Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Morning peak in the incidence of myocardial infarction: experience in the ISIS-2 trial
ISIS-2 (SECOND INTERNATIONAL STUDY OF INFARCT SURVIVAL) COLLABORATIVE GROUPDepartment of Medicine, Klinikum Steglitz, Free University of Berlin, Germany and Clinical Trial Service Unit Radcliffe Infirmary, Oxford 0X2 6HE, U.K
accepted 6 March 1991.
Correspondence: Dr Stefan N. Willich, Department of Medicine, Klinikum Steglitz, Free University of Berlin, Hindenburgdamm 30, 1000 Berlin 45, Germany.
Abstract
To investigate the circadian pattern of acute myocardial infarction (MI) in a large international patient population, the time of day of the onset of symptoms was prospectively determined in 12 163 consecutive patients randomized in the ISIS-2 Trial (Second International Study of Infarct Survival). Overall, there was a marked circadian variation (P< 0.001) in the incidence of MI characterized by a sharp increase from 0600 h to 0800 h, with a peak period from 0800 hto 1100 h followed by a gradual decline from 1100 h to 1800 h. During the evening and night there was a steady trough, with no evidence of a second peak. Although there was some scatter, this circadian pattern was similar among patients of five different geographic regions on three continents and in various subcategories of patients defined with respect to age, gender, previous MI, and aspirin intake prior to MI. The circadian pattern of diabetics, however, was different compared with non-diabetics (P<0.005, adjusted < 0.01), and it demonstrated no significant variation. This increased morning incidence of MI indicates specific triggering mechanisms that are particularly likely to occur during, or just before, that time of day. Further investigation of physiological changes during the day is needed to identify any such triggers of MI and so perhaps to aid in improving preventive strategies of the disease.
Key Words: Myocardial infarction • circadian variation • diabetes • aspirin
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