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

Hanna Al-Makhamreh, Dana Alkhulaifat, Abdallah Al-Ani, Baraa Mafrachi, Aseel Saadeh, Hashim Al-Ani, Amjad Bani Hani and Saif Aldeen AlRyalat
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Hanna Al-Makhamreh: Department of Internal Medicine, Jordan University Hospital, Amman 11942, Jordan
Dana Alkhulaifat: School of Medicine, University of Jordan, Amman 11942, Jordan
Abdallah Al-Ani: School of Medicine, University of Jordan, Amman 11942, Jordan
Baraa Mafrachi: School of Medicine, University of Jordan, Amman 11942, Jordan
Aseel Saadeh: School of Medicine, University of Jordan, Amman 11942, Jordan
Hashim Al-Ani: School of Medicine, University of Jordan, Amman 11942, Jordan
Amjad Bani Hani: Department of Surgery, Jordan University Hospital, Amman 11942, Jordan
Saif Aldeen AlRyalat: Department of Ophthalmology, Jordan University Hospital, Amman 11942, Jordan

IJERPH, 2021, vol. 18, issue 6, 1-10

Abstract: Background: Due to the strong relationship between stress and heart disease, particularly acute myocardial infarction (MI), this study investigated the complexity of coronary artery disease (CAD) among Syrian refugee patients referred to Jordan University Hospital and its relation to war-related stressors. Methods: This is a retrospective study that utilized the SYNTAX I score in order to evaluate all Syrian refugees that underwent coronary artery catheterization at Jordan University Hospital during the period between May of 2014 and December of 2017. Results: There was a significant association between war-related stressors and high SYNTAX score (SX score), thus indicating a higher complexity of CAD in Syrian war survivors with higher stress scores. The strongest war-related correlation was observed with crossing green-lines, in which Syrian refugee patients who had crossed such lines had significantly higher SYNTAX scores. Regression analysis demonstrated that war stressors were positive predictors of increased SYNTAX scores even when adjusted for conventional CAD risk factors. Surprisingly, none of the CAD risk factors were significantly associated with SYNTAX score. Conclusion: Our findings suggest that exposure to multiple war-related stressors may increase the complexity and severity of CAD in Syrian war survivors. Thus, special attention, efforts, and resources should be allocated to screen for such vulnerable patients in order to provide them with the appropriate healthcare.

Keywords: armed conflicts; coronary artery disease; refugees; stress; SYNTAX (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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