The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study

Al-Makhamreh, Hanna; Alkhulaifat, Dana; Al-Ani, Abdallah; Mafrachi, Baraa; Saadeh, Aseel; Al-Ani, Hashim; Hani, Amjad Bani; AlRyalat, Saif Aldeen

doi:10.3390/ijerph18063233

Cited by 7 publications

(13 citation statements)

References 31 publications

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“…Therefore, it is possible to detect a significant degree of concern among Syrians about their lack of information about CVDs. This is because Syria's educational and health care levels have been worsened following 11 years of civil war, which destroyed many hospitals and physicians' immigration to neighbouring countries to get enough resources for survival [25][26][27] .…”

Section: Discussionmentioning

confidence: 99%

Syrians' awareness of cardiovascular disease risk factors and warning indicators: a descriptive cross-sectional study

Swed

Alibrahim

Bohsas

et al. 2023

Sci Rep

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The awareness of cardiovascular diseases (CVDs) contributes to the complications and fatality rates from these diseases among individuals; however, no previous study in Syria was conducted on this topic; thus, this study aims to assess Syrians' awareness of CVDs warning symptoms and risk factors. This online cross-sectional study was performed in Syria between the 1st and 25th of August 2022. The inclusion criteria for the sample were citizens of Syria over 18 who currently reside in Syria. The questionnaire included open- and closed-ended questions to assess the awareness of CVDs. A total of 1201 participants enrolled in the study with a response rate of 97.2%; more than half of the participants (61.4%) were aged 18–24. The most recognizable risk factors and warning signs when asking close-ended and open-ended questions were smoking (95.2%, 37.1%) and chest pain (87.8%, 24.8%), respectively. Overall knowledge scores for risk factors and warning signs were (61.5%). Regarding knowledge score of CVDs risk factors and warning signs, participants aged 45–54 scored higher than other age groups, and respondents with a university education level had a higher score than other educational levels (15.7 ± 0.3), (14.5 ± 0.1), respectively. Participants aged 45–54 have a higher probability of good knowledge of CVDs risk factors and warning signs than participants aged 18–24 (OR = 4.8, P value < 0.001), while participants living in the countryside were less likely to have good knowledge of CVDs risk factors and warning signs than city residents (OR = 0.6, P value < 0.05). According to our results, there is inadequate knowledge of the risk factors and warning signs of CVDs. Consequently, there is a greater need to raise CVD awareness and learning initiatives on the disease's risk factors and symptoms.

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Section: Discussionmentioning

confidence: 99%

Syrians' awareness of cardiovascular disease risk factors and warning indicators: a descriptive cross-sectional study

Swed

Alibrahim

Bohsas

et al. 2023

Sci Rep

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“…2 In the United States, studies have consistently demonstrated racial disparity in hypertension particularly among African American and Mexican-American individuals. 5 Immigrants and war refugees represent another vulnerable group [6][7][8] Exposure to humanitarian crises such as war, leads to worsening cardiovascular disease. 6 Groups that are exposed to armed conflict in low and middle income countries appear to have a higher prevalence of coronary heart disease and cerebrovascular disease.…”

Section: Introductionmentioning

confidence: 99%

“…5 Immigrants and war refugees represent another vulnerable group [6][7][8] Exposure to humanitarian crises such as war, leads to worsening cardiovascular disease. 6 Groups that are exposed to armed conflict in low and middle income countries appear to have a higher prevalence of coronary heart disease and cerebrovascular disease. 9 They are also subject to massive trauma, which can result in psychiatric disorders such as depression and posttraumatic stress disorder that can increase risk of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

“…These can result in stimulation of the sympathetic nervous system and a proinflammatory response with endothelial dysfunction, which prompt atherosclerotic changes. 6,12,13 Our healthcare organization owns and operates several hospitals as well as primary and specialty clinics within the State of Minnesota which has a diverse racial/ethnic distribution including 79.1% white, 7.0% African American, 5.6% Hispanic, 5.2% Asian, and 1.4% American Indian and Alaska native. 14 Minnesota is also home for nearly 91,000 Hmong and 70,000 Somali people who entered the country as war refugees.…”

