Skip to main content
SpringerLink
Log in

Excess cardiac mortality on Monday: the importance of gender, age and hospitalisation

European Journal of Epidemiology volume 20, pages 395–399 (2005)Cite this article

Abstract

Background: Available evidence suggests a peak in the incidence of cardiovascular events on Mondays compared to other days of the week. The underlying mechanism may be summarised as naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour. Change in these rhythms may lead to attenuation of the peak on Mondays. Objective: To quantify the excess risk associated with the Monday peak in cardiovascular mortality and to explore the role of age, gender and hospitalisation. Methods: Details on time and cause of all deaths which occurred in the city of Rotterdam between November 21, 1988 and November 21, 1990 were obtained by sending a questionnaire to the physician who signed the death certificate. We studied the weekly distribution of 1828 confirmed cases of sudden cardiac death, for the group as a whole and in subgroups according to gender, age (<65 years/≥65 years) and hospitalisation. Results: The odds ratio (OR) of sudden cardiac death on Monday compared to other days of the week was 1.20 (95% CI: 1.06–1.36). The excess mortality due to the Monday peak amounted to 4.9 per 1000 deaths. The Monday peak was more pronounced in non-hospitalised (OR: 1.25; 95% CI: 1.08–1.44) than in hospitalised patients (OR: 1.06; 95% CI: 0.83–1.37), in men (OR: 1.25; 95% CI: 1.06–1.48) than in women (OR: 1.14; 95% CI: 0.95–1.36), and in those younger than 65 (OR: 1.29; 95% CI: 0.95–1.74) compared to those aged 65 years or over (OR: 1.18; 95% CI: 1.03–1.35). Yet, the confidence limits overlap. Conclusion: The incidence of sudden cardiac death is markedly increased on Monday, more pronounced in non-hospitalised patients. Our results may point to the relevance of naturally occurring rhythmic fluctuations in human physiology, and socially determined rhythms in human behaviour as underlying mechanism.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. MC Cohen KM Rohtla CE Lavery JE Muller MA Mittleman (1997) ArticleTitleMeta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death Am J Cardiol 79 1512–1516 Occurrence Handle9185643

    PubMed  Google Scholar 

  2. AL Oberg JA Ferguson LM McIntyre RD Horner (2000) ArticleTitleIncidence of stroke and season of the year: evidence of an association Am J Epidemiol 152 558–564 Occurrence Handle10997546

    PubMed  Google Scholar 

  3. HR Arntz J Muller-Nordhorn SN Willich (2001) ArticleTitleCold Monday mornings prove dangerous: epidemiology of sudden cardiac death Curr Opin Crit Care 7 139–144 Occurrence Handle11436519

    PubMed  Google Scholar 

  4. SW Rabkin FA Mathewson RB Tate (1980) ArticleTitleChronobiology of cardiac sudden death in men JAMA 244 1357–1358 Occurrence Handle7411810

    PubMed  Google Scholar 

  5. SN Willich M Maclure M Mittleman HR Arntz JE Muller (1993) ArticleTitleSudden cardiac death Support for a role of triggering in causation. Circulation 87 1442–1450

    Google Scholar 

  6. JE Muller GS Abela RW Nesto GH Tofler (1994) ArticleTitleTriggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier J Am Coll Cardiol 23 809–813 Occurrence Handle8113568

    PubMed  Google Scholar 

  7. GH Tofler PH Stone M Maclure E Edelman VG Davis T Robertson et al. (1990) ArticleTitleAnalysis of possible triggers of acute myocardial infarction (the MILIS study) Am J Cardiol 66 22–27 Occurrence Handle2193495

    PubMed  Google Scholar 

  8. J Kauhanen GA Kaplan DE Goldberg JT Salonen (1997) ArticleTitleBeer binging and mortality: results from the Kuopio ischaemic heart disease risk factor study, a prospective population based study Br Med J 315 846–851

    Google Scholar 

  9. DR Witte ML Bots AW Hoes DE Grobbee (2000) ArticleTitleCardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study Br Med J 321 1552–1554

