Circadian variation in the onset of myocardial infarction and sudden cardiac death

  • James E. Muller
  • Stefan N. Willich
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 170)


Study of triggering of the acute coronary syndromes received great stimulus from the relatively simple observation that the disorders have a prominent circadian variation of onset. The widespread recognition of the morning increase of myocardial infarction [1] and sudden cardiac death [2] has convinced many that the activities of the morning “trigger” onset of a sizeable percentage of the events.


Acute Myocardial Infarction Sudden Cardiac Death Coronary Thrombosis Circadian Variation Nonfatal Myocardial Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Muller JE, Tofler GH, Stone PH. Circadian variation and triggers of onset of acute cardiovascular disease. [Review] Circulation 1989; 79: 733–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Muller JE, Ludmer PL, Willich SN et al. Circadian variation in the frequency of sudden cardiac death. Circulation 1987; 75: 131–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson DR, Blandford RL, Sutton TW, Marchant PR. Time of onset of chest pain in acute myocardial infarction. Int J Cardiol 1985; 7: 139–48.PubMedCrossRefGoogle Scholar
  4. 4.
    Myers A, Dewar HA. Circumstances attending 100 sudden deaths from coronary artery disease with coroner’s necropsies. Br Heart J 1975; 37: 1133–43.PubMedCrossRefGoogle Scholar
  5. 5.
    World Health Organization. Myocardial infarction community registers: results of a WHO international collaborative study coordinated by the regional office for Europe. 1976; Copenhagen: Regional Office for Europe: World Health Organization. 5: 1 p. Public Health in Europe.Google Scholar
  6. 6.
    Muller JE, Stone PH, Turi ZG et al. Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 1985; 313: 1315–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Willich SN, Linderer T, Wegscheider K, Leizorovicz A, Alamercery I, Schroder R. Increased morning incidence of myocardial infarction in the ISAM Study: absence with prior beta-adrenergic blockade. ISAM Study Group. Circulation 1989; 80: 853–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg RJ, Brady P, Muller JE et al. Time of onset of symptoms of acute myocardial infarction. Am J Cardiol 1990; 66: 140–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Willich SN, Löwel H, Lewis M et al. Association of waketime and the onset of myocardial infarction: TRIM (Triggers and Mechanisms of myocardial Infarction) Pilot Study. Circulation 1991; 84(Suppl): VI-62–7.Google Scholar
  10. 10.
    Kleiman NS, Schechtman KB, Young PM et al. Lack of diurnal variation in the onset of non-Q wave infarction. Circulation 1990; 81: 548–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Ogawa H, Misumi I, Masuda T, Sakamoto T, Okubo H, Miyao Y. Difference in plasminogen activator inhibitor-1 (PAI-1) activity between Q wave infarction and Non-Q wave infarction. Circulation 1991; 84: II-289 (Abstract).Google Scholar
  12. 12.
    DeWood MA, Spores J, Notske R et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med 1980; 303: 897–902.PubMedCrossRefGoogle Scholar
  13. 13.
    Ambrose JA, Winters SL, Stern A et al. Angiographic morphology and the pathogenesis of unstable angina pectoris. J Am Coll Cardiol 1985; 5: 609–16.PubMedCrossRefGoogle Scholar
  14. 14.
    Sherman CT, Litvack F, Grundfest W et al. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med 1986; 315: 913–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Constantinides P. Plaque fissure in human coronary thrombosis. J Atherosclerosis Res 1966; 1: 1–17.CrossRefGoogle Scholar
  16. 16.
    Nakagawa S, Hanada Y, Koiwaya Y, Tanaka K. Angiographic features in the infarct-related artery after intracoronary urokinase followed by prolonged anticoagulation. Role of ruptured atheromatous plaque and adherent thrombus in acute myocardial infarction in vivo. Circulation 1988; 78: 1335–44.PubMedCrossRefGoogle Scholar
  17. 17.
    Falk E. Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J 1983; 50: 127–34.PubMedCrossRefGoogle Scholar
  18. 18.
    Little WC, Constantinescu M, Applegate RJ et al. Can coronary angiography predict the site of a subsequent myocardial infarction in patients with mild-to-moderate coronary artery disease? Circulation 1988; 78: 1157–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Brown BG, Gallery CA, Badger RS et al. Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations. Circulation 1986; 73: 653–61.PubMedCrossRefGoogle Scholar
  20. 20.
    Haft JI, Haik BJ, Goldstein JE. Catastrophic progression of coronary artery lesions, the common mechanism for coronary disease progression. Circulation 1987; 76: 168.Google Scholar
  21. 21.