Section: Introductionmentioning

confidence: 99%

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Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice

Hussein,

Chrenka,

Yang

et al. 2023

Health Services Research and Managerial Epidemiology

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Introduction This analysis is a part of ongoing quality improvement efforts aiming at improving hypertension control among various racial minority groups seen in a large outpatient practice with a special focus on two war refugee populations, the Hmong and the Somali populations. Method Deidentified medical records were reviewed for adult hypertensive patients who had an outpatient encounter with a hypertension diagnosis during the years 2015 through 2019. The study outcome was the rate of uncontrolled hypertension, defined as systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, and stratified by race, age, and gender. Results There were 752,504 patient records representing 259,824 unique patients (mean age 61 ± 13 years) with 49.1% women, 82.1% white 8.3% African American, 4% Asian, 1.6% Hispanic, Somali 0.6%, and 0.2% Hmong. Hmong men had the highest rate of uncontrolled HTN (33.6%) followed by African American (31.3%) then Somali (29.2%). Among women, African Americans had the highest rate (28.6%) followed by Hmong (28.5%) then Somali (25.7%). In all races except Somali, the rate of uncontrolled hypertension was highest in the 18–29 age group, decreased progressively over the next several decades, then increased again in the ≥70 age group. Conclusion Hmong, African American, and Somali groups have the highest rates of uncontrolled hypertension. Efforts to address hypertension management need to be tailored to the specific characteristics of each racial group and to target young adults.

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“…When it comes to chronic conditions, lessons learned from previous armed conflicts show that, in the case of Ukrainian people, other sequelae may also occur. These include a variety of stress-mediated conditions, such as exacerbations of cardiovascular diseases, strokes and heart attacks, cancers and many more, which, in turn, may lead to substantially increased mortality among civilians, including children who are burdened most severely ( Jawad et al, 2020 ; Sadetzki et al, 2017 ; Al-Makhamreh et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

The impact of the war on maintenance of long-term therapies in Ukraine

et al. 2022

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Due to the Russian invasion, which started on 24 February 2022, the Ukrainian healthcare system is facing multiple challenges. A great number of healthcare facilities have been destroyed, while availability of other ones is often limited due to a lack of qualified medical staff. Certain services, e.g. cancer therapies, have been seriously disrupted. Moreover, millions of Ukrainians with chronic conditions are also suffering as due to war-related problems with execution of their long-term therapies. Availability of drugs is particularly limited in the occupied regions. According to the national statistics, as of 18 August 2022, about 505 pharmacies were damaged in Eastern Ukraine and 47 completely ruined. Moreover, the invaders have been blocking humanitarian aid provided to these territories by the Ukrainian government or other countries. Fortunately, in the areas controlled by the Government of Ukraine, the acute shortage of medicines, observed at the beginning of the war, has already been eliminated. Nevertheless, not all drugs are now fully available, even in the areas where no military attacks occur. The economic availability of drugs is also profoundly influenced by the significant increase in the cost of medications and the fall in average salaries. The Government of Ukraine is trying to minimise the impact of these war-related challenges by adopting a new legislation. This includes, among others, simplification of procedures for licensing, quality control and import of medicinal products to Ukraine. Other measures involve securing displaced people with the option of benefiting from local healthcare facilities, broadening the scope of the ePrescription system, authorizing primary care doctors to issue prescriptions to refugees, increasing the number of drugs reimbursed for long-term therapies, etc. These solutions, however, cannot balance all the harmful consequences the war in Ukraine brings in terms of maintenance of long-term therapies. Therefore, in order to minimise this negative impact, Ukraine still needs urgent international support in this area.

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The Impact of War-Related Stress on Coronary Artery Disease Severity in War Survivors: A SYNTAX Study

Cited by 7 publications

References 31 publications

Syrians' awareness of cardiovascular disease risk factors and warning indicators: a descriptive cross-sectional study

Syrians' awareness of cardiovascular disease risk factors and warning indicators: a descriptive cross-sectional study

Describing Racial Disparity in Hypertension Control in a Large Minnesota Outpatient Practice

The impact of the war on maintenance of long-term therapies in Ukraine

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