Circadian, day-of-week, and seasonal variability in myocardial infarction: Comparison between working and retired patients

doi:10.1016/S0002-8703(96)90241-0

American Heart Journal

Volume 132, Issue 3, September 1996, Pages 579-585

https://doi.org/10.1016/S0002-8703(96)90241-0 Get rights and content

Abstract

The circadian, day-of-week, and seasonal distributions of acute myocardial infarction and its association with the patients' working status were analyzed in a regionally defined population (n = 103,322) monitored from 1980 to 1988. Included were 2906 consecutive patients (1746 [60.1%] men and 1160 [39.9%] women; mean age 67.8 years) with confirmed diagnosis (by standardized diagnostic criteria in hospitalized patients and autopsy results in out-of-hospital deaths). The time of myocardial infarction on the basis of onset of symptoms was known in 1901 cases. Myocardial infarction occurred more frequently (p < 0.05) during the morning from 7:00 to 10:00 am, on Mondays, and during the winter from January to March compared with other times of day, days of the week, and seasons. Compared with retired patients, working patients (32%) had a second circadian peak, in the afternoon at 4:00 pm (p < 0.05), and a trend toward an additional seasonal peak in September (p value not significant), whereas the day-of-week pattern was similar in the two subgroups. The occurrence of myocardial infarction demonstrates marked circadian, day-of-week, and seasonal variations, with some differences between working and retired patients. Further investigation of possible triggering events may aid in identifying underlaying mechanisms and perhaps in improving prevention of the disease.

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Light, temperature, humidity, and atmospheric pressure may all impact significantly on neurobiology, hormone physiology and cardiovascular functions [6]. Accordingly, seasonal and circadian changes in the incidence and severity of cardiovascular disease have been reported for several conditions such as angina, pulmonary thromboembolism, aneurysmal rupture, and sudden cardiac death [4,7–9]. Most studies reported so far on the association between coronary atherothrombosis and climate have highlighted a J- or U-shaped association, with increased risk for temperatures which are too high or too low, whereas limited and conflicting data are available for humidity, pressure and rainfall [4,7,10–14].
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Climate has a significant impact on the risk of PPCI in the current era, with a complex interplay according to season. Higher risk risk is expected with lower minimum atmospheric pressure in the preceding days, lower rainfall in Winter, greater changes in atmospheric pressure in Spring, and higher temperatures in Summer. These findings have important implications for prevention strategies.
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Clinical investigationCircadian, day-of-week, and seasonal variability in myocardial infarction: Comparison between working and retired patients

Abstract

Int J Cardiol

Am J Cardiol

Am J Cardiol

Lancet

Fibrinolysis

Lancet

Lancet

Lancet

Lancet

Circadian variation in the frequency of onset of acute myocardial infarction

N Engl J Med

Circadian variation in myocardial infarction

N Engl J Med

Increased morning incidence of myocardial infarction in the ISAM study: absence with prior beta-adrenergic blockade

Circulation

Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction

Circulation

Morning peak in the incidence of myocardial infarction: experience in the ISIS-2 trial

Eur Heart J

Morning and Monday: critical periods for the onset of acute myocardial infarction—the GISSI 2 study experience

Eur Heart J

Register ostrowo infarkta myokarda w Wologde

Kardiologija

Daily and seasonal variation in sudden cardiac death, Rochester, Minnesota, 1950–1975

Mayo Clin Proc

Myocardial infarction on various days of the week

Psychol Med

Weekly variation of acute myocardial infarction: increased Monday risk in the working population

Circulation

Seasonal, regional and secular variations of cardiovascular and cerebrovascular mortality in New Zealand

Aust N Z J Med

Clinical investigation
Circadian, day-of-week, and seasonal variability in myocardial infarction: Comparison between working and retired patients