Circadian Variation in the Timing of Stroke Onset: A Meta-analysis
Abstract
Background and Purpose —Acute myocardial infarction and sudden death display a circadian rhythm, with a higher risk between 6 am and noon. Some reports suggest that stroke does not follow such a circadian variation and that hemorrhagic stroke occurs more often during the evening. Methods —A meta-analysis of 31 publications reporting the circadian timing of 11 816 strokes was performed, subdividing (when possible) by the type of stroke, according to the time of onset of symptoms. When precise timing was not given, strokes were distributed evenly (that is, biasing toward the null hypothesis of lack of circadian variation). Results —All subtypes of strokes displayed a significant ( P <0.001) circadian variation in time of onset, whether divided into 3-, 4-, or 6-hour time periods. There was a 49% increase (95% confidence interval, 44% to 55%) in stroke of all types between 6 am and noon (compared with expectations if no circadian variation was present), which is a 79% (95% confidence interval, 72% to 87%) increase over the normalized risk of the other 18 hours of the day. There were 29% fewer strokes between midnight and 6 am , a 35% decrease compared with the other 18 hours of the day. All three subtypes of stroke had a significantly higher risk between 6 am and noon (55% for 8250 ischemic strokes; 34% for 1801 hemorrhagic strokes, and 50% for 405 transient ischemic attacks). Conclusions —These data support the presence of a circadian pattern in the onset of stroke, with a significantly higher risk in the morning.
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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 [7]
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- Authors
- Elliott, W. J.
- Affiliations
- Rush University Medical Center (US)
- Corresponding author
- Elliott, William J.
- ORCID
- Elliott, William J.
- Venue
- Stroke
- Published
- 1998-05
- Volume
- 29
- Issue
- 5
- Pages
- 992-996
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2110792462
- Cited by
- 638
- References
- 46
- Citations by year
- 2026: 27 · 2025: 21 · 2024: 36 · 2023: 38 · 2022: 28 · 2021: 25 · 2020: 30 · 2019: 19 · 2018: 25 · 2017: 35 · 2016: 32 · 2015: 17 · 2014: 34 · 2013: 23 · 2012: 26
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- 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, transient ischemic attack, time of day, morning surge, circadian variation
- MeSH terms
- Cerebral Hemorrhage, Cerebrovascular Disorders, Circadian Rhythm, Humans, Time Factors
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