Circadian patterns of ST elevation myocardial infarction in the new millennium
Rajan Kanth1, Sunitha Ittaman, Shereif Rezkalla
1Department of Internal Medicine, Marshfield Clinic, Marshfield, WI 54449, USA.
Insights
Despite medical advances, ST elevation myocardial infarction (STEMI) still shows a morning peak. Beta-blockers and diabetes history abolish this circadian pattern in heart attack patients.
Area of Science:
- Cardiology
- Circadian Biology
- Public Health
Background:
- A circadian pattern of acute myocardial infarction (AMI) with an early morning peak was previously identified.
- Significant advancements in medical therapies and lifestyle changes have occurred over the past four decades.
Purpose of the Study:
- To investigate if the previously described circadian pattern of AMI has changed.
- To assess the influence of modern medical treatments and lifestyle factors on the timing of ST elevation myocardial infarction (STEMI).
Main Methods:
- Retrospective chart review of 519 patients diagnosed with STEMI over five years.
- Analysis of the time of symptom onset recorded over a 24-hour period.
- Examination of circadian patterns in relation to patient demographics, medical history, and medication use.
Main Results:
- A significant circadian pattern of STEMI occurrence was observed, with a peak around 11:30 AM.
- This pattern was highly significant in patients not using beta-blockers and without a history of diabetes.
- The pattern was attenuated in younger patients, females, and those using statins or aspirin; smokers experienced an earlier peak.
Conclusions:
- The circadian pattern of STEMI symptom onset persists despite medical and lifestyle changes.
- Beta-blocker use and a history of diabetes mellitus eliminate this morning peak.
- Medications, age, and gender attenuate but do not abolish the circadian pattern of STEMI.
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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