Circadian variation and triggers of acute coronary syndromes
S N Willich1, S Klatt, H R Arntz
1Institute for Social Medicine and Epidemiology, Klinikum Chartié, Humboldt University of Berlin, Germany.
Insights
Sudden cardiac death and myocardial infarction risk increases in the morning. External triggers like physical exertion or anger can significantly increase the risk of acute coronary syndromes.
Area of Science:
- Cardiology
- Epidemiology
- Environmental Health
Background:
- Myocardial infarction and sudden cardiac death exhibit significant circadian variation, with a notable increase in risk during morning hours.
- While morning activities are often implicated, coronary events occur throughout the day, albeit less frequently.
Purpose of the Study:
- To investigate the association between external triggers and the onset of myocardial infarction and sudden cardiac death.
- To explore the potential role of various triggers in the development of acute coronary syndromes.
Main Methods:
- Review of existing literature on circadian variation in cardiovascular events.
- Analysis of the association between reported triggers and the incidence of myocardial infarction and sudden cardiac death.
- Evaluation of the magnitude of risk associated with identified triggers.
Main Results:
- A strong association exists between external triggers and the onset of myocardial infarction and sudden cardiac death, with a relative risk of two- to threefold.
- Trigger factors are frequent and may contribute causally to up to 20% of acute coronary syndromes.
- Proven triggers include physical exertion, anger, and sexual activity, alongside environmental factors like climatic changes.
Conclusions:
- External triggers play a significant role in the onset of acute coronary syndromes, comparable in magnitude to established long-term risk factors.
- Understanding the pathophysiological links between triggers and coronary events is crucial for improving preventive strategies.
- Further research into causal relationships can enhance preventative measures for cardiovascular disease.
Abstract:
Myocardial infarction and sudden cardiac death demonstrate a marked circadian variation with an increased risk during the morning after awakening and arising. The recognition of the morning increase of acute coronary heart disease has convinced many that morning activities can 'trigger' its onset. It is of note, however, that coronary events may occur throughout the day--even if at lower frequency compared with the morning. There is a strong association between external triggers and onset of myocardial infarction and sudden cardiac death beyond that expected by chance alone. The magnitude of this association (relative risk two- to threefold) is comparable to that of other known long term risk factors of cardiac disease. Trigger factors occur relatively frequently and may play a causative role in up to 20% of cases of acute coronary syndromes. Physical exertion, burst of anger and sexual activity have been proven to have triggering potential. Other possible triggers include external and environmental events such as earthquakes, war threat and climatic factors. The pathophysiological links between external triggers and onset of coronary syndromes are important in addressing the question of a causal relationship between triggers and disease onset and, perhaps, in improving preventive strategies.
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