Circadian variations in cardiac disease: clinical implications. Current strategies for preventing MI, dysrhythmias,

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G P Lundberg1, P R Liebson, J E Calvin

  • 1Piedmont Hospital, Atlanta, Georgia, USA.

The Journal of Critical Illness
|September 5, 1995
PubMed

Insights

Cardiovascular events like myocardial infarction (MI) and sudden cardiac death (SCD) peak in the morning. Medications such as beta-blockers and aspirin may help reduce these morning occurrences.

Area of Science:

  • Cardiology
  • Chronobiology
  • Pharmacology

Background:

  • Myocardial infarction (MI), ischemia, ventricular dysrhythmias, and sudden cardiac death (SCD) predominantly occur in the morning hours post-awakening.
  • Physiological changes like increased heart rate, blood pressure, and platelet aggregability, alongside decreased fibrinolytic activity, are implicated in this morning predilection.

Purpose of the Study:

  • To investigate the temporal patterns of cardiovascular events and the potential impact of pharmacological interventions on these diurnal variations.

Main Methods:

  • Review of existing literature on the diurnal variation of cardiovascular events.
  • Analysis of the effects of beta-blockers, calcium channel blockers, and aspirin on the timing and occurrence of MI, ischemia, and SCD.

Main Results:

  • A morning peak incidence for MI, myocardial ischemia, ventricular dysrhythmias, and SCD was observed.
  • Beta-blockers demonstrated potential in blunting the peak occurrence of MI, SCD, and ischemia.
  • Alternate-day aspirin therapy (325 mg) was shown to reduce the morning onset of MI.
  • Calcium channel blockers may influence the pattern of ischemia, and thrombolytic efficacy might be affected by daily fibrinolytic activity fluctuations.

Conclusions:

  • Cardiovascular events exhibit a significant diurnal variation with a morning peak.
  • Pharmacological agents, including beta-blockers and aspirin, can modulate the timing and incidence of these events, suggesting a role for chronotherapy in cardiovascular medicine.

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