Circadian activity of the endogenous fibrinolytic system in stable coronary artery disease: effects of beta-adrenoreceptor blockers and angiotensin-converting enzyme inhibitors

Sayer, Jeremy; Gutteridge, C. N.; Syndercombe‐Court, Denise; Wilkinson, Paul

doi:10.1016/s0735-1097(98)00481-1

Cited by 35 publications

(28 citation statements)

References 28 publications

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“…Together, these hemostatic changes, changes in gene expression, and external triggers may create a shearing stress and cause rupture of vulnerable coronary atherosclerotic plaques in the morning, when an elevated prothrombotic state already exists. [44][45][46][47][48][49] In addition to the morning peak, a secondary peak of AMI occurrence in the evening has been identified in several earlier studies. [4][5][6]10,24 This peak is notably absent in our study as well as in two contemporary studies published in 2007 and 2010 by Leiza et al 15 and Holmes et al, 17 respectively.…”

Section: Discussionmentioning

confidence: 99%

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Kanth

Ittaman

Rezkalla

2013

Clinical Medicine & Research

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Objective: Nearly four decades ago, a circadian pattern of acute myocardial infarction (AMI) with a peak in the early morning waking hours was described. The goal of the present study was to determine whether major changes in lifestyle and significant advances in medical therapy have altered this pattern in the intervening years. Design: Retrospective chart review.Setting: Tertiary care hospital in central Wisconsin. Methods:We examined circadian patterns of ST elevation myocardial infarction (STEMI) in 519 patients diagnosed with STEMI over a 5-year period. Time of symptom onset was obtained from patient self-reports in the medical record and was recorded over 24 hours. Results:We observed a circadian pattern of STEMI occurrence with a morning peak at approximately 11:30 AM. This pattern was highly significant in patients who were not using beta-blockers (P <0.0001) and had no history of diabetes (P <0.0001), but was otherwise absent. The circadian pattern appeared to be attenuated in patients of a younger age, female gender, or who used statins or aspirin. Peak STEMI occurrence was earlier in smokers than non-smokers.Conclusions: Despite significant lifestyle changes and medical advances in the nearly four decades since a circadian pattern of AMI occurrence was first described, patients with STEMI had a circadian pattern of symptom onset with a morning peak. Use of beta-blockers and a history of diabetes mellitus abolished this pattern. Other modifying factors, including medications, age, and gender attenuated, but did not abolish, the circadian pattern.

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Section: Discussionmentioning

confidence: 99%

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Kanth

Ittaman

Rezkalla

2013

Clinical Medicine & Research

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“…16 An increase in platelet aggregation has been described in the morning, 17 and the fibrinolytic system has marked circadian variation. 18 The mechanisms underlying the increase in STEMI, which is more often associated with an occlusive, fibrin-rich thrombus than NSTEMI and UA, may also underpin the resistance to thrombolytic therapy that has been observed in the early morning and late evening hours. 19 Morning and evening peaks of ischemia in patients with UA and with vasospasm and nonsignificant CAD have been described, 20 suggesting that differences in coronary vasospasm may play a role in the nighttime increase in STEMI.…”

Section: Hypotheses To Explain the Findingsmentioning

confidence: 99%

The impact of time and day on the presentation of acute coronary syndromes

et al. 2006

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SummaryBackground: The frequency of acute myocardial infarction (AMI) peaks on Mondays and in the mornings. However, the distribution of the types of acute coronary syndromes (ACS), including unstable angina (UA), has not been systematically evaluated.Hypothesis: The distribution of the types of ACS and clinical presentations varies by time and day of admission.Methods: A retrospective cohort study was conducted in 1,946 consecutive nontransfer ACS admissions (1999)(2000)(2001)(2002)(2003)(2004) to a tertiary-care academic center to assess presenting clinical variables in patients admitted on days versus nights (6 P.M. -6 A.M.) and weekdays versus weekends (Friday 6 P.M. -Monday 6 A.M.).Results: There were fewer ACS admissions than expected on nights and weekends (p < 0.001), but the proportion of patients with ACS presenting with STelevation myocardial infarction (STEMI) is 64% higher on weekends (p < 0.001) and 31% higher on nights (p = 0.022). This increased proportion with STEMI results in a greater proportion of ACS with AMI on weekends

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“…21 Sayer et al reported that bisoprolol modifies fibrinolytic activity through alteration of the clock system and the sympathoadrenal system. 22 The TIBBS group also revealed that bisoprolol had an effect that was prognostically favorable. 23 These results indicate that modulation of sympathovagal balance is one of the favorable effects of b-blockade.…”

Section: Discussionmentioning

confidence: 98%

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

et al. 2010

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There is a deep relationship between impaired circadian rhythm and hypertension. However, the detailed mechanisms between the daily sleep-wake rhythm and cardiovascular disorders have not yet been elucidated. To clarify the mechanism, we examined salt-sensitive Dahl rats that were fed normal chow (n¼10), high-salt chow (n¼10) and high-salt chow with bisoprolol (n¼10). Simultaneous electroencephalogram, electromyogram and locomotor activity were examined to analyze the sleep-wake state. We also examined heart rate, blood pressure and echocardiographic findings to verify the presence of hypertension. Hypertension with impaired ventricular contraction was observed in the rats with high-salt-chow consumption whereas normal-chow rats did not show these disorders. Although rats with the normal diet showed a standard daily rhythm with normal rapid eye movement (REM) sleep duration and locomotor activity, the high-salt-diet group exhibited an impaired daily rhythm with suppressed REM sleep and significant abnormal locomotor activity. Bisoprolol significantly improved the daily sleep-wake rhythm and locomotor activity. We showed that an impaired daily rhythm was closely related to the development of hypertension. Keywords: b-blocker; daily rhythm; locomotor activity INTRODUCTION It is well known that there is a deep relationship between sleep disorders and cardiovascular diseases such as hypertension and congestive heart failure (CHF). The fact that patients with advanced CHF induced by hypertension frequently suffer from central breathing disorders 1 suggests that CHF is causally related to alterations in the central control of breathing, resulting in Cheyne-Stokes respiration during sleep. 2 Disorders in the central control of breathing are a key factor in altered daily sleep-wake rhythm and are also an independent predictor for premature death. 3,4 Although it is known that cardiovascular diseases are closely related to circadian rhythm, 5 the relationship among changes in circadian rhythm, sleep disorders and cardiovascular diseases has not yet been elucidated.It has been reported that long-term treatment with b-receptorblocking substances (b-blockers) improves hypertension and CHF. bBlockers also reduce the inappropriate increase of ventilation during exercise and alleviate central breathing disorders during wakefulness. 6,7 These positive effects result in improved exercise capacity and slower progression of underlying hypertension and CHF. However, little is known about the effects of b-blocker treatment on sleep

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Circadian activity of the endogenous fibrinolytic system in stable coronary artery disease: effects of beta-adrenoreceptor blockers and angiotensin-converting enzyme inhibitors

Cited by 35 publications

References 28 publications

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

The impact of time and day on the presentation of acute coronary syndromes

A critical role of sympathetic nerve regulation for the treatment of impaired daily rhythm in hypertensive Dahl rats

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