Circadian Variation In Onset Of Myocardial Infarction : Comparison Between Diabetics (Niddm) And Non-Diabetics
Circadian Variation In MI
Keywords:
Circadian Rhythm, Myocardial InfarctionAbstract
Aims and Objectives : A number of retrospective and prospective studies have demonstrated a peak in the onset of MI in the morning hours and a trough at night. This has led to investigations of the factors which can affect or modify the circadian pattern of onset of MI. The current study was undertaken with an objective of assessing whether the presence of diabetes can or cannot affect the circadian pattern of onset of myocardial infarction in an Indian population. Material & methods : 50 non diabetic subjects and 50 diabetic subjects were randomly selected from among patients admitted to cardiac ICCU of LTMMC and GH Sion, Mumbai. For all patients the time of onset of MI was noted and the results were tabulated. Results : 44% of non-diabetic subjects experienced onset of myocardial infarction in the period between midnight to 6:00 a.m. as compared to 32% in case of diabetics but an application of Chi Square Test, did not come out to be significant. But on comparing diabetics with >5 years and <5 years history, a significant loss of circadian rhythm was observed in case of diabetics of >5 years duration, indicating that autonomic neuropathy may play a role in the loss of circadian rhythm. Conclusion: It has important implications for the treatment of myocardial infarction in case of diabetics. This study can be followed up with additional studies to verify other factors which can affect circadian pattern of onset of myocardial infarction. Loss of biorhythms can result in increased incidence of thrombotic events throughout the day leading to increased cardiovascular mortality and morbidity.
References
2. Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas.International Diabetes Federation. 3rd ed. Belgium: International Diabetes Federation; 2006 p. 15-103.
3. Joshi R. Metabolic syndrome - Emerging clusters of the Indian phenotype. J Assoc Physicians India 2003; 51 : 445-6.
4. Deepa R, Sandeep S, Mohan V. Abdominal obesity, visceral fat and type 2 diabetes- “Asian Indian phenotype. In: Mohan V, Rao GHR, editors. Type 2 diabetes in South Asians: Epidemiology, risk factors and prevention. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2006 p. 138-52.
5. Zarisch S, Waxman S, Freeman RT, Mittleman M, Hegarty P, Nesto RW: Effect of autonomic nervous system dysfunction on the circadian pattern of myocardial ischemia in diabetes mellitus. J Am Coll Cardiol24 :956 –962,1994
6. Mitler,M.M.et al:When people die;Cause of death versus time of death.Am.J.Med.,82;266,1987 7. Thompson D.R.,Blandford R.L.,Sutton,T.W.,Marchant P.R.,Time of onset of chest Pain in acute myocardial infarction,Int.J. of cardiol.,1985:7:139-46
8. Muller JE, Kaufmann PG, Luepker RV, Weisfeldt ML, Deedwania PC, Willerson JT: Mechanisms precipitating acute cardiac events: review and recommendations of an NHLBI workshop. Mechanisms Precipitating Acute Cardiac Events Participants. Circulation96 :3233 –3239,1997
9. Furlan R, Guzzetti S, Crivellaro W, Dassi S, Tinelli M, Baselli G, Cerutti S, Lombardi F, Pagani M,Malliani A. Continuous 24-hour: assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects. Circulation81 :537 –547,1990
10. Muller JE, Stone PH, Turi ZG, Rutherford JD, Czeisler CA, Parker C, Poole WK, Passamani E, Roberts R, Robertson T, et al: Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med313 :1315 –1322,1985
11. Graham T.,Lane D.,Carroll D.,Gregory Y.H.,A systematic review of prothrombotic effects of an acute change in posture, Chest 2007; 132:1337–1347
12. Hjalmarson A, Gilpin EA, Nicod P, Dittrich H, Henning H, Engler R, Blacky AR, Smith SC Jr, Ricou F, Ross J Jr: Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation80 :267 –275,1989
13. Fava S, Azzopardi J, Muscat HA, Fenech FF: Absence of circadian variation in the onset of acute myocardial infarction in diabetic subjects. Br Heart J74 :370 –372,1995
14. Yamamoto M, Yamasaki Y, Kodama M, Matsuhisa M, Kishimoto M, Ozaki H, Tani A, Ueda N, Iwasaki M, Hori M: Impaired diurnal cardiac autonomic function in subjects with type 2 diabetes. Diabetes Care22 :2072 –2077,1999
15. Toyry JP, Niskanen LK, Mantysaari MJ, Lansimies EA, Uusitupa MI: Occurrence, predictors, and clinical significance of autonomic neuropathy in NIDDM. Ten-year follow-up from the diagnosis. Diabetes45 :308 –315,1996
