Circadian rhythm of angina: Similarity to circadian rhythms of myocardial infarction, ischemic ST segment depression, and sudden cardiac death

Taylor, Colin R.; Hodge, Elsa M.; White, Denise

doi:10.1016/0002-8703(89)90833-8

Cited by 35 publications

(7 citation statements)

References 3 publications

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“…This finding is similar to many prior studies that have reported circadian variability of other cardiovascular conditions. [1][2][3][4][5][6][7][8][9][10][11][12] We also demonstrate that the peak incidence of this adverse cardiovascular event occurs during early morning, when people awaken and begin normal activities, identical to the timing of onset of other adverse cardiovascular events. 4,12 This similarity suggests that common underlying pathophysiological mechanisms may be responsible for the triggering of these cardiovascular events, including aortic dissection.…”

Section: Discussionsupporting

confidence: 57%

“…The cardiovascular conditions shown to be associated with such rhythmic variations include acute myocardial infarction, [1][2][3][4][5] sudden death, 6 supraventricular tachycardia, 7 stable angina, 8 silent ischemia, 9 cerebrovascular accidents, 10 subarachnoid hemorrhage, 11 and spontaneous rupture of abdominal aortic aneurysm. 12 An increased incidence of these events has been shown to occur early in the morning within the first 3 hours of waking up, 1,2,4 in winter, 3 and on Monday mornings.…”

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confidence: 99%

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Chronobiological Patterns of Acute Aortic Dissection

et al. 2002

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Background— Chronobiological rhythms have been shown to influence the occurrence of a variety of cardiovascular disorders. However, the effects of the time of the day, the day of the week, or monthly/seasonal changes on acute aortic dissection (AAD) have not been well studied. Methods and Results— Accordingly, we evaluated 957 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2000 (mean age 62±14 years, type A 61%). A χ 2 test for goodness of fit and partial Fourier analysis were used to evaluate nonuniformity and rhythmicity of AAD during circadian, weekly, and monthly periods. A significantly higher frequency of AAD occurred from 6:00 am to 12:00 noon compared with other time periods (12:00 noon to 6:00 pm , 6:00 pm to 12:00 midnight, and 12:00 midnight to 6:00 am ; P <0.001 by χ 2 test). Fourier analysis showed a highly significant circadian variation ( P <0.001) with a peak between 8:00 am and 9:00 am . Although no significant variation was found for the day of the week, the frequency of AAD was significantly higher during winter ( P =0.008 versus other seasons by χ 2 test). Fourier analysis confirmed this monthly variation with a peak in January ( P <0.001). Subgroup analysis identified a significant association for all subgroups with circadian rhythmicity. However, seasonal/monthly variations were observed only among patients aged <70 years, those with type B AAD, and those without hypertension or diabetes. Conclusions— Similar to other cardiovascular conditions, AAD exhibits significant circadian and seasonal/monthly variations. Our findings may have important implications for the prevention of AAD by tailoring treatment strategies to ensure maximal benefits during the vulnerable periods.

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Section: Discussionsupporting

confidence: 57%

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confidence: 99%

Chronobiological Patterns of Acute Aortic Dissection

et al. 2002

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“…7,8) By analyzing daily rhythmicity, many studies confirmed a peak of AAD onset in morning hours, as well as cyclic variability in other cardiovascular diseases. [5][6][7][8][9][10][11][12][13][14][15][16] Increases in disease incidence were recorded both for other cardiovascular events and aortic dissection within the first 3 hours of awakening. This was observed both in previous studies [8][9][10]16) and the present one.…”

Section: Discussionmentioning

confidence: 99%

Temporal Variations at the Onset of Spontaneous Acute Aortic Dissection

et al. 2006

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SUMMARYThere have only been a few studies of the chronobiological occurrence of acute aortic dissection (AAD), and most were international and multicentered. The aim of the present study, conducted at only one center, was to determine the most frequent daily, monthly, and seasonal occurrences of AAD.The study population included 204 patients (66.5% male) treated at our institute between January 1, 1998 and January 1, 2004. A significantly higher frequency of AAD occurred from 6:00 AM to 12:00 noon, compared with other time periods (P < 0.001). The results showed a significant circadian variation in AAD (P < 0.001) with a peak between 9:00 AM and 10:00 AM. No significant variation was found for the day of the week; however, AAD occurred most frequently on Wednesday and Monday. The frequency of AAD was found to be significantly higher during winter versus other seasons (P < 0.001). The analysis of monthly variations of the onset of AAD confirmed a peak in February (12.9%) and in January (12.3%).Similar to other cardiovascular diseases, AAD exhibits significant circadian and seasonal/monthly variations. Our findings indicate that the prevention of AAD, especially during the aforementioned vulnerable periods, is possible by adequate tailoring of the treatment of hypertension, which is the main AAD predisposing factor. (Int Heart J 2006; 47: 585-595)

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“…Since the first observation of Miller‐Craig and colleagues (3), it has been demonstrated that many acute cardiovascular events show a strong circadian periodicity with the highest incidence of events coinciding with the early morning blood pressure surge. Events that are noted to occur with a relatively high frequency between 6.00 a.m. and noon include sudden death (22,23), acute myocardial infarction (24,25), typical angina pectoris (25), ventricular arrhythmias (26,27), silent ischaemia (28) and ischaemic stroke (29). Meta‐analyses of studies looking at the timing of acute myocardial infarction in 66 635 patients and sudden cardiac death in more than 19 000 patients, found a 40% increase in the risk of myocardial infarction and a 29% increase in sudden cardiac death between 6.00 a.m. and noon (30).…”

Section: Relationship Between the Morning Blood Pressure Surge And Camentioning

confidence: 99%

The normal circadian pattern of blood pressure: implications for treatment

Redón¹

2004

International Journal of Clinical Practice

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Blood pressure fluctuates over 24 h following a circadian rhythm that reaches a peak in the morning shortly after awakening. The onset of many acute cardiovascular and cerebrovascular events shows a synchronous cyclical pattern, with the highest incidence of morbidity and mortality in the early morning hours. Strong, although circumstantial, evidence suggests that the early morning surge in blood pressure may contribute to the onset of acute cardiovascular episodes. Sustained blood pressure control that blunts the early morning blood pressure surge may help to reduce the incidence of these events.Antihypertensive agents are needed that provide smooth and sustained blood pressure control for the full 24 h, including the risky early morning hours. The angiotensin II receptor blocker telmisartan given once daily, because of its long half-life and mechanism of action, is likely to confer benefit in terms of 24-h blood pressure control and may reduce cardiovascular risk at the time of greatest patient vulnerability.

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Circadian rhythm of angina: Similarity to circadian rhythms of myocardial infarction, ischemic ST segment depression, and sudden cardiac death

Cited by 35 publications

References 3 publications

Chronobiological Patterns of Acute Aortic Dissection

Chronobiological Patterns of Acute Aortic Dissection

Temporal Variations at the Onset of Spontaneous Acute Aortic Dissection

The normal circadian pattern of blood pressure: implications for treatment

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