Circulation, Vol 90, 87-93, Copyright © 1994 by American Heart Association
SN Willich, H Lowel, M Lewis, A Hormann, HR Arntz and U Keil
BACKGROUND: Seasonal and circadian variations in the occurrence of
myocardial infarction and sudden cardiac death have been documented,
suggesting that triggering factors may play a role in the causation of
cardiac events. However, there are only sparse and conflicting data on the
weekly distribution of the disorders. METHODS AND RESULTS: To determine the
weekly variation of acute myocardial infarction and sudden cardiac death,
5596 consecutive patients (71% men; age, 63 +/- 1 years) were analyzed in a
regionally defined population (n = 330,000; age, 25 to 74 years) monitored
from 1985 to 1990. The exact time of onset of symptoms was used to
determine the day of the event. Patients with myocardial infarction (n =
2636) demonstrated a significant weekly variation (P < .01) with a peak
on Monday, whereas patients with sudden cardiac death (n = 2960) were
evenly distributed throughout the week. A similar weekly pattern was
observed in subgroups of patients with myocardial infarction defined with
respect to age, sex, cardiac risk factors, prior cardiac medication, and
infarct characteristics. The working population demonstrated a weekly
variation of myocardial infarction as opposed to the nonworking population,
with a 33% increase in relative risk of disease onset on Monday (P <
.05) and a trough on Sunday compared with the expected number of cases, if
homogeneity was assumed. CONCLUSIONS: The onset of acute myocardial
infarction demonstrates a peak on Monday primarily in the working
population. If this finding is confirmed in other communities, it may aid
in identifying acute triggering events of myocardial infarction and perhaps
in improving prevention of the disease.
ARTICLES
Weekly variation of acute myocardial infarction. Increased Monday risk in the working population
Department of Medicine, Klinikum Steglitz, Free University of Berlin, Germany.
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