Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes
Osamu Kurihara1, Masamichi Takano2, Erika Yamamoto1
1Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.
Insights
Seasonal variations in acute coronary syndromes (ACS) show distinct underlying causes. Plaque rupture is more common in winter, while plaque erosion is more frequent in summer, suggesting season-specific treatment approaches.
Area of Science:
- Cardiology
- Pathophysiology
- Public Health
Background:
- Seasonal variations in acute coronary syndromes (ACS) incidence and mortality, particularly peaks in winter, have been observed.
- The underlying pathophysiology driving these seasonal differences in ACS remains largely speculative.
- Understanding these variations is crucial for developing targeted prevention and treatment strategies.
Purpose of the Study:
- To investigate the seasonal differences in the prevalence of major acute coronary syndrome (ACS) pathologies.
- To compare the frequency of plaque rupture, plaque erosion, and calcified plaque across the four seasons.
- To identify potential links between seasonal variations and specific ACS underlying mechanisms.
Main Methods:
- A multinational study involving 1113 patients with ACS from 6 countries who underwent optical coherence tomography.
- Comparison of the prevalence of plaque rupture, plaque erosion, and calcified plaque between spring, summer, autumn, and winter.
- Statistical analysis, including logistic regression, adjusted for age, sex, and coronary risk factors.
Main Results:
- Overall prevalence of plaque rupture, erosion, and calcified plaque varied significantly by season (P=0.039).
- Winter was significantly associated with an increased risk of plaque rupture (OR, 1.652) and a decreased risk of plaque erosion (OR, 0.623) compared to summer.
- Hypertension was more prevalent in patients with plaque rupture during winter.
Conclusions:
- Seasonal variations in ACS incidence are linked to distinct underlying pathobiology.
- Plaque rupture is most prevalent in winter, whereas plaque erosion is most common in summer.
- Tailored prevention and treatment strategies for ACS may be necessary depending on the season of occurrence.
Abstract:
Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (P=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (P=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
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