Abstract
Over the last few years, patterns have emerged re‐gardingthe daily (circadian), weekly (circaseptan), and yearly (circannual) variation in the incidence of acute coronary syndromes (ACS). Peaks of incidence occur in the morning, on Mondays, and in winter. There is a difference in the pattern of incidence in different subgroups such as diabetics and smokers, which, along with the incidence alteration seen with aspirin and beta blockers, gives us some potential understanding of underlying mechanisms. Recent advances in the study of endothelial function, cytokine biology, and adhesion molecules have led to new insights into the way that natural fluctuations in these systems may affect ACS incidence. It is hoped that understanding these developments will lead to therapeutic advances in ACS prevention.
Keywords: circadian, variation, coronary, syndrome, mechanism
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References
- 1. Spielberg C, Falkenhahn D, Willich SN, Wegscheider K, Voller H: Circadian, day‐of‐week, and seasonal variability in myocardial infarction: Comparison between working and retired patients. Am Heart J 1996; 132 (3): 579–585 [DOI] [PubMed] [Google Scholar]
- 2. Gnecchi‐Ruscone T, Piccaluga E, Guzzetti S, Contini M, Montano N, Nicolis E: Morning and Monday: Critical periods for the onset of acute myocardial infarction. The GISSI 2 Study Experience. Eur Heart J 1994; 15: 882–887 [DOI] [PubMed] [Google Scholar]
- 3. WHO International Study Group : Myocardial Infarction Community Registers: Public Health in Europe. 5 ed., 1976.
- 4. Willich SN, Lowel H, Lewis M, Arntz R, Baur R, Winther K, Keil U, Schroder R: Association of wake time and the onset of myocardial infarction. Triggers and Mechanisms of Myocardial Infarction (TRIMM) pilot study. TRIMM Study Group. Circulation 1991; 84 (6 suppl): VI62–VI67 [PubMed] [Google Scholar]
- 5. Tofler GH, Muller JE, Stone PH, Forman S, Solomon RE, Knatterud GL, Braunwald E: Modifiers of timing and possible triggers of acute myocardial infarction in the Thrombolysis in Myocardial Infarction Phase II (TIMIII) Study Group. J Am Coll Cardiol 1992; 20 (5): 1049–1055 [DOI] [PubMed] [Google Scholar]
- 6. Gilpin EA, Hjalmarson A, Ross J Jr: Subgroups of patients with atypical circadian patterns of symptom onset in acute myocardial infarction. Am J Cardiol 1990; 66 (16): 7G–11G [DOI] [PubMed] [Google Scholar]
- 7. Tofler GH, Brezinski D, Schafer AI, Czeisler CA, Rutherford JD, Willich SN, Gleason RE, Williams GH, Muller JE: Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987; 316 (24): 1514–1518 [DOI] [PubMed] [Google Scholar]
- 8. Cohen MC, Rohtla KM, Lavery CE, Muller JE, Mittleman MA: Meta‐analysis of the morning excess of acute myocardial infarction and sudden cardiac death. Am J Cardiol 1997; 79 (11): 1512–1516 [DOI] [PubMed] [Google Scholar]
- 9. Willich SN, Linderer T, Wegscheider K, Leizorovicz A, Alamercery I, Schroder R: Increased morning incidence of myocardial infarction in the ISAM Study: Absence with prior beta‐adrenergic blockade. ISAM Study Group. Circulation 1989; 80 (4): 853–858 [DOI] [PubMed] [Google Scholar]
- 10. Willich SN, Lowel H, Lewis M, Hormann A, Arntz HR, Keil U: Weekly variation of acute myocardial infarction. Increased Monday risk in the working population. Circulation 1994; 90: 87–93 [DOI] [PubMed] [Google Scholar]
