Circadian variation in stroke onset: identical temporal pattern in ischemic and hemorrhagic events
Abstract
Stroke is the culmination of a heterogeneous group of cerebrovascular diseases that is manifested as ischemia or hemorrhage of one or more blood vessels of the brain. The occurrence of many acute cardiovascular events--such as myocardial infarction, sudden cardiac death, pulmonary embolism, critical limb ischemia, and aortic aneurysm rupture--exhibits prominent 24 h patterning, with a major morning peak and secondary early evening peak. The incidence of stroke exhibits the same 24 h pattern. Although ischemic and hemorrhagic strokes are different entities and are characterized by different pathophysiological mechanisms, they share an identical double-peak 24 h pattern. A constellation of endogenous circadian rhythms and exogenous cyclic factors are involved. The staging of the circadian rhythms in vascular tone, coagulative balance, and blood pressure plus temporal patterns in posture, physical activity, emotional stress, and medication effects play central and/or triggering roles. Features of the circadian rhythm of blood pressure, in terms of their chronic and acute effects on cerebral vessels, and of coagulation are especially important. Clinical medicine has been most concerned with the prevention of stroke in the morning, when population-based studies show it is of greatest risk during the 24 h; however, improved protection of at-risk patients against stroke in the early evening, the second most vulnerable time of cerebrovascular accidents, has received relatively little attention thus far.
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Cerebrovascular and cardiovascular events exhibit a bimodal pattern.
“It is known that cerebrovascular and cardiovascular events exhibit a bimodal pattern (116).”
From Chronotype: Implications for Epidemiologic Studies on Chrono-Nutrition and Cardiometabolic Health (2019) · cites this paper as [116]
Strokes follow a circadian rhythm with a major morning peak and a secondary early evening peak.
“Strokes, for instance, follow a circadian rhythm with a major morning peak and a secondary early evening peak.”
From Chronotype: Implications for Epidemiologic Studies on Chrono-Nutrition and Cardiometabolic Health (2019) · cites this paper as [116]
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 [8]
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 [8]
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High Proportion of Lacunar Strokes at Night: The Bergen Stroke Study
Næss, H., Idicula, T. T., Brøgger, J. C., Waje‐Andreassen, U., & Thomassen, L. (2010) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2010.02.014 · Cited by 14 · see citing works
Ando, H., Otoda, T., OOKAMI, H., Nagai, Y., Inano, A., Takamura, T., Ushijima, K., Hosohata, K., Matsushita, E., Saito, T., et al. (2013) · Clinical and Experimental Pharmacology and Physiology · doi:10.1111/1440-1681.12055 · Cited by 14 · see citing works
Normal hypercapnic cerebrovascular conductance in obstructive sleep apnea
Ryan, C. M., Battisti‐Charbonney, A., Sobczyk, O., Duffin, J., & Fisher, J. A. (2013) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2013.09.003 · Cited by 14 · see citing works
The Monday peak in the onset of ischemic stroke is independent of major risk factors
Manfredini, R., Manfredini, F., Boari, B., Salmi, R., & Gallerani, M. (2009) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2008.10.024 · Cited by 14 · see citing works
- Authors
- Manfredini, R., Boari, B., Smolensky, M. H., Salmi, R., la Cecilia, O., Maria Malagoni, A., Haus, E., & Manfredini, F.
- Affiliations
- University of Ferrara (IT)
- The University of Texas Health Science Center at Houston (US)
- Vascular Diseases Center, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Regions Hospital (US)
- Corresponding author
- Manfredini, Roberto
- Venue
- Chronobiology International
- Publisher
- Informa UK Limited
- Published
- 2005-01
- Volume
- 22
- Issue
- 3
- Pages
- 417-453
- ISSN
- 0742-0528 (ISSN-L)
- 1525-6073
- OpenAlex
- W2104603409
- Cited by
- 197
- References
- 232
- Citations by year
- 2026: 7 · 2025: 5 · 2024: 12 · 2023: 12 · 2022: 13 · 2021: 15 · 2020: 5 · 2019: 8 · 2018: 7 · 2017: 7 · 2016: 3 · 2015: 10 · 2014: 9 · 2013: 8 · 2012: 9
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Chronobiology International (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- circadian rhythm, stroke onset, ischemic stroke, hemorrhagic stroke, morning peak, circadian variation, blood pressure, coagulation, vascular tone, stroke prevention
- MeSH terms
- Blood Coagulation, Blood Pressure, Cerebral Hemorrhage, Brain Ischemia, Circadian Rhythm, Pharmaceutical Preparations, Fibrinolysis, Humans, Motor Activity, Sleep, Stress, Psychological, Time Factors, Stroke
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