Circadian variation in the onset of unstable angina and non-Q-wave acute myocardial infarction (the TIMI III Registry and TIMI IIIB)
Abstract
Circadian variation has been demonstrated in several types of acute cardiovascular disease, including acute myocardial infarction (AMI), sudden cardiac death, silent ambulatory ischemia, and thrombotic stroke. In contrast, no diurnal variation was observed in 1 study of non-Q-wave AMI, and limited data are available for unstable angina. To assess whether circadian variation is present in unstable angina and non-Q-wave AMI, we examined the time of onset of ischemic pain in 7,731 patients who were prospectively identified in the Thrombolysis in Myocardial Ischemia (TIMI) III Registry, 3,318 of whom were enrolled in the prospective study, and in 1,473 patients enrolled in the TIMI IIIB trial. A circadian variation in the onset of pain was observed, with an increase in the number of patients experiencing the onset of pain in the morning hours between 6 A.M. and 12 noon (p <0.001). This circadian variation was observed both in patients with unstable angina and in those with evolving non-Q-wave AMI. A similar circadian pattern was observed in all subgroups tested. These findings were confirmed in the TIMI IIIB trial and complement previous studies suggesting that circadian variation exists in the onset of the full spectrum of myocardial ischemic syndromes.
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Adverse cardiovascular events peak in the morning, between approximately 6 AM and noon.
“Epidemiological studies show that adverse cardiovascular events peak in the morning (i.e., between 6 AM and noon)”
From The impact of the circadian timing system on cardiovascular and metabolic function (2012) · cites this paper as Cannon et al., 1997
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- Authors
- Cannon, C. P., McCabe, C. H., Stone, P. H., Schactman, M., Thompson, B., Theroux, P., Gibson, R. S., Feldman, T., Kleiman, N. S., Tofler, G. H., Muller, J. E., Chaitman, B. R., & Braunwald, E.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Cannon, Christopher P.
- ORCID
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1997-02
- Volume
- 79
- Issue
- 3
- Pages
- 253-258
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W1979609806
- Cited by
- 122
- References
- 29
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 5 · 2018: 2 · 2017: 8 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 2 · 2012: 5
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl042311-03, 5r01hl042428-04, 1r01hl042419-01)
- National Heart, Lung, and Blood Institute (R01 HL 42419, R01-HL42311, R01-HL-42428)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Keywords
- circadian variation, unstable angina, diurnal variation, myocardial ischemia, thrombolysis
- MeSH terms
- Aged, Angina, Unstable, Circadian Rhythm, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Infarction, Prospective Studies, Registries, Thrombolytic Therapy
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