Favorable inflammatory status following intermittent fasting in patients with atherosclerotic coronary heart disease after revascuralization

Background: Muslims practise a 30 days intermittent abstinence from food and drinks from dawn to sunset during the month of Ramadan, which follows a lunar calendar and thus comes in different seasons. Intermittent fasting may be also involved in weight reduction programs. Fasting might cause hemoconcentration, which may induce a hypercoagulable state and increase the risk of thrombosis especially in the summer. Little is known about safety of Ramadan fasting in patients with Ischemic Heart Disease (IHD) revascuralized by Coronary Artery Bypass Grafting (CABG) or Percutaneous Coronary Intervention (PCI).

Aim: To study the effect of intermittent fasting in Ramadan on the inflammatory state, lipid profile, plasma osmolarity and occurrence of ischemic events in IHD patients after CABG or PCI.

Methods: We prospectively studied the effect of fasting Ramadan in the summer on 61 patients previously treated by CABG or PCI, followed up in the out patient clinic. Occurrence of ischemic episodes was recorded. Blood osmolarity, serum total Cholesterol (s-Ch), Triglycerides (s-TG), and high sensitivity C-Reactive Protein (hs-CRP), were measured one week before Ramadan as Non-Fasting State (NFS) and on the last day of Ramadan as Fasting State (FS).

Results: Sixty-one patients were studied (25 females, mean age 54.6±7.2 years). 24 had hypertension, 27 had diabetes, and 23 were smokers. 42 underwent successfull CABG and 19 underwent successfull PCI, 31.4±21.7 and 10.8±2.2 months, respectively, before the study. No ischemic episodes were recorded during the period of fasting. s-Ch was 142±59 in FS vs. 138.5±7.09 mg/dL in NFS, (p=0.736). s-TG was 102.7±50.7 in FS vs. 101.7±53.3mg/dl in NFS, (p=0.914). Osmolarity increased, but non-significantly, in FS vs. NFS (285.5±25.5 vs. 278.5±29.07 mOs/kg, p=0.163) despite the relatively high peak and average temperature as well as humidity, which were not different from the month before (p=0.933, p=0.214, p=0.493, p=0.791, respectively), suggesting absence of significant hemoconcentration. Interestingly, hs-CRP decreased significantly in FS vs. NFS (4.88±3.75 vs. 7.64±3.9, mg/dL, p<0.001), This decrease occurred similarly in males and females (p=0.003, <0.001), smokers and non-smokers (p=0.008, <0.001), diabetics and non-diabetics (p=0.001, <0.001), and hypertensives and non hypertensives (p=0.005, <0.001).

Conclusion: Intermittent fasting in the month of Ramadan results in a favorable inflammatory state, does not cause significant change in the lipid profile or blood osmolarity (a marker of hemoconcentration). Moreover it does not increase the risk of ischemic coronary events.