Living in a war zone is associated with an increased risk of heart attack and stroke among civilians, even years after the conflict ends, according to a study.
Published in the journal Heart, the study analysed data from a number of studies on associations between armed conflict and the health of civilian adults in low- and middle-income countries—including Syria, Lebanon, Bosnia, Croatia, Palestine, Colombia and Sudan.
The researchers at Imperial College London and the London School of Hygiene & Tropical Medicine in the UK found that conflicts were associated with a litany of negative health outcomes for civilians.
These included increased risk of coronary heart disease, stroke, diabetes, increased blood pressure and cholesterol, as well as increased alcohol and tobacco use, they said.
Beyond the immediate impacts of conflict, such as blast injuries, infectious diseases or malnutrition, the researchers cite longer-lasting health risks for civilians which may be due to multiple factors, including disruptions to healthcare services, putting them at greater risk of heart disease in the medium to long term.
The findings could help inform international health policy in the prevention of heart disease in politically unstable countries where conflict is taking place, or likely to occur, researchers said.
The researchers offer recommendations, including prioritising primary healthcare during and after conflicts and training healthcare professionals to focus on both the cheapest and effective ways to prevent heart disease.
These include prescribing generic medicines instead of branded ones and helping people to quit smoking, researchers said.
This is the first review of its kind to examine the links between armed conflict and the risk of heart disease among civilians," said Mohammed Jawad, from Imperial College.
"Because of the nature of war, data is often scarce and patchy, but our study shows evidence of a link between armed conflicts and increased deaths from heart disease and stroke," Jawad said.
The team carried out a literature search, trawling science publication libraries to look at a total of 65 studies incorporating 23 armed conflicts.
The studies included in the review focused on cardiovascular disease and its risk factors.
In one example, researchers included studies looking at the causes of death before and after the 2003 US-led invasion of Iraq.
Data collected from household surveys showed the rate of deaths from heart attack or stroke increased significantly, from 147.9 per 100,000 people before the invasion to 228.8 per 100,000 post-invasion.
In a similar study, heart disease was the principal cause of about half of non-violent deaths during the US-led invasion of Iraq, researchers said.
The review was unable to identify clear mechanisms underlying the findings, but these are likely to be complex and numerous.
According to the researchers armed conflict could potentially impact chronic health conditions through two main mechanisms.
Firstly, the direct effects of living in a conflict zone itself can increase stress and anxiety, leading to higher blood pressure, as well as worsening risk behaviours such as drinking more alcohol and smoking more.
Second, the destruction of healthcare systems can eliminate screening programmes, reduce patient access to working hospitals and healthcare staff, reduce the availability of medicines and make taking regular medications—such as statins or insulin—a lower priority for people facing conflict.
"The experience of armed conflict, be it specific traumatic events or displacement from your home, appears to place civilian populations at greater risk of increased blood pressure, alcohol use and smoking, which are established risk factors for heart disease," said Christopher Millett, a professor at Imperial College.
"Even if civilians are willing and able to seek healthcare services during armed conflict, access is often limited due to hospital closures, road blockades, lack of available medications, and more," Millet said.
The researchers found evidence that conflict is associated with increased coronary heart disease, cerebrovascular disease (stroke) and endocrine disease (such as diabetes).
There was also evidence of increased alcohol and tobacco consumption, during and after conflict.