    Richardson PD, Davies MJ, Born GV. Influence of plaque configuration and stress distribution on Assuring of coronary atherosclerotic plaques. Lancet 1989; 2: 941–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Falk E. Why do plaques rupture? [Review] Circulation 1992; 86: III30–42.Google Scholar
  23. 23.
    van der Wal AC, Becker AE, van der Loos CM, Das PK. Site of intimai rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation 1994; 89: 36–44.PubMedGoogle Scholar
  24. 24.
    Fernandez-Ortiz A, Badimon JJ, Falk E et al. Characterization of the relative thrombogenicity of atherosclerotic plaque components: implications for consequences of plaque rupture. J Am Coll Cardiol 1994; 23: 1562–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Alexander RW. Inflammation and coronary artery disease (editorial; comment). N Engl J Med 1994; 331: 468–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Toiler GH, Brezinski D, Schafer AI et al. Concurrent morning increase in platelet aggregability and the risk of myocardial infarction and sudden cardiac death. N Engl J Med 1987; 316: 1514–8.CrossRefGoogle Scholar
  27. 27.
    Jimenez AH, Toiler GH, Chen X, Stubbs ME, Solomon HS, Muller JE. Effects of nadolol on hemodynamic and hemostatic responses to potential mental and physical triggers of myocardial infarction in subjects with mild systemic hypertension. Am J Cardiol 1993; 72: 47–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Behar S, Halabi M, Reicher-Reiss H et al. Circadian variation and possible external triggers of onset of myocardial infarction. SPRINT Study Group. Am J Med 1993; 94: 395–400.PubMedCrossRefGoogle Scholar
  29. 29.
    Weitzman ED, Fukushima D, Nogeire C, Roffwarg H, Gallagher TF, Hellman L. Twenty-four hour pattern of the episodic secretion of Cortisol in normal subjects. J Clin Endocrinol Metabolism 1971; 33: 14–22.CrossRefGoogle Scholar
  30. 30.
    Winther K, Hillegass W, Toiler GH et al. Effects on platelet aggregation and fibrinolytic activity during upright posture and exercise in healthy men. Am J Cardiol 1992; 70: 1051–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Peters RW, Zoble RG, Liebson PR, Pawitan Y, Brooks MM, Proschan M. Identification of a secondary peak in myocardial infarction onset 11 to 12 hours after awakening: the Cardiac Arrhythmia Suppression Trial (CAST) experience. J Am Coll Cardiol 1993; 22: 998–1003.PubMedCrossRefGoogle Scholar
  32. 32.
    Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med 1993; 328: 303–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Fan WH, Dai RH. Further studies on the factors influencing the onset of acute myocardial infarction. Chin J Prev Med 1993; 27: 337–9.Google Scholar
  34. 34.
    Rose G. Cold weather and ischaemic heart disease. Br J Prev Social Med 1966; 20: 97–100.Google Scholar
  35. 35.
    Anderson T, Rochard C. Cold snaps, snowfall, and sudden death from ischemic heart disease. Can Med J 1979; 121: 1580–3.Google Scholar
  36. 36.
    Marchant B, Ranjadayalan K, Stevenson R, Wilkinson P, Timmis AD. Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: the influence of environmental temperature. Br Heart J 1993; 69: 385–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Willich SN, Lowel H, Lewis M, Hormann A, Arntz HR, Keil U. Weekly variation of acute myocardial infarction. Increased Monday risk in the working population. Circulation 1994; 90: 87–93.PubMedGoogle Scholar
  38. 38.
    Hansen O, Johansson BW, Gullberg B. Circadian distribution of onset of acute myocardial infarction in subgroups from analysis of 10,791 patients treated in a single center. Am J Cardiol 1992; 69: 1003–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Peters RW, Muller JE, Goldstein S, Byington R, Friedman LM. Propranolol and the morning increase in the frequency of sudden cardiac death (BHAT Study). Am J Cardiol 1989; 63:1518–20.PubMedCrossRefGoogle Scholar
  40. 40.
    Ridker PM, Manson JE, Buring JE, Muller JE, Hennekens CH. Circadian variation of acute myocardial infarction and the effect of low-dose aspirin in a randomized trial of physicians. Circulation 1990; 82: 897–902.PubMedCrossRefGoogle Scholar
  41. 41.
    Mulcahy D, Keegan J, Cunningham D et al. Circadian variation of total ischaemic burden and its alteration with anti-anginal agents. Lancet 1988; 2: 755–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Parker JD, Testa MA, Jimenez AH et al. Morning increase in ambulatory ischemia in patients with stable coronary artery disease. Importance of physical activity and increased cardiac demand. Circulation 1994; 89: 604–14.PubMedGoogle Scholar
  43. 43.
