Circadian analysis of myocardial infarction incidence in an Argentine and Uruguayan population

D'Negri, Carlos E; Nicola-Siri, Leonardo; Vigo, Daniel Eduardo; Girotti, Luis; Cardinali, Daniel P.

doi:10.1186/1471-2261-6-1

Cited by 27 publications

(22 citation statements)

References 43 publications

(31 reference statements)

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“…[3][4][5][6][7][8][9][10][11][12][13][14][15]17,24 The past four decades have seen major changes in lifestyle and significant improvements in medical intervention. It is generally accepted that poor diet and a shift toward a more sedentary lifestyle have resulted in a dramatic rise in obesity in the United States and a concurrent rise in obesity-related comorbidities.…”

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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“…The onset of unstable angina, myocardial infarction, sudden cardiac death, and stroke occurs usually at specific moments of the day. [17][18][19][20][21] It has been suggested that it is attributed primarily to the diurnal variations of cardiovascular parameters, such as sympathetic nerve activity, blood pressure, and heart rate, in addition to variations in plasma lipid, platelets, coagulation factors, or endothelial dysfunction. [22][23][24][25][26][27][28][29] However, it is unknown whether the diurnal variation of cardiovascular parameters is controlled primarily by circadian clock genes or influenced secondarily by external factors.…”

Section: Clinical Perspective P 2195mentioning

confidence: 99%

Mutation of the Circadian Clock Gene Per2 Alters Vascular Endothelial Function

et al. 2007

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Background-The circadian clock regulates biological processes including cardiovascular function and metabolism. In the present study, we investigated the role of the circadian clock gene Period2 (Per2) in endothelial function in a mouse model. Methods and Results-Compared with the wild-type littermates, mice with Per2 mutation exhibited impaired endotheliumdependent relaxations to acetylcholine in aortic rings suspended in organ chambers. During transition from the inactive to active phase, this response was further increased in the wild-type mice but further decreased in the Per2 mutants. The endothelial dysfunction in the Per2 mutants was also observed with ionomycin, which was improved by the cyclooxygenase inhibitor indomethacin. No changes in the expression of endothelial acetylcholine-M 3 receptor or endothelial nitric oxide synthase protein but increased cyclooxygenase-1 (not cyclooxygenase-2) protein levels were observed in the aortas of the Per2 mutants. Compared with Per2 mutants, a greater endothelium-dependent relaxation to ATP was observed in the wild-type mice, which was reduced by indomethacin. In quiescent aortic rings, ATP caused greater endothelium-dependent contractions in the Per2 mutants than in the wild-type mice, contractions that were abolished by indomethacin. The endothelial dysfunction in the Per2 mutant mice is not associated with hypertension or dyslipidemia. Conclusions-Mutation in the Per2 gene in mice is associated with aortic endothelial dysfunction involving decreased production of NO and vasodilatory prostaglandin(s) and increased release of cyclooxygenase-1-derived vasoconstrictor(s). The results suggest an important role of the Per2 gene in maintenance of normal cardiovascular functions.

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“…For example, a maximal peak of onset of MI between 04:00 PM and 12:00 AM hours, with a second smaller peak between 06:00 AM and 08:00 AM hours, was found in a Bulgarian cohort [21], and a peak between 01:00 AM and 07:00 AM hours and a trough between 01:00 PM and 07:00 PM hours was demonstrated in a Chinese cohort [22]. On the other hand, a double-peak distribution of MI was reported in a South American patient population, with a lower MI incidence between 03:00 AM and 07:00 AM hours, a first maximum between 08:00 AM and 12:00 PM hours, and a second maximum between 03:00 PM and 10:00 PM hours [23]. The data on circadian variation of acute myocardial infarction in the Turkish population came from the very well-designed study by Sari et al, who examined circadian variation of AMI in a Turkish cohort [24].…”

Section: Discussionmentioning

confidence: 99%

Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort

Çelik

İyisoy

et al. 2011

Med Sci Monit

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SummaryBackgroundTo evaluate the relationship between site of infarction (anterior vs. inferior) and circadian variation in patients with ST segment elevation myocardial infarction (STEMI) in a Turkish cohort.Material/MethodsThis restrospective study enrolled 465 patients (407 male, mean age 65±7 years) with STEMI. Patients were then categorised into 4 6-hour increments according to the time of day during which the symptoms began (12:00 AM–06:00 AM, 06:00 AM–12:00 PM; 12:00 PM–06:00 PM and 06:00 PM–12:00 AM hours). Characteristics of patients by site of infarction (anterior vs. inferior) were compared.ResultsThe frequency of onset of acute anterior MI as determined by onset of pain demonstrated significant circadian variation among the 4 time periods, demonstrating bimodal peaks (afternoon and morning) and a trough between 06:00 PM to 06:00 AM. The incidence of occurrence of MI between 06:00 AM to 06:00 PM was 4.50 times that of the average frequency of the remaining 12 hours of the day. The frequency of onset of acute inferior MI as determined by onset of pain exhibited significant circadian variation among the 4 time periods, demonstrating bimodal peaks (midnight to 06:00 AM and 06:00 AM to noon) and a trough between noon to midnight. The incidence of occurrence of MI between midnight to noon was 4.25 times that of the average frequency of the remaining 12 hours of the day.ConclusionsDifferent circadian periodicity in the time of onset of STEMI was found regarding infarction site in a Turkish cohort. This may be related to genetic and/or demographic characteristics of the Turkish population.

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Circadian analysis of myocardial infarction incidence in an Argentine and Uruguayan population

Cited by 27 publications

References 43 publications

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Circadian Patterns of ST Elevation Myocardial Infarction in the New Millennium

Mutation of the Circadian Clock Gene Per2 Alters Vascular Endothelial Function

Circadian variation of acute st segment elevation myocardial infarction by anatomic location in a Turkish cohort

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