Circadian variation in the frequency of onset of acute myocardial infarction

J. E. Muller, P. H. Stone, Z. G. Turi, J. D. Rutherford, C. A. Czeisler, C. Parker, W. K. Poole, E. Passamani, R. Roberts, T. Robertson

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Abstract

To determine whether the onset of myocardial infarction occurs randomly throughout the day, we analyzed the time of onset of pain in 2999 patients admitted with myocardial infarction. A marked circadian rhythm in the frequency of onset was detected, with a peak from 6 a.m. to noon (P < 0.01). In 703 of the patients, the time of the first elevation in the plasma creatine kinase MB (CK-MB) level could be used to time the onset of myocardial infarction objectively. CK-MB-estimated timing confirmed the existence of a circadian rhythm, with a threefold increase in the frequency of onset of myocardial infarction at peak (9 a.m.) as compared with trough (11 p.m.) periods. The circadian rhythm was not detected in patients receiving beta-adrenergic blocking agents before myocardial infarction but was present in those not receiving such therapy. If coronary arteries become vulnerable to occlusion when the intima covering an atherosclerotic plaque is disrupted, the circadian timing of myocardial infarction may result from a variation in the tendency to thrombosis. If the rhythmic processes that drive the circadian rhythm of myocardial-infarction onset can be indentified, their modification may delay or prevent the occurrence of infarction.

Original languageEnglish (US)
Pages (from-to)1315-1322
Number of pages8
JournalNew England Journal of Medicine
Volume313
Issue number21
StatePublished - 1985

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Myocardial Infarction
Circadian Rhythm
MB Form Creatine Kinase
Adrenergic beta-Antagonists
Atherosclerotic Plaques
Infarction
Coronary Vessels
Thrombosis
Pain
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Muller, J. E., Stone, P. H., Turi, Z. G., Rutherford, J. D., Czeisler, C. A., Parker, C., ... Robertson, T. (1985). Circadian variation in the frequency of onset of acute myocardial infarction. New England Journal of Medicine, 313(21), 1315-1322.

Circadian variation in the frequency of onset of acute myocardial infarction. / Muller, J. E.; Stone, P. H.; Turi, Z. G.; Rutherford, J. D.; Czeisler, C. A.; Parker, C.; Poole, W. K.; Passamani, E.; Roberts, R.; Robertson, T.

In: New England Journal of Medicine, Vol. 313, No. 21, 1985, p. 1315-1322.

Research output: Contribution to journalArticle

Muller, JE, Stone, PH, Turi, ZG, Rutherford, JD, Czeisler, CA, Parker, C, Poole, WK, Passamani, E, Roberts, R & Robertson, T 1985, 'Circadian variation in the frequency of onset of acute myocardial infarction', New England Journal of Medicine, vol. 313, no. 21, pp. 1315-1322.
Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C et al. Circadian variation in the frequency of onset of acute myocardial infarction. New England Journal of Medicine. 1985;313(21):1315-1322.
Muller, J. E. ; Stone, P. H. ; Turi, Z. G. ; Rutherford, J. D. ; Czeisler, C. A. ; Parker, C. ; Poole, W. K. ; Passamani, E. ; Roberts, R. ; Robertson, T. / Circadian variation in the frequency of onset of acute myocardial infarction. In: New England Journal of Medicine. 1985 ; Vol. 313, No. 21. pp. 1315-1322.
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AU - Stone, P. H.

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AU - Czeisler, C. A.

AU - Parker, C.

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