CIRCADIAN VARIATION IN THE ONSET OF ACUTE MYOCARDIAL INFARCTION IN DIABETICS
AbstractBackground: It has been shown in previous studies there is circadian variation in the onset of acute myocardial infarction. The objective of this study was to evaluate the relation of circadian variation in onset of Acute Myocardial infarction in Diabetic subjects. Methods: This study was conducted at the Services Institute of Medical Sciences Lahore and Punjab Institute of Cardiology from January 2015 to February 2016. Hundred diabetic and 100 Non-diabetic patients with Myocardial infarction were included in the study. Among diabetics those were included in the study who had diabetes for ≥5 years. The time of onset of symptoms to determine the circadian rhythm was noted. In order to determine the frequency of acute myocardial infarction associated with circadian rhythm, 24 hours of the day were divided into four equal sections of 6 hours each. We noted time of onset of acute MI. Thereafter, patients were bracketed in their respective six-hour time periods. These six-hour periods were 0–6, 6:01–12, 12:01–18, and 18:01–24 hours. Result: In this study patients’ mean age was 59.16±13.81. Forty-two (71.2%) non-diabetic patients had acute myocardial infarction (AMI) during 6:00–12:00 hours whereas 17 (28.8%) diabetic patients presented with AMI during this time. Conclusion: Incidence of AMI is significantly increased in the morning 6:01-12:00 hours in non-diabetics. However, diabetic subjects did not show significant increased incidence of AMI during this time rather there was increased incidence of AMI during 0–6:00 hours. Keywords: Circadian variation; Myocardial infarction; Diabetes
Gaziam JM. Global Burden of cardiovascular Disease. In: Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: Saunders Elsevier; 2008;1–22.
Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: an overview. Circ J 2013;77(7):1646–52.
Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart 2008;94(1):16–26.
Sari I, Davutoglu V, Erer B, Tekbas E, Ucer E, Ozer O, et al. Analysis of circadian variation of acute myocardial infarction: afternoon predominance in Turkish population. Int J Clin Pract 2009;63(1):82–6.
Takeda N, Maemura K. Circadian clock and cardiovascular disease. J Cardiol 2011;57(3):249–56.
Hjalmarson A, Gilpin EA, Nicod P, Dittrich H, Henning H, Engler R, Blacky AR, et al. Differing circadian patterns of symptom onset in subgroups of patients with acute myocardial infarction. Circulation 1989;80(2):267–75.
Behar S, Halabi M, Reicher-Reiss H, Zion M, Kaplinsky E, Mandelzweig L, et al. Circadian variation and possible external triggers of onset of myocardial infarction. SPRINT Study Group. Am J Med 1993;94(4):395–400.
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 Cardiol 1994;24(4):956 –62.
Rana JS, Mukamal KJ, Morgan JP, Muller JE, Mittleman MA. Circadian Variation in the Onset of Myocardial Infarction Effect of Duration of Diabetes. Diabetes 2003;52(6):1464–8.
Reiter R, Swingen C, Moore L, Henry TD, Traverse JH. Circadian Dependence of Infarct Size and Left Ventricular Function after ST Elevation Myocardial Infarction. Circ Res 2012;110(1):105–10.
Kumar S, Meraj L, Akhter I, Sultana I, Mufti MA, Junaid K. Circadian variation in the onset of Acute ischemic stroke. J Rawal Med Coll 2014;18(2):190–2.
Holmes DR Jr, Aguirre FV, Aplin R, Lennon RJ, Nestler DM, Bell MR, et al. Circadian Rhythms in Patients With ST-Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2010;3(4):382–9.
Lopez Messa JB, Garmendia Leiza JR, Aguilar García MD, Andrés de Llano JM, Alberola López C, Ardura Fernández J. Cardiovascular risk factors in the circadian rhythm of acute myocardial infarction. Rev Esp Cardiol 2004;57(9):850–8.
Mishra P, Sahoo B, Bhimani N, Rathi N. Circadian variation in onset of myocardial infarction: Comparison between diabetics (Niddm) and non-diabetics. Natl J Integr Res Med 2013;4(6):107–10.
Li J, Hua Q, Pi L, Tan J, Li B. Circadian variation on the onset of acute ST segment elevation myocardial infarction in diabetic subjects. J Cardiovasc Dis Res 2010;1(1):23–6.
Pop-Busui R. Cardiac Autonomic Neuropathy in Diabetes: a clinical perspective. Diabetes Care 2010;33(2):434–41.
Poulsen PL, Ebbehoj E, Arildsen H, Knudsen ST, Hansen KW, Molgaard H, et al. Increased QTc dispersion is related to blunted circadian blood pressure variation in normoal buminuric type 1 diabetic patients. Diabetes 2001;50(4):837–42.
Yamamoto M, Yamasaki Y, Kodama M, Matsuhisa M, Kishimoto M, Ozaki H, et al. Impaired diurnal cardiac autonomic function in subjects with type2 diabetes. Diabetes Care 1999;22(12):2072–77.
Ziegler D, Gries FA, Spuler M, Lessmann F. The epidemiology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group. J Diabetes Complications 1992;6(1):49–57.
Rana JS, Mukamal KJ, Morgan JP, Muller JE, Mittleman MA. Circadian Variation in the Onset of Myocardial Infarction: effect of duration of diabetes. Diabetes 2003;52(6):1464–68.
Fava S, Azzopardi J, Muscat HA, Fenech FF. Absence of circadian variation in the onset of acute myocardial infarction in diabetic subjects. Heart 1995;74(4):370–72.