Chronobiology of rupture and dissection of aortic aneurysms

Abstract

A growing body of evidence suggests that the occurrence of cardiovascular events is not evenly distributed over time, but shows peculiar temporal patterns that vary with time of day, day of the week, and month (season) of the year. These patterns coincide with the temporal variation in the pathophysiologic mechanisms that trigger cardiovascular events and the physiologic changes in body rhythms. These two factors in combination contribute to the periodicity in susceptibility to acute cardiovascular events. The classic assumption of epidemiologic studies that there is a constancy in risk for disease during the various time domains has now been challenged by the emerging new concept of chronorisk. In the last two decades temporal patterns (circadian, weekly, seasonal) have been identified for several acute cardiovascular diseases, such as acute myocardial infarction, sudden death, pulmonary embolism, and stroke, with peak incidence for most in the morning and during winter. One of the most life-threatening cardiovascular emergencies, aortic aneurysm rupture or dissection, also demonstrates periodicity, characterized by a similar temporal distribution, which suggests a common pathophysiologic mechanism or triggers similar to other cardiovascular acute emergencies. We review the data on chronobiology of acute aortic rupture or dissection, and discuss various pathophysiologic mechanisms that account for this variability. It is likely that identification of consistent recurring patterns in the underlying risk mechanisms could provide potential new insights for more precise diagnosis and efficacious therapeutic intervention.

A meta-analysis of monthly variation in occurrence of abdominal aortic aneurysm rupture

“…The cardiovascular event occurrence is suggested not to be evenly distributed over time, but to show peculiar temporal patterns varying with time of day, day of week, and month (season) of year [1]. A clear seasonal trend in cardiovascular diseases (such as deep venous thrombosis, pulmonary embolism, aortic dissection, stroke, intracerebral haemorrhage, hypertension, heart failure, angina pectoris, myocardial infarction, sudden cardiac death, ventricular arrhythmia, and atrial fi brillation) exists with the highest incidence occurring during the colder winter months [2].…”

Disturbed Diurnal Rhythm Alters Gene Expression and Exacerbates Cardiovascular Disease With Rescue by Resynchronization

“…Epidemiological studies suggest an important role for day/night rhythms in the cyclic variation of heart rate and blood pressure, 1,2 timing of endocrine hormone secretion, 3,4 temporal variations of cardiac vulnerability, 5 and susceptibility to adverse cardiovascular events (including myocardial infarction, 6,7 stroke, 8 angina, 9 ventricular arrhythmias, 10 dissection/rupture of aortic aneurysm, 11 and sudden cardiac death 12 ). Shift workers and patients with sleep disorders are at increased risk of adverse cardiovascular events and poorer prognosis.…”

Circadian Proteomics and Its Unique Advantage for Discovery of Biomarkers of Heart Disease

“…The incidence of myocardial infarction in humans peaks in the morning (~6:00A.M.-12:00 noon) (Cohen et al, 1997;Goldberg et al, 1990;Muller et al, 1985). A similar pattern is observed in the incidences of sudden cardiac death (Muller et al, 1989;Willich et al, 1987), ventricular tachyarrhythmia (Eksik et al, 2007;Tofler et al, 1995), and rupture of aortic aneurysms (Manfredini et al, 2004;Mehta et al, 2002;Sumiyoshi et al, 2002). Precursor risk factors such as vasomotor tone, platelet aggregability, and other factors involved in thrombosis or thrombolysis also exhibit daily rhythms (Andrews et al, 1996;Angleton et al, 1989;Decousus et al, 1985;Maemura et al, 2000;Otto et al, 2004).…”