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Circulation, Vol 79, 733-743, Copyright © 1989 by American Heart Association
JE Muller, GH Tofler and PH Stone
Information obtained during the past decade suggests the need to reexamine
the possibility that the onset of myocardial infarction and sudden cardiac
death is frequently triggered by daily activities. The importance of
physical or mental stress in triggering onset of coronary thrombosis is
supported by the findings that 1) the frequencies of onset of myocardial
infarction, sudden cardiac death, and stroke show marked circadian
variations with parallel increases in the period from 6:00 AM to noon, 2)
transient myocardial ischemia shows a similar morning increase, and
episodes are often preceded by mental or physical triggers, 3) a ruptured
atherosclerotic plaque, often nonobstructive by itself, lies at the base of
most coronary thrombi, 4) a number of physiologic processes that could lead
to plaque rupture, a hypercoagulable state or coronary vasoconstriction,
are accentuated in the morning, and 5) aspirin and beta-adrenergic blocking
agents, which block certain of these processes, have been shown to prevent
disease onset. The hypothesis is presented that occlusive coronary
thrombosis occurs when 1) an atherosclerotic plaque becomes vulnerable to
rupture, 2) mental or physical stress causes the plaque to rupture, and 3)
increases in coagulability or vasoconstriction, triggered by daily
activities, contribute to complete occlusion of the coronary artery lumen.
Recognition of the circadian variation--and the possibility of frequent
triggering--of onset of acute disease suggests the need for pharmacologic
protection of patients during vulnerable periods, and provides clues to
mechanism, the investigations of which may lead to improved methods of
prevention.
ARTICLES
Circadian variation and triggers of onset of acute cardiovascular disease
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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K. Matsuo, T. Kurita, M. Inagaki, M. Kakishita, N. Aihara, W. Shimizu, A. Taguchi, K. Suyama, S. Kamakura, and K. Shimomura The circadian pattern of the development of ventricular fibrillation in patients with Brugada syndrome Eur. Heart J., March 2, 1999; 20(6): 465 - 470. [Abstract] [PDF]
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J. D. Folts, A. I. Schafer, J. Loscalzo, J. T. Willerson, and J. E. Muller A perspective on the potential problems with aspirin as an antithrombotic agent: a comparison of studies in an animal model with clinical trials J. Am. Coll. Cardiol., February 1, 1999; 33(2): 295 - 303. [Abstract] [Full Text] [PDF]
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P. Li, M. Morris, C. M. Ferrario, C. Barrett, D. Ganten, and M. F. Callahan Cardiovascular, endocrine, and body fluid-electrolyte responses to salt loading in mRen-2 transgenic rats Am J Physiol Heart Circ Physiol, October 1, 1998; 275(4): H1130 - H1137. [Abstract] [Full Text] [PDF]
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A. Lago, D. Geffner, J. Tembl, L. Landete, C. Valero, and M. Baquero Circadian Variation in Acute Ischemic Stroke : A Hospital-Based Study Stroke, September 1, 1998; 29(9): 1873 - 1875. [Abstract] [Full Text] [PDF]
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M. Peckova, C. E. Fahrenbruch, L. A. Cobb, and A. P. Hallstrom Circadian Variations in the Occurrence of Cardiac Arrests : Initial and Repeat Episodes Circulation, July 7, 1998; 98(1): 31 - 39. [Abstract] [Full Text] [PDF]
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A. Cagnacci, S. Arangino, M. Angiolucci, E. Maschio, and G. B. Melis Influences of melatonin administration on the circulation of women Am J Physiol Regulatory Integrative Comp Physiol, February 1, 1998; 274(2): R335 - R338. [Abstract] [Full Text] [PDF]
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M. Gheorghiade and R. O. Bonow Chronic Heart Failure in the United States : A Manifestation of Coronary Artery Disease Circulation, January 27, 1998; 97(3): 282 - 289. [Full Text] [PDF]
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B. S. McEwen Protective and Damaging Effects of Stress Mediators N. Engl. J. Med., January 15, 1998; 338(3): 171 - 179. [Full Text] [PDF]
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R. W. Nesto and S. Zarich Acute Myocardial Infarction in Diabetes Mellitus : Lessons Learned From ACE Inhibition Circulation, January 13, 1998; 97(1): 12 - 15. [Full Text] [PDF]
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D. Mehta, J. Curwin, J. A. Gomes, and V. Fuster Sudden Death in Coronary Artery Disease : Acute Ischemia Versus Myocardial Substrate Circulation, November 4, 1997; 96(9): 3215 - 3223. [Full Text]
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J. T. Korpelainen, K. A. Sotaniemi, H. V. Huikuri, and V. V. Myllyla Circadian Rhythm of Heart Rate Variability Is Reversibly Abolished in Ischemic Stroke Stroke, November 1, 1997; 28(11): 2150 - 2154. [Abstract] [Full Text]
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R. T. Lee and P. Libby The Unstable Atheroma Arterioscler Thromb Vasc Biol, October 1, 1997; 17(10): 1859 - 1867. [Full Text]
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T. Yamashita, Y. Murakawa, K. Sezaki, M. Inoue, N. Hayami, Y. Shuzui, and M. Omata Circadian Variation of Paroxysmal Atrial Fibrillation Circulation, September 2, 1997; 96(5): 1537 - 1541. [Abstract] [Full Text]
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S. Kapiotis, B. Jilma, P. Quehenberger, K. Ruzicka, S. Handler, and W. Speiser Morning Hypercoagulability and Hypofibrinolysis : Diurnal Variations in Circulating Activated Factor VII, Prothrombin Fragment F1+2, and Plasmin–Plasmin Inhibitor Complex Circulation, July 1, 1997; 96(1): 19 - 21. [Abstract] [Full Text]
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R. J MacFadyen, C. S Barr, and A. D Struthers Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients Cardiovasc Res, July 1, 1997; 35(1): 30 - 34. [Abstract] [Full Text] [PDF]
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C. A. Desouza, D. R. Dengel, M. A. Rogers, K. Cox, and R. F. Macko Fibrinolytic responses to acute physical activity in older hypertensive men J Appl Physiol, June 1, 1997; 82(6): 1765 - 1770. [Abstract] [Full Text] [PDF]
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B. Rocca and G. A. FitzGerald Simply Read: Erythrocytes Modulate Platelet Function: Should We Rethink the Way We Give Aspirin? Circulation, January 7, 1997; 95(1): 11 - 13. [Full Text]
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G. Y.H. Lip, J. Zarifis, I. S. Farooqi, A. Page, G. Sagar, and D. G. Beevers Ambulatory Blood Pressure Monitoring in Acute Stroke: The West Birmingham Stroke Project Stroke, January 1, 1997; 28(1): 31 - 35. [Abstract] [Full Text]
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E. Lee, A. J. Grodzinsky, P. Libby, S. K. Clinton, M. W. Lark, and R. T. Lee Human Vascular Smooth Muscle Cell–Monocyte Interactions and Metalloproteinase Secretion in Culture Arterioscler Thromb Vasc Biol, December 1, 1995; 15(12): 2284 - 2289. [Abstract] [Full Text]
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M. A. Mittleman, M. Maclure, J. B. Sherwood, R. P. Mulry, G. H. Tofler, S. C. Jacobs, R. Friedman, H. Benson, and J. E. Muller Triggering of Acute Myocardial Infarction Onset by Episodes of Anger Circulation, October 1, 1995; 92(7): 1720 - 1725. [Abstract] [Full Text]
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