Morning increase of onset of myocardial infarction. Implications concerning triggering events
1Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115.
Insights
Acute myocardial infarction and related cardiovascular events show a notable morning increase. This highlights the need for morning pharmacologic protection and understanding patient activities in triggering coronary thrombosis.
Area of Science:
- Cardiology
- Circadian Rhythms
- Thrombosis
Background:
- Established evidence shows a prominent morning increase in acute myocardial infarction (AMI) onset.
- Similar morning peaks are observed for sudden cardiac death, stroke, and transient myocardial ischemia.
- Physiologic changes in the morning, including increased arterial pressure, coronary tone, and platelet aggregability, may contribute to coronary thrombosis.
Purpose of the Study:
- To emphasize the importance of morning pharmacologic protection for patients at risk.
- To explore the concept that patient activities may trigger coronary thrombosis onset throughout the day.
- To facilitate the design of more effective preventive therapies for cardiovascular disease.
Main Methods:
- Review of established scientific literature on the timing of cardiovascular events.
- Analysis of physiological changes occurring in the morning hours.
- Conceptual framework development linking patient activities to thrombosis onset.
Main Results:
- Consistent observation of increased frequency of AMI, sudden cardiac death, stroke, and transient myocardial ischemia in the morning hours (6 a.m. to noon).
- Identification of intensified physiological processes during this period, including elevated arterial pressure, coronary tone, and platelet aggregability.
- Recognition that daily patient activities may be triggers for coronary thrombosis.
Conclusions:
- Pharmacologic interventions should prioritize morning hours for patients susceptible to cardiovascular events.
- Understanding the role of patient activities in triggering coronary thrombosis is crucial for long-term prevention.
- Further investigation into activity-related triggers can improve therapeutic strategies for cardiovascular disease onset.
Abstract:
During the past 5 years it has been clearly established that there is a prominent morning increase in the frequency of onset of acute myocardial infarction. Similar increases have also been observed for the related conditions of sudden cardiac death, stroke and episodes of transient myocardial ischemia. The period from 6 a.m. to noon is also a time when a number of physiologic processes that could contribute to the onset of coronary thrombosis are intensified. Arterial pressure, which could lead to plaque rupture, rises; coronary tone increases; and platelet aggregability, which could contribute to a hypercoagulable state, increases. The immediate significance of these observations is the emphasis that should be placed on pharmacologic protection of patients during the morning hours. The primary longer-term significance of the recognition of the morning increase of onset of acute cardiovascular disease is the contribution it makes to the concept that onset of coronary thrombosis at any time of the day is frequently triggered by the activities of the patient. Investigation of this possibility may yield more information about the mechanism of disease onset and facilitate design of more effective preventive therapy.
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