Circulation, Vol 78, 35-40, Copyright © 1988 by American Heart Association
DA Brezinski, GH Tofler, JE Muller, S Pohjola-Sintonen, SN Willich, AI Schafer, CA Czeisler and GH Williams
The frequencies of onset of myocardial infarction and sudden cardiac death
are increased between 6 AM and 12 noon. Platelet aggregability, which may
play a role in the cause of these disorders, has been observed to increase
after the normal morning activities of awakening, arising, and ambulating.
To determine which morning activity or activities are responsible for this
aggregability increase, we measured platelet aggregation in 16 normal
subjects on a control day of delayed arising (i.e., subjects remained
supine until 12:30 PM) and on a day in which normal morning activities were
divided into three isolated components of awakening (8 AM), assumption of
upright posture (9:30 AM), and ambulating (11 AM). Blood samples to assess
platelet aggregability were drawn at 8 AM before activity and 90 minutes
after the initiation of each activity (i.e., at 9:30 AM, 11 AM, and 12:30
PM). For the group, in vitro platelet responsiveness to adenosine
diphosphate and epinephrine increased only after assumption of the upright
posture. The lowest concentration of agonist required to produce biphasic
platelet aggregation decreased (aggregability increased) between 9:30 and
11 AM (90 minutes after assumption of the upright posture) from 3.3 +/- 0.3
to 2.4 +/- 0.2 microM for adenosine diphosphate (p less than 0.05) and from
2.1 +/- 0.5 to 1.0 +/- 0.4 microM for epinephrine (p less than 0.05).
During the same interval, plasma epinephrine increased from 34 +/- 7 to 55
+/- 9 pg/ml (p less than 0.05), and plasma norepinephrine increased from
169 +/- 19 to 298 +/- 25 pg/ml (p less than 0.01). There was no significant
change in aggregability or catecholamine concentrations on the control
day.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Morning increase in platelet aggregability. Association with assumption of the upright posture
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
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