Circadian distribution of onset of acute myocardial infarction in subgroups from analysis of 10,791 patients treated in a single center

Hansen, Ole; Johansson, Bengt W.; Gullberg, Bo

doi:10.1016/0002-9149(92)90854-r

Cited by 69 publications

(48 citation statements)

References 26 publications

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“…4,7,8,12,15,[17][18][19][20][21] It is interesting that while use of beta-blockers and a history of diabetes completely abolished the presence of a circadian pattern of AMI onset, other modifying factors including age, gender, statin use, and aspirin use merely attenuated the pattern. Beta-blockers are known to prevent increases in sympathetic activity, catecholamine concentrations, heart rate, blood pressure, and cardiac oxygen demand.…”

Section: Discussionmentioning

confidence: 99%

“…The absence of a circadian pattern in patients taking beta-blockers has been remarkably consistent overtime and between studies, with several other groups observing a complete loss of circadian pattern in patients taking betablockers. 4,7,12,18 However, some have observed an attenuation or change in pattern, as opposed to complete loss. 8,19 Results in diabetic patients are more variable.…”

Section: Discussionmentioning

confidence: 99%

“…However, others have observed an attenuated or altered pattern 8,21 or even no effect of diabetes. 18 These differences may be attributable to the inherent difficulties in studying diabetic patients, as the effects of diabetes on other health conditions are dependent on a number of factors including length of time the person has been afflicted, glycemic control, and medication use, among others. We were unable to capture detail regarding medication use, insulin-dependence, or diabetes duration in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Others have not observed any effect of age or gender. 15,18 Attenuation of the circadian pattern in patients using statins and aspirin may be the result of the anti-inflammatory and anti-platelet properties of these medications, which may dampen the early morning triggers of AMI.…”

Section: Discussionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Kanth

Ittaman

Rezkalla

2013

Clinical Medicine & Research

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“…An additional peak in the late evening or in the very early morning was reported in other studies. [2][3][4][5] Among them, the morning onset (6.00 am-12.00 am) of MI has been studied extensively, 4,5 and a causative relationship has been suggested to the morning surge in blood pressure (BP) 6 as well as the morning rises in platelet aggregability, 7 thrombotic activity, 8 and serum concentrations of cortisol and catecholamines. 9,10 Based on the suppressant effect of sympatholytic drugs, 11 the morning surge in BP is thought to be associated with the excessive activation of the sympathetic nervous system.…”

Section: Introductionmentioning

confidence: 99%

Salt-induced exacerbation of morning surge in blood pressure in patients with essential hypertension

et al. 2000

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The morning surge in blood pressure (BP) is related to the morning occurrence of lethal cardiovascular events. We tested the hypothesis that salt intake may be associated with the morning surge in BP in essential hypertension. Seventy-six patients were admitted and placed on a low salt diet (2 g/day) for 7 days followed by a high salt diet (20-23 g/day) for another 7 days. At the end of each salt diet, 24-h ambulatory BP and heart rate monitorings and head-up tilt (HUT) test were performed. Patients whose average mean BP (MBP) was increased by more than 10% by salt loading were assigned to the salt-sensitive (SS) group (n ‫؍‬ 37); the remaining patients, whose MBP was increased by less than 10%, were assigned to the non-salt-sensitive (NSS) group (n ‫؍‬ 39). The increase in ambulatory MBP during 6.30-8.00 am above the baseline (2.00-4.00 am) was significantly

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Patient Demographic and Clinical Features and Circadian Variation in Onset of Ischemic Stroke

Casetta¹,

Granieri²,

Fallica³

et al. 2002

Arch Neurol

120

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Our study confirms the circadian rhythm of stroke reported in previous studies. There is a chronological pattern of ischemic stroke in the morning, which appears to be independent of the presence of risk factors and of clinical stroke subtypes. The role of circadian variability of blood pressure (present in patients with and without hypertension) and a concurrent morning hypercoagulability are suggested as possible determinants of this pattern. Preventive pharmacological interventions aimed at specifically targeting the morning rise in risk factors could be advantageous in reducing the overall risk of ischemic stroke.

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Circadian distribution of onset of acute myocardial infarction in subgroups from analysis of 10,791 patients treated in a single center

Cited by 69 publications

References 26 publications

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Salt-induced exacerbation of morning surge in blood pressure in patients with essential hypertension

Patient Demographic and Clinical Features and Circadian Variation in Onset of Ischemic Stroke

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