European Survey on Circadian Variation of Angina Pectoris (ESCVA) in Treated Patients

Abstract

The study demonstrated a marked wake time-related circadian variation in the occurrence of angina pectoris attacks. To improve preventive strategies, type, dosage and particularly timing of cardiac medication appear of importance, as may be behavior modification.

Circadian influences on myocardial infarction

“…It is also clear that, other than output from a central clock, the manner by which a given peripheral clock is synchronized with another, or the extent to which a peripheral clock can establish feedback to the SCN that it is, in fact, synchronized is not known. At present, the literature does support the premise that pathophysiologic conditions can both cause uncoupling of peripheral oscillators and be caused by uncoupling of peripheral clocks (Muller, 1999a , b ; Young et al, 2001a , b ; Willich et al, 2004 ; Lee et al, 2005 ; Fujino et al, 2006 ; Maywood et al, 2010 ; Tsimakouridze et al, 2012 ; Reddy and Rey, 2014 ; Robinson and Reddy, 2014 ; Wu and Reddy, 2014 ).…”

“…The significance of circadian rhythms to myocardial infarction has been identified in several studies in which onset of non-Q-wave angina, unstable angina, myocardial infarctions, and sudden cardiac death all show marked elevations in occurrence between the hours of 0600 and 1200 (Muller, 1999a , b ; Willich et al, 2004 ; Mosendane and Raal, 2008 ). Ethnic genetic, medications, co-morbidities, lifestyle, cultural, and/or social factors may shift the time of highest incidence (Kanth et al, 2013 ).…”

Effect of aspirin intake at bedtime versus on awakening on circadian rhythm of platelet reactivity

“…Platelet aggregation and activation surface markers follow a circadian rhythm, with a peak between 6 AM to noon (5,6). This might play a role in the observed peak of acute CVD during morning hours, which is present in patients with-and without previous CVD (7)(8)(9)(10). Moreover, patients with a myocardial infarction during morning hours have larger infarct size than those with events dur-ing the rest of the day, which has a worse prognosis (11,12).…”

Attenuation of myocardial injury in mice with functional deletion of the circadian rhythm gene mPer2

“…Epidemiologic studies demonstrate the existence of circadian patterns in the incidence of cardiovascular disease. For example, the onset of non-Qwave angina, unstable angina, myocardial infarctions (MIs), and sudden cardiac death all show marked elevations in the occurrence between the hours of 6:00 AM and 12:00 PM, compared with any other time of day (27,44). A better understanding of the function of circadian genes in the heart and in response to injury may lead to innovative therapies for cardiovascular disease (9,29,46).…”

“…However, all of these genes function essentially as reciprocally controlling transcription factors, and in many cases the expression of these genes is monitored by the modulation of many "noncircadian" proteins as readouts. Enzymes regulating cardiac metabolism (57), reactivity of vascular endothelial cells (22,50,54), modulation of inflammatory responses (3,27,33,34,44), bone marrow progenitor cell release (2), and apoptosis (25) all have circadian gene components of control, and all are associated with the myocardial response to coronary artery occlusion. However, the specific relationship between a circadian gene and the inflammatory response and injury associated with early MI has not been determined.…”