CoChat
Sign Up
Cited by 1,884Acute Myocardial Infarction ResearchCircadian rhythm and melatoninCardiac Health and Mental Health

Circadian Variation in the Frequency of Onset of Acute Myocardial Infarction

Muller, James E., Stone, Peter H., Turi, Zoltan G., Rutherford, John D., Czeisler, Charles A., Parker, Corette, Poole, W. Kenneth, Passamani, Eugene +6 more·1985·New England Journal of Medicine
DOI 10.1056/nejm198511213132103
Open this paper in CoChat — free account

Abstract

To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain in 2999 patients admitted with myocardial infarction. A marked circadian rhythm in the frequency of onset was detected, with a peak from 6 a.m. to noon (P less than 0.01). In 703 of the patients, the time of the first elevation in the plasma creatine kinase MB (CK-MB) level could be used to time the onset of myocardial infarction objectively. CK-MB-estimated timing confirmed the existence of a circadian rhythm, with a three-fold increase in the frequency of onset of myocardial infarction at peak (9 a.m.) as compared with trough (11 p.m.) periods. The circadian rhythm was not detected in patients receiving beta-adrenergic blocking agents before myocardial infarction but was present in those not receiving such therapy. If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis. If the rhythmic processes that drive the circadian rhythm of myocardial-infarction onset can be identified, their modification may delay or prevent the occurrence of infarction.

Integrity signals

Registry

Crossref · 10.1056/nejm198511213132103

Cites

33 of 33 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Murray et al. found no significant increase in cardiac events in morning as compared with afternoon cardiac-rehabilitation classes, but the study had insufficient power to exclude a relative risk of 6 or less.

    “Murray et al.33 found no significant increase in cardiac events in morning as compared with afternoon cardiac-rehabilitation classes, but the study had insufficient power to exclude a relative risk of 6 or less and many patients were taking beta-blockers, which might decrease a morning peak in onset.34-36”

    From Triggering of Acute Myocardial Infarction by Heavy Physical Exertion -- Protection against Triggering by Regular Exertion (1993) · cites this paper as [35]

  • Epidemiological data reveal a robust morning increase in adverse cardiovascular events, including stroke, myocardial infarction, serious ventricular arrhythmias, and sudden cardiac death.

    “Moreover, epidemiological data reveal a robust morning increase in adverse CV events, including stroke (7,8), myocardial infarction (9)(10)(11), serious ventricular arrhythmias (12), and sudden cardiac death (refs.11, 13, and Figure 1).”

    From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [9]

  • Use of β-adrenoreceptor blockers reduces adverse cardiovascular events on an overall-population basis and abolishes the day/night pattern of such events.

    “Use of β-adrenoreceptor blockers reduces adverse CV events on an overall-population basis and abolishes the day/ night pattern of such events (9, 174).”

    From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [9]

  • Adverse cardiovascular events, including myocardial infarction, sudden cardiac death, and ischemic stroke, occur more frequently in the morning hours than at other times of the day and night in the general population.

    “the vulnerable period for an adverse CV event in the general population is in the morning, coinciding with a morning surge in BP (183)”

    From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [9]

  • 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 Muller et al., 1985

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Muller, J. E., Stone, P. H., Turi, Z. G., Rutherford, J. D., Czeisler, C. A., Parker, C., Poole, W. K., Passamani, E., Roberts, R., Robertson, T., Sobel, B. E., Willerson, J. T., Braunwald, E., & the MILIS Study Group*
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1985-11-21
Volume
313
Issue
21
Pages
1315-1322
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm198511213132103
OpenAlex
W2313938778
Cited by
1,884
References
33
Citations by year
2026: 30 · 2025: 31 · 2024: 34 · 2023: 38 · 2022: 43 · 2021: 45 · 2020: 47 · 2019: 36 · 2018: 36 · 2017: 45 · 2016: 33 · 2015: 44 · 2014: 48 · 2013: 42 · 2012: 55
FWCI
26.06
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Heart, Lung, and Blood Institute (N01-HV-7-2941, N01-HV72942, N01-HV-7-2940)
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 › Cardiac Health and Mental Health
Keywords
acute myocardial infarction, circadian rhythm, onset time, creatine kinase-MB, beta-adrenergic blocking agents, thrombosis, atherosclerotic plaque rupture, coronary artery occlusion
MeSH terms
Adrenergic beta-Antagonists, Circadian Rhythm, Creatine Kinase, Female, Humans, Isoenzymes, Male, Myocardial Infarction, Random Allocation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review