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Cited by 236Acute Myocardial Infarction ResearchCircadian rhythm and melatoninHeart rate and cardiovascular health

Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction.

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Hjalmarson, A, Gilpin, E A, Nicod, P, Dittrich, H, Henning, H, Engler, R, Blacky, A R, Smith, S C +2 more·1989·Circulation
DOI 10.1161/01.cir.80.2.267
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Abstract

Circadian variation of the onset of acute myocardial infarction has been noted in many studies and may carry important pathophysiologic implications. However, only a few previous studies have attempted subgroup analyses. In 4,796 patients with documented acute myocardial infarction, the time of symptom onset was recorded. As in other studies, the peak of onset occurred in the morning from 6:01 AM to 12:00 noon, and 28% of the population (1.16 times the average percentage for the other time periods) experienced symptom onset in that period (p less than 0.001). There was a second, lower peak (25%) in the evening between 6:01 PM and 12:00 midnight, which was also observed in some previous studies. We sought to determine whether or not the presence of subgroups with specific clinical characteristics would exhibit different patterns and thereby contribute to these peaks in the overall population. In patients with a history of congestive heart failure (n = 606) or with non-Q wave infarction (n = 832), a pronounced peak (29%) occurred only in the evening. Two nearly equal peaks were observed in patients older than 70 years of age (n = 1,422), smokers (n = 2,057), diabetics (n = 767), women (n = 1,213), and patients taking beta-blocking drugs (n = 847). Finally, in patients with a previous myocardial infarction (n = 1,104), no peaks were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

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  • 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 [36]

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Cited by

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Authors
Hjalmarson, A., Gilpin, E. A., Nicod, P., Dittrich, H., Henning, H., Engler, R., Blacky, A. R., Smith, S. C., Ricou, F., & Ross, J.
Affiliations
  • Division of Cardiology, University of California, San Diego, La Jolla 92093.
  • University of California San Diego (US)
ORCID
Dittrich, H
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1989-08
Volume
80
Issue
2
Pages
267-275
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.80.2.267
OpenAlex
W1979147677
Cited by
236
References
1
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2022: 4 · 2021: 5 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 4 · 2016: 3 · 2015: 2 · 2014: 5 · 2013: 4 · 2012: 8
FWCI
11.62
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
  • Circulation
Funders
  • Sveriges Läkarförbund
  • National Institutes of Health
  • Medical Research Council
  • National Heart, Lung, and Blood Institute (HL-17682)
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
acute myocardial infarction, circadian variation, symptom onset, morning peak, congestive heart failure, non-Q-wave myocardial infarction, elderly patients, smokers, diabetes mellitus, sex differences, beta-blockers, old myocardial infarction, subgroup analysis
MeSH terms
Adrenergic beta-Antagonists, Circadian Rhythm, Electrocardiography, Female, Heart Failure, Humans, Hypertension, Male, Middle Aged, Myocardial Infarction, Risk Factors, Smoking, Diabetes Complications

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