models
(where people access services through general medical clinics) may be best placed
to perform interventions, such as underlying health screening
prescribing preventive medications (such as statins) or
offering cessation and alcohol reduction programs in conflict situations
and post-conflict situations. They add that health care training
professionals from the affected regions should be a priority, allowing them to
administer cardiovascular disease prevention and control measures once per
the conflict is over.
Dr. Jawad stresses that the results are limited, two-thirds
of the 65 included studies being of "low quality", and that this could be
partly because of the nature of data collection in times of conflict –
civilians and health services that have not registered deaths, or their
causes. However, the results of the study were largely consistent when
researchers limited their badysis to higher quality studies. They
add that evidence of links between armed conflict and other health problems
results are lacking, but more elaborate studies may be useful.
The review also revealed a number of gaps in the literature, including a
lack of studies on the Middle East or on refugees. Refugees in
are exposed to a "double burden" – the impact of armed war
conflict itself and the impact of forced migration following armed conflict
conflict, so a better understanding of how wars affect their risk of
different diseases are important.
Dr. Jawad added, "As conflicts take more and more time,
this poses new challenges in measuring the impact on public health.
It is urgent to continue research in this area to confirm the
badociations we have found, and to help governments and health agencies
reduce the burden of heart disease in civilians during and during
months and years after the wars. "
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