    Kurnik PB. Circadian variation in the efficacy of t-PA. Circulation 1991; 84: 289 (Abstract).Google Scholar
  44. 44.
    Fujita M, Araie E, Yamanishi K, Miwa K, Kida M, Nakajima H. Circadian variation in the success rate of intracoronary thrombolysis for acute myocardial infarction. Am J Cardiol 1993; 71: 1369–71.PubMedCrossRefGoogle Scholar
  45. 45.
    Hansen O, Johansson BW, Gullberg B. The clinical outcome of acute myocardial infarction is related to the circadian rhythm of myocardial infarction onset. Angiology 1993; 44: 509–16.PubMedCrossRefGoogle Scholar
  46. 46.
    Muller JE, Abela GS, Nesto RW, Tofler GH. Triggers, acute risk factors and vulnerable plaques: the lexicon of a new frontier. J Am Coll Cardiol 1994; 23: 809–13.PubMedCrossRefGoogle Scholar
  47. 47.
    Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984; 310: 1137–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Ip JH, Fuster V, Badimon L, Badimon J, Taubman MB, Chesebro JH. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. [Review] J Am Coll Cardiol 1990; 15: 1667–87.PubMedCrossRefGoogle Scholar
  49. 49.
    Willerson JT, Campbell WB, Winniford MD et al. Conversion from chronic to acute coronary artery disease: speculation regarding mechanisms. Am J Cardiol 1984; 54: 1349–54.PubMedCrossRefGoogle Scholar
  50. 50.
    Coller BS, Folts JD, Smith SR, Scudder LE, Jordan R. Abolition of in vivo platelet thrombus formation in primates with monoclonal antibodies to the platelet GPIIb/IIIa receptor. Correlation with bleeding time, platelet aggregation, and blockade of GPIIb/IIIa receptors. Circulation 1989; 80: 1766–74.PubMedCrossRefGoogle Scholar
  51. 51.
    Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes (2). N Engl J Med 1992; 326: 310–8.PubMedCrossRefGoogle Scholar
  52. 52.
    Arbustini E, Grasso M, Diegoli M et al. Coronary thrombosis in non-cardiac death. Coronary Artery Dis 1993; 4: 751–9.CrossRefGoogle Scholar
  53. 53.
    Belch JJ, McArdle BM, Burns P, Lowe GD, Forbes CD. The effects of acute smoking on platelet behaviour, fibrinolysis and haemorheology in habitual smokers. Thrombosis Haemostasis 1984; 51: 6–8.Google Scholar
  54. 54.
    Egan B, Schork N, Panis R, Hinderliter A. Vascular structure enhances regional resistance responses in mild essential hypertension. J Hypertension 1988; 6: 41–8.CrossRefGoogle Scholar
  55. 55.
    Ludmer PL, Selwyn AP, Shook TL et al. Paradoxical vasoconstriction induced by acetylcholine in atherosclerotic coronary arteries. N Engl J Med 1986; 315: 1046–51.PubMedCrossRefGoogle Scholar
  56. 56.
    Khanna PK, Seth HN, Balasubramanian V, Hoon RS. Effect of submaximal exercise on fibrinolytic activity in ischaemic heart disease. Br Heart J 1975; 37: 1273–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Gillum RF. Sudden coronary death in the United States: 1980–1985. Circulation 1989; 79: 756–65.PubMedCrossRefGoogle Scholar
  58. 58.
    Goldberg J. Declining out-of-hospital sudden coronary death rates: additional pieces of the epidemiologic puzzle. Circulation 1989; 79: 1369–73.PubMedCrossRefGoogle Scholar
  59. 59.
    Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death. Structure, function, and time-dependence of risk. Circulation 1992; 85: I2–10.PubMedGoogle Scholar
  60. 60.
    Lown B. Sudden cardiac death: the major challenge confronting contemporary cardiology. Am J Cardiol 1979; 43: 313–28.PubMedCrossRefGoogle Scholar
  61. 61.
    Gallerani M, Manfredini R, Ricci L et al. Sudden death may show a circadian time of risk depending on its anatomo-clinical causes and age. Jpn Heart J 1993; 34: 729–39.PubMedCrossRefGoogle Scholar
  62. 62.
    Hinkle LE, Jr., Thaler HT. Clinical classification of cardiac deaths. Circulation 1982; 65: 457–64.PubMedCrossRefGoogle Scholar
  63. 63.
