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Impact of armed conflict on cardiovascular disease risk: a systematic review

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Title: Impact of armed conflict on cardiovascular disease risk: a systematic review
Authors: Jawad, M
Vamos, E
Najim, M
Roberts, B
Millett, C
Item Type: Journal Article
Abstract: Objectives Prolonged armed conflict may constrain efforts to address non-communicable disease in some settings. We assessed the impact of armed conflict on cardiovascular disease (CVD) risk among civilians in low- and middle-income countries (LMICs). Methods In February 2019 we performed a systematic review (Prospero ID: CRD42017065722) searching Medline, Embase, PsychINFO, Global Health, and Web of Science without language or date restrictions. We included adult, civilian populations in LMICs. Outcomes included CVDs and diabetes, and eight clinical and behavioural factors (blood pressure, blood glucose, lipids, tobacco, alcohol, body mass index, nutrition, physical activity). We systematically re-analysed data from original papers and presented them descriptively. Results Sixty-five studies analysed 23 conflicts, and 66% were of low quality. We found some evidence that armed conflict is associated with an increased coronary heart disease, cerebrovascular, and endocrine diseases, in addition to increased blood pressure, lipids, alcohol, and tobacco use. These associations were more consistent for mortality from chronic ischaemic heart disease or unspecified heart disease, systolic blood pressure, and tobacco use. Associations between armed conflict and other outcomes showed no change, or had mixed or uncertain evidence. We found no clear patterning by conflict type, length of follow up, and study quality, nor strong evidence for publication bias. Conclusions Armed conflict may exacerbate CVDs and their risk factors, but the current literature is somewhat inconsistent. Post-conflict reconstruction efforts should deliver low resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality.
Issue Date: 21-Aug-2019
Date of Acceptance: 22-Mar-2019
URI: http://hdl.handle.net/10044/1/68101
DOI: 10.1136/heartjnl-2018-314459
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: 1388
End Page: 1394
Journal / Book Title: Heart
Volume: 105
Copyright Statement: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. This article has been accepted for publication in Heart following peer review. The definitive copyedited, typeset version is available online at: https://heart.bmj.com/content/early/2019/05/22/heartjnl-2018-314459
Sponsor/Funder: Medical Research Council
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
cardiac risk factors and prevention
global health
systemic review
cardiac risk factors and prevention
global health
systemic review
1102 Cardiorespiratory Medicine and Haematology
Cardiovascular System & Hematology
Publication Status: Published
Online Publication Date: 2019-05-28
Appears in Collections:School of Public Health