"Summer Shift": A Potential Effect of Sunshine on the Time Onset of ST-Elevation Acute Myocardial Infarction
Carlo Vittorio Cannistraci1,2, Tuomo Nieminen3,4, Masahiro Nishi5
1Biomedical Cybernetics Group, Biotechnology Center (BIOTEC), Center for Molecular and Cellular Bioengineering (CMCB), Center for Systems Biology Dresden (CSBD), Department of Physics, Technische Universität Dresden, Dresden, Germany kalokagathos.agon@gmail.com enrico.ammirati@ospedaleniguarda.it.
Insights
The circadian rhythm of ST-elevation myocardial infarction (STEMI) onset shifts in summer, with fewer cases occurring during the day. Sunshine duration appears to influence this seasonal change in STEMI timing.
Area of Science:
- Cardiovascular Epidemiology
- Chronobiology
- Environmental Health
Background:
- ST-elevation acute myocardial infarction (STEMI) is a major cause of mortality.
- STEMI exhibits circadian and seasonal patterns, with peaks in winter and reduced incidence in summer.
- Previous research explored winter STEMI peaks but not seasonal alterations in circadian rhythm.
Purpose of the Study:
- To investigate if the circadian variation of STEMI onset is modified during the summer season.
- To analyze the relationship between seasonal patterns and STEMI occurrence timing.
Main Methods:
- Conducted a multiethnic, multinational epidemiological study of 2270 STEMI cases from both hemispheres.
- Analyzed STEMI onset times to compare diurnal (6:00-18:00) and nocturnal (18:00-6:00) occurrences.
- Correlated STEMI timing with sunshine duration and other environmental factors.
Main Results:
- The difference between diurnal and nocturnal STEMI cases significantly decreased in summer.
- STEMI onset exhibits a season-dependent circadian rhythm, with a notable 'summer shift' towards nocturnal events.
- Sunshine duration was identified as a key factor influencing this seasonal circadian perturbation.
Conclusions:
- The circadian rhythm of STEMI onset is season-dependent, particularly altered during summer.
- Sunshine duration, a proxy for solar irradiance, underpins the observed seasonal shift in STEMI timing.
- Further research should explore the roles of sunshine duration and Vitamin D in STEMI pathogenesis.
Background:
ST-elevation acute myocardial infarction (STEMI) represents one of the leading causes of death. The time of STEMI onset has a circadian rhythm with a peak during diurnal hours, and the occurrence of STEMI follows a seasonal pattern with a salient peak of cases in the winter months and a marked reduction of cases in the summer months. Scholars investigated the reason behind the winter peak, suggesting that environmental and climatic factors concur in STEMI pathogenesis, but no studies have investigated whether the circadian rhythm is modified with the seasonal pattern, in particular during the summer reduction in STEMI occurrence.
Methods And Results:
Here, we provide a multiethnic and multination epidemiological study (from both hemispheres at different latitudes, n=2270 cases) that investigates whether the circadian variation of STEMI onset is altered in the summer season. The main finding is that the difference between numbers of diurnal (6:00 to 18:00) and nocturnal (18:00 to 6:00) STEMI is markedly decreased in the summer season, and this is a prodrome of a complex mechanism according to which the circadian rhythm of STEMI time onset seems season dependent.
Conclusions:
The "summer shift" of STEMI to the nocturnal interval is consistent across different populations, and the sunshine duration (a measure related to cloudiness and solar irradiance) underpins this season-dependent circadian perturbation. Vitamin D, which in our results seems correlated with this summer shift, is also primarily regulated by the sunshine duration, and future studies should investigate their joint role in the mechanisms of STEMI etiogenesis.
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