    Lovegrove T, Thompson P. The role of acute myocardial infarction in sudden cardiac death-a statistician’s nightmare. Am Heart J 1978; 96: 711–3.PubMedCrossRefGoogle Scholar
  64. 64.
    Goldstein S. Toward a new understanding of the mechanism and prevention of sudden death in coronary heart disease. [Review] Circulation 1990; 82: 284–8.PubMedCrossRefGoogle Scholar
  65. 65.
    Davies MJ. Anatomic features in victims of sudden coronary death. Coronary artery pathology. Circulation 1992; 85: I19–24.PubMedGoogle Scholar
  66. 66.
    Goldstein S, Landis JR, Leighton R et al. Characteristics of the resuscitated out-of-hospital cardiac arrest victim with coronary heart disease. Circulation 1981; 64: 977–84.PubMedCrossRefGoogle Scholar
  67. 67.
    Willich SN, Maclure M, Mittleman M, Arntz HR, Muller JE. Sudden cardiac death. Support for a role of triggering in causation. Circulation 1993; 87: 1442–50.PubMedGoogle Scholar
  68. 68.
    Willich SN, Levy D, Rocco MB, Tofler GH, Stone PH, Muller JE. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol 1987; 60: 801–6.PubMedCrossRefGoogle Scholar
  69. 69.
    Levine RL, Pepe PE, Fromm RE, Curka PA, Clark PA. Prospective evidence of a circadian rhythm for out-of-hospital cardiac arrests. J Am Med Assoc 1992; 267: 2935–7.CrossRefGoogle Scholar
  70. 70.
    Ishida K, Takagi T, Ohkura K, Yabuki S, Machii K, Ito M. Out-of-hospital sudden cardiac death: a comparative study spanning 10 years. [Japanese]. J Cardiol 1989; 19: 765–73.PubMedGoogle Scholar
  71. 71.
    Arntz HR, Willich SN, Oeff M et al. Circadian variation of sudden cardiac death reflects age-related variability in ventricular fibrillation. Circulation 1993; 88: 2284–9.PubMedGoogle Scholar
  72. 72.
    Hausmann D, Trappe HJ, Bargheer K, Daniel WG, Wenzlaff P, Lichtlen PR. Circadian variation of ventricular tachycardia in patients after myocardial infarction. J Am Coll Cardiol 1992; 19: 368A (Abstract).Google Scholar
  73. 73.
    Willich SN, Goldberg RJ, Maclure M, Perriello L, Muller JE. Increased onset of sudden cardiac death in the first three hours after awakening. Am J Cardiol 1992; 70: 65–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Peters RW, Mitchell LB, Brooks MM et al. Circadian pattern of arrhythmic death in patients receiving encainide, flecainide or moricizine in the Cardiac Arrhythmia Suppression Trial (CAST). J Am Coll Cardiol 1994; 23: 283–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Gebara OCE, Mittleman M, Rasmussen C, Venditti FJ, Muller JE, Tofler GH. Morning peak in ventricular arrhythmias detected by time of implantable cardioverter defibrillator therapy. Circulation 1995; 92: 1203–8.PubMedGoogle Scholar
  76. 76.
    Karch SB, Billingham ME. The pathology and etiology of cocaine-induced heart disease. Arch Pathol Lab Med 1988; 112: 225–30.PubMedGoogle Scholar
  77. 77.
    de Silva RA. Central nervous system risk factors for sudden cardiac death. In Greenberg HM, Dwyer EM (eds): Sudden Coronary Death. New York: New York Academy of Sciences 1982; 143–160.Google Scholar
  78. 78.
    Corbalan R, Verrier R, Lown B. Psychological stress and ventricular arrhythmias during myocardial infarction in the conscious dog. Am J Cardiol 1974; 34: 692–6.PubMedCrossRefGoogle Scholar
  79. 79.
    Folts JD, Stamler J, Loscalzo J. Intravenous nitroglycerin infusion inhibits cyclic blood flow responses caused by periodic platelet thrombus formation in stenosed canine coronary arteries. Circulation 1991; 83: 2122–7.PubMedGoogle Scholar
  80. 80.
    Huikuri HV, Linnaluoto MK, Seppanen T et al. Circadian rhythm of heart rate variability in survivors of cardiac arrest. Am J Cardiol 1992; 70: 610–5.PubMedCrossRefGoogle Scholar
  81. 81.
    Verrier RL, Nearing BD. Electrophysiologic basis for T wave alternans as an index of vulnerability to ventricular fibrillation. J Cardiovasc Electrophysiol 1994; 5: 445–61.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • James E. Muller
  • Stefan N. Willich

There are no affiliations available

Personalised recommendations