- 11. Tofler GH, Stone PH, Maclure M, Edelman E, Davis VG, Robertson T, Antman EM, Muller JE: Analysis of possible triggers of acute myocardial infarction (the MILIS Study). Am J Cardiol 1990; 66 (1): 22–27 [DOI] [PubMed] [Google Scholar]
- 12. Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C, Poole WK, Passamani E, Roberts R, Robertson T: Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985; 313 (21): 1315–1322 [DOI] [PubMed] [Google Scholar]
- 13. Sayer JW, Wilkinson P, Ranjadayalan K, Ray S, Marchant B, Timmis AD: Attenuation or absence of circadian and seasonal rhythms of acute myocardial infarction. Heart 1997; 77: 325–329 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Ridker PM, Manson JE, Buring JE, Muller JE, Hennekens CH: Circadian variation of acute myocardial infarction and the effect of low‐dose aspirin in a randomized trial of physicians. Circulation 1990; 82: 897–902 [DOI] [PubMed] [Google Scholar]
- 15. Kono T, Morita H, Nishina T, Fujita M, Hirota Y, Kawamura K, Fujiwara A: Circadian variations of onset of acute myocardial infarction and efficacy of thrombolytic therapy. J Am Coll Cardiol 1996; 27: 774–778 [DOI] [PubMed] [Google Scholar]
- 16. Arntz HR, Willich SN, Schreiber C, Bruggemann T, Stern R, Schultheiss HP: Diurnal, weekly and seasonal variation of sudden death. Population‐based analysis of 24,061 consecutive cases. Eur Heart J 2000; 21: 315–320 [DOI] [PubMed] [Google Scholar]
- 17. Hjalmarson A, Gilpin EA, Nicod P, Dittrich H, Henning H, Engler R, Blacky AR, Smith SC Jr, Ricou F, Ross J Jr: Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation 1989; 80: 267–275 [DOI] [PubMed] [Google Scholar]
- 18. Peters RW, Muller JE, Goldstein S, Byington R, Friedman LM: Propranolol and the morning increase in the frequency of sudden cardiac death (BHAT Study). Am J Cardiol 1989; 63: 1518–1520 [DOI] [PubMed] [Google Scholar]
- 19. Ku CS, Yang CY, Lee WJ, Chiang HT, Liu CP, Lin SL: Absence of a seasonal variation in myocardial infarction onset in a region without temperature extremes. Cardiology 1998; 89: 277–282 [DOI] [PubMed] [Google Scholar]
- 20. British Heart Foundation. Coronary Heart Disease Statistics. 2002.
- 21. Marchant B, Ranjadayalan K, Stevenson R, Wilkinson P, Timmis AD: Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: The influence of environmental temperature. Br Heart J 1993; 69: 385–387 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Douglas AS, al Sayer H, Rawles JM, Allan TM: Seasonality of disease in Kuwait. Lancet 1991; 337: 1393–1397 [DOI] [PubMed] [Google Scholar]
- 23. Millar‐Craig MW, Bishop CN, Raftery EB: Circadian variation of blood‐pressure. Lancet 1978; 1: 795–797 [DOI] [PubMed] [Google Scholar]
- 24. Fujita M, Franklin D: Diurnal changes in coronary blood flow in conscious dogs. Circulation 1987; 76: 488–491 [DOI] [PubMed] [Google Scholar]
- 25. Vgontzas AN, Papanicolaou DA, Bixler EO, Lotsikas A, Zachman K, Kales A, Prolo P, Wong ML, Licinio J, Gold PW, Hermida RC, Mastorakos G, Chrousos GP: Circadian interleukin‐6 secretion and quantity and depth of sleep. J Clin Endocrinol Metab 1999; 84: 2603–2607 [DOI] [PubMed] [Google Scholar]
- 26. Sothern RB, Roitman‐Johnson B, Kanabrocki EL, Yager JG, Fuerstenberg RK, Weatherbee JA, Young MR, Nemchausky BM, Scheving LE: Circadian characteristics of interleukin‐6 in blood and urine of clinically healthy men. In Vivo 1995; 9: 331–339 [PubMed] [Google Scholar]
