t is well known that there is a circadian variation in the onset of acute myocardial infarction (AMI), in which a peak incidence occurs in early to late morning and a secondary peak exists in the late evening. 1,2 Investigation of pathophysiologic triggers of AMI showing diurnal variation, such as hemodynamic and hematological variables, has enhanced the understanding of mechanisms of the onset and sequence of coronary heart disease (CHD) events. [3][4][5][6] In recent years, the effects of environmental factors, such as temperature, on the onset of CHD were examined and a seasonal periodicity was reported to exist. Several investigators have showed a seasonal variation in the incidence of the onset of CHD and mortality from AMI with a peak in the winter months. [7][8][9] In contrast, the greatest frequency of its onset was observed during the hottest season of the year. 10 Thus, the results of the previous studies are conflicting and there have been no precise reports on the onset season of CHD in the young population. The purpose of the present study was to investigate whether or not the seasonal difference was present in the onset of CHD in young patients with CHD compared with older patients with CHD living in Nagano Prefecture, a suburban area of Japan. We also examined the association between the onset season of CHD events and disease classification, severity of coronary lesions, and established coronary risk factors in the young patients.
Methods
SubjectsNagano Prefecture is a suburban community with a population of approximately 2.2 million. The population of people aged ≥65 years accounts for approximately 25% of the whole population. Twenty of the 117 general medical hospitals that hold over 100 beds were selected and asked to be collaborative institutions. These 20 hospitals covered the entire region of Nagano Prefecture.Eligible young subjects aged ≤40 years were admitted to one of these 20 hospitals and diagnosed with CHD between 1992 and 2002, and 101 young patients were enrolled. According to the statistics of National Cardiovascular Center of Japan between 1977 and 1996, AMI events reached a peak in men aged in their 60 s and in women aged in their 70 s, and the population from 50 to 79 years occupied over 80% of the AMI patients. 11 Therefore, eligible older subjects were set patients aged ≥50 years who were diagnosed with CHD from 1992 to 2002, and 94 older patients consented to participate in the study.After written informed consent was obtained from each subject, biological data, including the number of coronary lesions and the particular month of the onset of CHD events, was copied from medical records. The presence of metabolic disorders, including obesity, hypertension, dyslipidemia, and diabetes, was noted. Then, each participant was asked to complete a mailed questionnaire addressing lifestyle factors, such as cigarette smoking, physical activi- Background The aim of the present multicenter study was to investigate whether there is a seasonal difference in the onset of coronary heart dis...