Evaluation of clinical factors involved in onset of myocardial infarction.

Sumiyoshi, Tetsuya; Haze, Kazuo; Saito, Muneyasu; Fukami, Kenichi; Goto, Yoichi; Hiramori, Katsuhiko

doi:10.1253/jcj.50.164

Cited by 50 publications

(19 citation statements)

References 14 publications

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“…More recently, however, in 1985 the Multicenter Investigation of the Limitation of Infarct Size (MILIS) study group, using mod ern epidemiologic methods, documented in creased rates of myocardial infarction onset in the morning hours [3], This finding, com bined with a new understanding of the patho genesis of myocardial infarction, has renewed interest into the investigation of triggering. Following the MILIS group report, Sumiyoshi et al [4] reported that 53% of 416 patients without prior angina admitted with infarction to the National Heart Center of Japan from 1977 to 1985 reported their infarct began dur ing moderate-to-heavy exercise, emotional stress or excitement [4], This rate was similar to the MILIS group finding that 48.5% re ported a possible trigger.…”

Section: History Of the Triggering Conceptmentioning

confidence: 85%

Circadian Variation and Triggers of Cardiovascular Disease

Muller

Mangel²

1994

Cardiology

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It has recently been shown that approximately 90% of cases of non-fatal myocardial infarction and many cases of sudden cardiac death are caused by disruption of a coronary atherosclerotic plaque, followed by occlusive thrombus formation. Secondly, the circadian pattern of myocardial infarction is well known to feature a prominent increase in the morning hours. Taken together, these factors may provide an opportunity to reduce deaths caused by cardiovascular disease. Findings indicate that, in many cases, plaque disruption and thrombus formation are triggered by the activities of the patient. It is postulated that onset occurs when a ‘vulnerable’ atherosclerotic plaque becomes disrupted and occlusive thrombus formation occurs. The occurrence of a myocardial infarction in the morning hours could result from the synchronization of a number of potential triggers. The importance of the recognition of the circadian variation of acute onset of myocardial infarction is that pharmacologic protection can be directed at the early waking hours. It would seem reasonable to propose that long-acting anti-ischemic agents would have an advantage over short-acting agents in providing protection against the morning occurrence of myocardial infarction. A future goal would be to design therapeutic regimens that would have the ability to sever the linkage between a potential triggering activity and the development of myocardial infarction.

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Section: History Of the Triggering Conceptmentioning

confidence: 85%

Circadian Variation and Triggers of Cardiovascular Disease

Muller

Mangel²

1994

Cardiology

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“…The activities most commonly reported were emotional upset (18%), moderate physical activity (14%), heavy physical activity (9%), lack of sleep (8%), and overeating (7%). This and other similar analyses 28 are limited by a lack of control data, because exposure to potential triggers is common, yet MI occurs rarely. To address this and other limitations in the study of triggering, Maclure and Mittleman developed the case-crossover study design, initially for the National Institutes of Health-sponsored Determinants of Onset of Myocardial Infarction Study (ONSET study).…”

Section: Evidence For Triggering Of Acute Cvdmentioning

confidence: 95%

Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies

2006

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“…INTERHEART includes large numbers of individuals from all regions of the world and multiple ethnicities, making the results broadly applicable, unlike previous studies of potential triggers that were performed primarily in 1 country or region. 9,16,[18][19][20][21]39,[43][44][45][46][47] IN-TERHEART also includes only participants with first AMI, thereby reducing the possibility that altered lifestyles or risk factors resulting from previous AMI would affect our estimates. In addition, sensitivity analyses including the controls from INTERHEART using multivariable-adjusted conditional logistic regression yielded similar associations.…”

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confidence: 99%

Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction

et al. 2016

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On behalf of the INTER-HEART InvestigatorsOriginal research article BACKGROUND: Physical exertion, anger, and emotional upset are reported to trigger acute myocardial infarction (AMI). In the INTERHEART study, we explored the triggering association of acute physical activity and anger or emotional upset with AMI to quantify the importance of these potential triggers in a large, international population. METHODS:INTERHEART was a case-control study of first AMI in 52 countries. In this analysis, we included only cases of AMI and used a casecrossover approach to estimate odds ratios for AMI occurring within 1 hour of triggers. RESULTS:Of 12 461 cases of AMI 13.6% (n=1650) engaged in physical activity and 14.4% (n=1752) were angry or emotionally upset in the case period (1 hour before symptom onset). Physical activity in the case period was associated with increased odds of AMI (odds ratio, 2.31; 99% confidence interval [CI], 1.96-2.72) with a population-attributable risk of 7.7% (99% CI,). Anger or emotional upset in the case period was associated with an increased odds of AMI (odds ratio, 2.44; 99% CI, 2.06-2.89) with a population-attributable risk of 8.5% (99% CI, 7.0-9.6). There was no effect modification by geographical region, prior cardiovascular disease, cardiovascular risk factor burden, cardiovascular prevention medications, or time of day or day of onset of AMI. Both physical activity and anger or emotional upset in the case period were associated with a further increase in the odds of AMI (odds ratio, 3.05; 99% CI, 2.29-4.07; P for interaction <0.001).CONCLUSIONS: Physical exertion and anger or emotional upset are triggers associated with first AMI in all regions of the world, in men and women, and in all age groups, with no significant effect modifiers. 1 The INTERHEART study reported that >90% of the risk of myocardial infarction was attributable to long-term exposure to 9 risk factors.2 Most longterm exposures (eg, lipids, obesity) are mediated through an intermediate phenotype (atherosclerotic change) rather than trigger acute rupture of atherosclerotic plaque, precipitating an acute myocardial infarction (AMI). Observational studies identified potential external triggers for AMI, including physical exertion and anger or emotional upset.3,4 However, with few exceptions, the included studies had small sample sizes (n<2000) and were completed primarily in 1 country or geographical region (predominantly Western countries). As with long-term exposure to cardiovascular risk factors, the prevalence of potential triggers of AMI may also vary by geographical region; triggers important in 1 region or ethnic group may be different in others. Large, international studies using standardized methodology are required to determine whether there are variations in the importance of triggering risk factors and to determine other factors that may modify the association. The INTERHEART study provides an opportunity to study the association between these potential external triggers of AMI and effect modifiers in a large,...

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Evaluation of clinical factors involved in onset of myocardial infarction.

Cited by 50 publications

References 14 publications

Circadian Variation and Triggers of Cardiovascular Disease

Circadian Variation and Triggers of Cardiovascular Disease

Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies

Physical Activity and Anger or Emotional Upset as Triggers of Acute Myocardial Infarction

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