    Google Scholar 

  10. AW Hoes DE Grobbee J Lubsen AJ Manin’t Veld DE der Particlevan A Hofman (1995) ArticleTitleDiuretics, beta-blockers, and the risk for sudden cardiac death in hypertensive patients Ann Intern Med 123 481–487 Occurrence Handle7661490

    PubMed  Google Scholar 

  11. SJ Servoss JL Januzzi JE Muller (2002) ArticleTitleTriggers of acute coronary syndromes Prog Cardiovasc Dis 44 369–380 Occurrence Handle12024335

    PubMed  Google Scholar 

  12. PM Ridker JE Manson JE Buring JE Muller CH Hennekens (1990) ArticleTitleCircadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians Circulation 82 897–902 Occurrence Handle2203556

    PubMed  Google Scholar 

  13. JW Sayer P Wilkinson K Ranjadayalan S Ray B Marchant AD Timmis (1997) ArticleTitleAttenuation or absence of circadian and seasonal rhythms of acute myocardial infarction Heart 77 325–329 Occurrence Handle9155610

    PubMed  Google Scholar 

  14. SN Willich T Linderer K Wegscheider A Leizorovicz I Alamercery R Schroder (1989) ArticleTitleIncreased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade ISAM Study Group. Circulation 80 853–858

    Google Scholar 

  15. KL Woods S Fletcher C Jagger (1992) ArticleTitleModification of the circadian rhythm of onset of acute myocardial infarction by long-term antianginal treatment Br Heart J 68 458–461 Occurrence Handle1361355

    PubMed  Google Scholar 

  16. F Yamasaki H Seo T Furuno et al. (2002) ArticleTitleEffect of age on chronological variation of acute myocardial infarction onset: study in Japan Clin Exp Hypertens 24 1–9 Occurrence Handle11848162

    PubMed  Google Scholar 

  17. MM Mitler RM Hajdukovic R Shafor PM Hahn DF Kripke (1987) ArticleTitleWhen people die Cause of death versus time of death. Am J Med 82 266–274

    Google Scholar 

  18. Morning peak in the incidence of myocardial infarction: experience in the ISIS-2 trial. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Eur Heart J 1992; 13: 594–598

  19. C Martyn (2000) ArticleTitleHebdomadal rhythms of the heart BMJ 321 1542–1543 Occurrence Handle11124165

    PubMed  Google Scholar 

  20. L Chenet A Britton R Kalediene J Petrauskiene (2001) ArticleTitleDaily variations in deaths in Lithuania: the possible contribution of binge drinking Int J Epidemiol 30 IssueID4 743–748 Occurrence Handle11511597

    PubMed  Google Scholar 

  21. C Evans J Chalmers S Capewell A Redpath A Finlayson J Boyd et al. (2000) ArticleTitle“I don’t like Mondays”-day of the week of coronary heart disease deaths in Scotland: study of routinely collected data Br Med J 320 218–219

    Google Scholar 

  22. RW Peters MM Brooks RG Zoble PR Liebson AA Seals (1996) ArticleTitleChronobiology of acute myocardial infarction: cardiac arrhythmia suppression trial (CAST) experience Am J Cardiol 78 1198–1201 Occurrence Handle8960574

    PubMed  Google Scholar 

  23. HR Arntz SN Willich C Schreiber T Bruggemann R Stern HP Schultheiss (2000) ArticleTitleDiurnal, weekly and seasonal variation of sudden death. Population-based analysis of 24,061 consecutive cases Eur Heart J 21 315–320 Occurrence Handle10653679

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huspostnummer str 6.131, Heidelberglann 100, 3584, CX Utrecht, The Netherlands

    D. R. Witte, D. E. Grobbee, M. L. Bots & A. W. Hoes

Authors
  1. D. R. Witte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. E. Grobbee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. L. Bots
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. W. Hoes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. L. Bots.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Witte, D.R., Grobbee, D.E., Bots, M.L. et al. Excess cardiac mortality on Monday: the importance of gender, age and hospitalisation. Eur J Epidemiol 20, 395–399 (2005). https://doi.org/10.1007/s10654-004-6594-4

Download citation

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-004-6594-4

Keywords

search

Navigation