Bmc Cardiovascular Disorders Circadian Analysis of Myocardial Infarction Incidence in an Argentine and Uruguayan Population

BackgroundThe occurrence of variations in the spectrum of cardiovascular disease between different regions of the world and ethnic groups have been the subject of great interest. This study report the 24-h variation of myocardial infarction (MI) occurrence in patients recruited from CCU located in Argentina and Uruguay.MethodsA cohort of 1063 patients admitted to the CCU within 24 h of the onset of symptoms of an acute MI was examined. MI incidence along the day was computed in 1 h-intervals.ResultsA minimal MI incidence between 03:00 and 07:00 h and the occurrence of a first maximum between 08:00 and 12:00 h and a second maximum between 15:00 and 22:00 h were verified. The best fit curve was a 24 h cosinor (acrophase ~ 19:00 h, accounting for 63 % of variance) together with a symmetrical gaussian bell (maximum at ~ 10:00 h, accounting for 37 % of variance). A similar picture was observed for MI frequencies among different excluding subgroups (older or younger than 70 years; with or without previous symptoms; diabetics or non diabetics; Q wave- or non-Q wave-type MI; anterior or inferior MI location). Proportion between cosinor and gaussian probabilities was maintained among most subgroups except for older patients who had more MI at the afternoon and patients with previous symptoms who were equally distributed among the morning and afternoon maxima.ConclusionThe results support the existence of two maxima (at morning and afternoon hours) in MI incidence in the Argentine and Uruguayan population.

[1]  Steven A. Brown,et al.  The mammalian circadian timing system: from gene expression to physiology , 2004, Chromosoma.

[2]  A. Rebuzzi,et al.  Circadian variation of ventricular tachycardia in acute myocardial infarction. , 1988, The American journal of cardiology.

[3]  Carlos E. D'Negri,et al.  Circadian periodicity of heart rate variability in hospitalized angor patients , 2005, Clinical Autonomic Research.

[4]  G. Stergiou,et al.  Parallel Morning and Evening Surge in Stroke Onset, Blood Pressure, and Physical Activity , 2002, Stroke.

[5]  E. Gilpin,et al.  Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. , 1989, Circulation.

[6]  A. Jovicic,et al.  Circadian variations of platelet aggregability and fibrinolytic activity in healthy subjects. , 1991, Thrombosis research.

[7]  F. Portaluppi,et al.  Circadian variation in spontaneous rupture of abdominal aorta , 1999, The Lancet.

[8]  R. Mehta,et al.  Influence of circadian rhythm on mortality after myocardial infarction: data from a prospective cohort of emergency calls. , 2004, The American journal of emergency medicine.

[9]  E. Granieri,et al.  Patient demographic and clinical features and circadian variation in onset of ischemic stroke. , 2002, Archives of neurology.

[10]  K. Chia,et al.  Ethnic differences in acute myocardial infarction in Singapore. , 2003, European heart journal.

[11]  K. Chia,et al.  Ethnic variations in female vulnerability after an acute coronary event , 2004, Heart.

[12]  J. Stessman,et al.  The siesta in the elderly: risk factor for mortality? , 1999, Archives of internal medicine.

[13]  A. Quyyumi,et al.  Circadian Variation in Ischemic Threshold: A Mechanism Underlying the Circadian Variation in Ischemic Events , 1992, Circulation.

[14]  M. Elizari,et al.  Morbidity and mortality following early administration of amiodarone in acute myocardial infarction. GEMICA study investigators, GEMA Group, Buenos Aires, Argentina. Grupo de Estudios Multicéntricos en Argentina. , 2000, European heart journal.

[15]  F. Portaluppi,et al.  Circadian variation in the onset of acute critical limb ischemia. , 1998, Thrombosis research.

[16]  C. Pepine Circadian variations in myocardial ischemia. Implications for management. , 1991, JAMA.

[17]  P. Pepe,et al.  Prospective evidence of a circadian rhythm for out-of-hospital cardiac arrests. , 1992, JAMA.

[18]  Mylan C. Cohen,et al.  Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death. , 1997, The American journal of cardiology.

[19]  M. Bursztyn,et al.  The siesta and ambulatory blood pressure: is waking up the same in the morning and afternoon? , 1996, Journal of human hypertension.

[20]  R. Peters,et al.  Identification of a secondary peak in myocardial infarction onset 11 to 12 hours after awakening: the Cardiac Arrhythmia Suppression Trial (CAST) experience. , 1993, Journal of the American College of Cardiology.

[21]  A. B. Reddy,et al.  A clockwork web: circadian timing in brain and periphery, in health and disease , 2003, Nature Reviews Neuroscience.

[22]  W. Frishman,et al.  Gender, ethnicity, and genes in cardiovascular disease. Part 2: implications for pharmacotherapy. , 2003, Heart disease.

[23]  B. T. Engel,et al.  Morning increase in whole blood viscosity: a consequence of a homeostatic nocturnal haemodynamic pattern. , 1993, Acta Physiologica Scandinavica.

[24]  W. Frishman,et al.  Gender, ethnicity and genetics in cardiovascular disease: part 1: Basic principles. , 2003, Heart disease.

[25]  G. Lip,et al.  Are there ethnic differences in the circadian variation in onset of acute myocardial infarction? A comparison of 3 ethnic groups in Birmingham, UK and Alicante, Spain. , 2005, International journal of cardiology.

[26]  Rosemary Stewart,et al.  Implications for Management , 1971 .

[27]  G. Tofler,et al.  Diurnal physiologic processes and circadian variation of acute myocardial infarction. , 1995, Journal of cardiovascular risk.

[28]  S. Willich,et al.  Increased onset of sudden cardiac death in the first three hours after awakening. , 1992, The American journal of cardiology.

[29]  S. Pell,et al.  ACUTE MYOCARDIAL INFARCTION IN A LARGE INDUSTRIAL POPULATION: REPORT OF A 6-YEAR STUDY OF 1,356 CASES. , 1963, JAMA.

[30]  S. Yusuf,et al.  Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE) , 2000, The Lancet.

[31]  S. Willich,et al.  Circadian variation in the frequency of sudden cardiac death. , 1987, Circulation.

[32]  A. Negassa,et al.  INTER-HEART: A global study of risk factors for acute myocardial infarction. , 2001, American heart journal.

[33]  U. Goldbourt,et al.  Circadian variation and possible external triggers of onset of myocardial infarction. SPRINT Study Group. , 1993, The American journal of medicine.

[34]  M. Elizari,et al.  Morbidity and mortality following early administration of amiodarone in acute myocardial infarction , 2000 .

[35]  S. Willich,et al.  Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade. ISAM Study Group. , 1989, Circulation.

[36]  J. Manson,et al.  Circadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians. , 1990, Circulation.

[37]  E. Granieri,et al.  Circadian variability in hemorrhagic stroke. , 2002, JAMA.

[38]  D. Levy,et al.  Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. , 1987, The American journal of cardiology.

[39]  Ethnic differences in utilization of invasive cardiac procedures and in long‐term survival following acute myocardial infarction , 2004, Clinical cardiology.

[40]  F. Calzolari,et al.  Circadian and circannual rhythmicity in the occurrence of subarachnoid hemorrhage. , 1996, Stroke.

[41]  F. Violi,et al.  Circadian variation in the frequency of ischemic stroke. , 1990, Stroke.

[42]  V. Fuster,et al.  Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. , 1985, Journal of the American College of Cardiology.

[43]  E. Braunwald,et al.  Circadian variation in the frequency of onset of acute myocardial infarction. , 1985, The New England journal of medicine.