- 27. el Tamimi H, Mansour M, Pepine CJ, Wargovich TJ, Chen H: Circadian variation in coronary tone in patients with stable angina. Protective role of the endothelium. Circulation 1995; 92 (11): 3201–3205 [DOI] [PubMed] [Google Scholar]
- 28. Elherik K, Khan F, McLaren M, Kennedy G, Belch JJ: Circadian variation in vascular tone and endothelial cell function in normal males. Clin Sci (Lond) 2002; 102: 547–552 [PubMed] [Google Scholar]
- 29. Gaenzer H, Sturm W, Kirchmair R, Neumayr G, Ritsch A, Patsch J: Circadian variation of endothelium‐dependent vasodilatation of the brachial artery as a confounding factor in the evaluation of endothelial function. Atherosclerosis 2000; 149: 227–228 [DOI] [PubMed] [Google Scholar]
- 30. Maple C, Kirk G, McLaren M, Veale D, Belch JJ: A circadian variation exists for soluble levels of intercellular adhesion molecule‐1 and E‐selectin in healthy volunteers. Clin Sci (Lond) 1998; 94: 537–540 [DOI] [PubMed] [Google Scholar]
- 31. Maemura K, Layne MD, Watanabe M, Perrell MA, Nagai R, Lee ME: Molecular mechanisms of morning onset of myocardial infarction. Ann NY Acad Sci 2001; 947: 398–402 [DOI] [PubMed] [Google Scholar]
- 32. Fujino T, Katou J, Fujita M, Ohta T, Harada T, Hasebe N, Kikuchi K: Relationship between serum lipoprotein(a) level and thrombin generation to the circadian variation in onset of acute myocardial infarction. Atherosclerosis 2001; 155: 171–178 [DOI] [PubMed] [Google Scholar]
- 33. Bridges AB, Scott NA, McNeill GP, Pringle TH, Belch JJ: Circadian variation of white blood cell aggregation and free radical indices in men with ischaemic heart disease. Eur Heart J 1992; 13: 1632–1636 [DOI] [PubMed] [Google Scholar]
- 34. ISIS‐2 (Second International Study of Infarct Survival) Collaborative Group : Morning peak in the incidence of myocardial infarction: Experience in the ISIS‐2 Trial. Eur Heart J 1992; 13: 594–598 [PubMed] [Google Scholar]
- 35. Cyrus T, Sung S, Zhao L, Funk CD, Tang S, Pratico D: Effect of low‐dose aspirin on vascular inflammation, plaque stability, and atherogenesis in low‐density lipoprotein receptor‐deficient mice. Circulation 2002; 106: 1282–1287 [DOI] [PubMed] [Google Scholar]
- 36. Cannon CP, McCabe CH, Stone PH, Schactman M, Thompson B, Théroux P, Gibson RS, Feldman T, Kleiman NS, Tofler GH, Muller JE, Chaitman BR, Braunwald E: Circadian variation in the onset of unstable angina and non‐Q‐wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB). Am J Cardiol 1997; 79: 253–258 [DOI] [PubMed] [Google Scholar]
- 37. Kleiman NS, Schechtman KB, Young PM, Goodman DA, Boden WE, Pratt CM, Roberts R: Lack of diurnal variation in the onset of non‐Q‐wave infarction. Circulation 1990; 81: 548–555 [DOI] [PubMed] [Google Scholar]
- 38. Bremner WF, Holmes EW, Kanabrocki EL, Hermida RC, Ayala D, Garbincius J, Third JL, Ryan MD, Johnson M, Foley S, Shirazi P, Nemchausky BA, Scheving LE: Circadian rhythm of serum total homocysteine in men. Am J Cardiol 2000; 86 (10): 1153–1156 [DOI] [PubMed] [Google Scholar]
- 39. Peters RW, McQuillan S, Resnick SK, Gold MR: Increased Monday incidence of life‐threatening ventricular arrhythmias. Experience with a third‐generation implantable defibrillator. Circulation 1996; 94: 1346–1349 [DOI] [PubMed] [Google Scholar]
- 40. Evans C, Chalmers J, Capewell S, Redpath A, Finlayson A, Boyd J, Pell J, McMurray J, Macintyre K, Graham L: “I Don't Like Mondays”—Day of the week of coronary heart disease deaths in Scotland: Study of routinely collected data. Br Med J 2000; 320: 218–219 [DOI] [PMC free article] [PubMed] [Google Scholar]
