Cited by 1,072Platelet Disorders and TreatmentsBlood Coagulation and Thrombosis MechanismsAntiplatelet Therapy and Cardiovascular Diseases

Concurrent Morning Increase in Platelet Aggregability and the Risk of Myocardial Infarction and Sudden Cardiac Death

Tofler, Geoffrey H., Brezinski, Damian, Schafer, Andrew I., Czeisler, Charles A., Rutherford, John D., Willich, Stefan N., Gleason, Ray E., Williams, Gordon H. +1 more·1987·New England Journal of Medicine

Abstract

We have previously reported that the frequencies of myocardial infarction and of sudden cardiac death are highest during the period from 6 a.m. to noon. Since platelet aggregation may have a role in triggering these disorders, we measured platelet activity at 3-hour intervals for 24 hours in 15 healthy men. In vitro platelet responsiveness to either adenosine diphosphate (ADP) or epinephrine was lower at 6 a.m. (before the subjects arose) than at 9 a.m. (60 minutes after they arose). The lowest concentration of these agents required to produce biphasic platelet aggregation decreased (i.e., aggregability increased) from a mean +/- SEM of 4.7 +/- 0.6 to 3.7 +/- 0.6 microM (P less than 0.01) for ADP and from 3.7 +/- 0.8 to 1.8 +/- 0.5 microM (P less than 0.01) for epinephrine. The period from 6 to 9 a.m. was the only interval in the 24-hour period during which platelet aggregability increased significantly. We subsequently studied 10 subjects on alternate mornings after they arose at the normal time and after delayed arising. The morning increase in platelet aggregability was not observed when the subjects remained supine and inactive. Thus, there is a temporal association between increased platelet aggregability in the morning and an increased frequency of myocardial infarction and of sudden cardiac death. Demonstration of this association does not establish a cause--effect relation, but together with other evidence linking platelets to these disorders, it may provide insight into the mechanisms precipitating myocardial infarction and sudden cardiac death and aid in the design of more effective preventive measures.

Integrity signals

Registry

Crossref · 10.1056/nejm198706113162405

Cites

35 of 35 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?

  • Highest platelet aggregability and highest concentration of plasminogen activator inhibitor-1 (PAI-1) occur in the morning.

    “For instance, highest platelet aggregability and highest concentration of plasminogen activator inhibitor-1 (PAI-1) occur in the morning (109, 110).”

    From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [109]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Tofler, G. H., Brezinski, D., Schafer, A. I., Czeisler, C. A., Rutherford, J. D., Willich, S. N., Gleason, R. E., Williams, G. H., & Muller, J. E.
Affiliations
Brigham and Women's Hospital (US)
Venue
New England Journal of Medicine
Published
1987-06-11
Volume
316
Issue
24
Pages
1514-1518
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W1974742589
Cited by
1,072
References
35
Citations by year
2026: 7 · 2025: 14 · 2024: 8 · 2023: 13 · 2022: 22 · 2021: 18 · 2020: 11 · 2019: 18 · 2018: 16 · 2017: 22 · 2016: 18 · 2015: 21 · 2014: 28 · 2013: 27 · 2012: 29
FWCI
21.71
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • U.S. Public Health Service (9535 A607606)
  • National Heart, Lung, and Blood Institute (HL-27465, HL-705861)
Topics
  • Health Sciences › Medicine › Hematology › Platelet Disorders and Treatments
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
Keywords
platelet aggregability, circadian rhythm, myocardial infarction, sudden cardiac death, adenosine diphosphate, epinephrine, supine rest, platelet function
MeSH terms
Adenosine Diphosphate, Adult, Death, Sudden, Epinephrine, Hematocrit, Humans, Male, Myocardial Infarction, Platelet Aggregation, Platelet Count, Posture, Time, In Vitro Techniques

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