Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Morning and Monday: critical periods for the onset of acute myocardial infaction
The GISSI 2 Study Experience
*Servizio di Cardiologia, Ospedale S. Leopoldo Mandic Merate (CO)
Divisione di Cardiologia e Medicina Interna II, Ospedale ‘L.Sacco’ Milano
Istituto di Ricerche Farmacologiche ‘Mario Negri’ Milano, Italy
Received 21 June 1993; revised 9 March 1994; .
Correspondence: Tomato Gnecchi-Ruscone, MD, Medicina Interna II, Ospedale ‘L.Sacco’, Via G.B. Grassi 74, 20157 Milano, Italy.
Abstract
The onset of acute myocardial infarction (AMI) is unevenly distributed over the 24 h and the week. While presence of a morning peak is generally agreed upon, contrasting results had been obtained regarding other periods of the day, probably due to differences of origin, size and composition of the populations.
The 24 h and weekly distributions were studied within 6 h from the beginning of the symptoms in a population following a Latin life-style, who were enrolled in the GISSI2 Study (n=11472). Subgroups (smokers, the elderly (>65 years), diabetics, hypertensives) were also considered. Six hour periods starting at midnight were tested for uniformity. Circadian non-uniformity was found. Events increased in the morning hours and reduced during the night regardless of the day of the week. The night and day difference was attenuated in smokers and diabetics. Non-uniformity of the events was also found among the days of the week. AMI significantly increased in non-smokers on Monday.
We suggest that there is a night-day gradient (characterized by the short time interval between the two frequency extremes) in the time of onset of AMI. The different distribution in smokers stresses the possible unfavourable and masking effect of a heightened sympathetic tone during the day while the general protective role of the night hours is preserved. Moreover, the increased incidence of events on Monday may suggest the importance of the shift from a period of non-scheduled to scheduled activity.
Key Words: Circadian variation • week distribution • acute myocardial infarction • smokers • diabetics
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. H. Tofler and J. E. Muller Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies Circulation, October 24, 2006; 114(17): 1863 - 1872. [Full Text] [PDF]
|
|
|
|
 |
|
 A. G Barnett and A. J Dobson Excess in cardiovascular events on Mondays: a meta-analysis and prospective study J Epidemiol Community Health, February 1, 2005; 59(2): 109 - 114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Jakovljevic and on behalf of the FINSTROKE Register Group Day of the Week and Ischemic Stroke: Is It Monday High or Sunday Low? Stroke, September 1, 2004; 35(9): 2089 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Kinjo, H Sato, H Sato, I Shiotani, T Kurotobi, Y Ohnishi, E Hishida, D Nakatani, H Mizuno, Y Yamada, et al. Variation during the week in the incidence of acute myocardial infarction: increased risk for Japanese women on Saturdays Heart, April 1, 2003; 89(4): 398 - 403. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. H. Mehta, R. Manfredini, F. Hassan, U. Sechtem, E. Bossone, J. K. Oh, J. V. Cooper, D. E. Smith, F. Portaluppi, M. Penn, et al. Chronobiological Patterns of Acute Aortic Dissection Circulation, August 27, 2002; 106(9): 1110 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Chenet, A. Britton, R. Kalediene, and J. Petrauskiene Daily variations in deaths in Lithuania: the possible contribution of binge drinking Int. J. Epidemiol., August 1, 2001; 30(4): 743 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Martyn Hebdomadal rhythms of the heart BMJ, December 23, 2000; 321(7276): 1542 - 1543. [Full Text]
|
|
|
|
 |
|
 H.-R Arntz, S.N Willich, C Schreiber, T Bruggemann, R Stern, and H.-P Schultheiss Diurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24061 consecutive cases Eur. Heart J., February 2, 2000; 21(4): 315 - 320. [Abstract] [PDF]
|
|
|
|
 |
|
 R. Rabbani and E. J. Topol Strategies to achieve coronary arterial plaque stabilization Cardiovasc Res, February 1, 1999; 41(2): 402 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K Shah Role of inflammation and metalloproteinases in plaque disruption and thrombosis Vascular Medicine, August 1, 1998; 3(3): 199 - 206. [Abstract] [PDF]
|
|
|
|
|
|
C. E. Lavery, M. A. Mittleman, M. C. Cohen, J. E. Muller, and R. L. Verrier Nonuniform Nighttime Distribution of Acute Cardiac Events : A Possible Effect of Sleep States Circulation, November 18, 1997; 96(10): 3321 - 3327. [Abstract] [Full Text]
|
|
|
|
|
|
R. W. Peters, S. McQuillan, S. K. Resnick, and M. R. Gold Increased Monday Incidence of Life-Threatening Ventricular Arrhythmias: Experience With a Third-Generation Implantable Defibrillator Circulation, September 15, 1996; 94(6): 1346 - 1349. [Abstract] [Full Text]
|
|
|
|
|
|
E. Falk, P. K. Shah, and V. Fuster Coronary Plaque Disruption Circulation, August 1, 1995; 92(3): 657 - 671. [Full Text]
|
|