Circadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians.
Open accessAbstract
Increased platelet aggregation in the morning and upon assuming an upright posture may account at least in part for the observed circadian variation in onset of acute myocardial infarction. The Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of alternate-day aspirin intake (325 mg) among 22,071 US male physicians, afforded the opportunity to assess this circadian pattern and examine whether it is altered by aspirin therapy. During a 5-year period of follow-up, 342 cases of nonfatal myocardial infarction were confirmed, of which the time of onset was available in 211 (62%). The placebo group showed a bimodal circadian variation in onset of myocardial infarction with a primary peak between 4:00 AM and 10:00 AM (p less than 0.001). In the aspirin group, however, this circadian variation was minimal (p = 0.16), due primarily to a marked reduction in the morning peak of infarction. Specifically, aspirin was associated with a 59.3% reduction in the incidence of infarction during the morning waking hours, compared with a 34.1% reduction for the remaining hours of the day. The greater reduction was observed during the 3-hour interval immediately after awakening, a period with a risk of infarction twice that of any other comparable time interval (p less than 0.001). Aspirin intake was associated with a mean reduction in the incidence of infarction of 44.8% over the entire 24-hour cycle. These data support the hypothesis that increased platelet aggregability in the morning and upon arising contributes to the occurrence of myocardial infarction and that aspirin reduces the risk of infarction by inhibiting platelet aggregation during these critical periods.
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Aspirin reduces the morning peak in myocardial infarction, suggesting that the prothrombotic milieu in the morning is partly responsible for increased cardiovascular risk during that period.
“Indeed, aspirin reduces the morning peak in myocardial infarction (116), suggesting that the prothrombotic milieu in the morning is partly responsible for increased CV risk during that period.”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [116]
Low-dose aspirin can reduce the morning peak in myocardial infarction by approximately 60%.
“Likewise, low-dose aspirin can reduce the morning peak in myocardial infarction by approximately 60% (116), with evening aspirin theoretically being best to reduce potential for thrombus formation across the morning vulnerable period, although evidence from placebo-controlled trials with long-term follow up of CV outcomes is lacking (177).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [116]
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- Authors
- Ridker, P. M., Manson, J. E., Buring, J. E., Muller, J. E., & Hennekens, C. H.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Circulation
- Published
- 1990-09
- Volume
- 82
- Issue
- 3
- Pages
- 897-902
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1986422577
- Cited by
- 285
- References
- 24
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 4 · 2018: 5 · 2017: 6 · 2016: 3 · 2015: 5 · 2014: 8 · 2013: 6 · 2012: 9
- FWCI
- 14.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (CA 34944, HL-26490)
- National Heart, Lung, and Blood Institute (HL-34595, HL07575, HL 26490, CA-34944, R01HL034595)
- National Cancer Institute (CA 34944)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- acute myocardial infarction, circadian variation, low-dose aspirin, platelet aggregation, morning peak, onset time, Physicians' Health Study, aspirin therapy, cardiovascular risk reduction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aspirin, Circadian Rhythm, Humans, Male, Middle Aged, Myocardial Infarction, Randomized Controlled Trials as Topic
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