Abstract
Background—Previous studies have shown that there is a circadian variation in the incidence of acute myocardial infarction. The aim of this study is to examine the circadian rhythms of acute myocardial infarction in patients with type 2 diabetes.Methods and Results—1016 consecutive patients admitted to a coronary care unit with acute ST elevation myocardial infarction were studied from January 2004 to December 2008. All patients were divided into two groups according to with or without diabetes. Admission rates were calculated according to the 6-hour interval of the day (circadian rhythm). The data were analyzed for variations within subgroups. In diabetic group, number of patients in the first to fourth quarters was 38, 45, 43, 46 respectively (NS). The corresponding figures for the controls were 174, 295, 183, 192 (P<0.01). The difference between the two groups was significant (P<0.02).Conclusion—There is no a significant circadian variation in the onset of acute myocardial infarction in diabetic subjects.
Highlights
Circadian variation of the onset of acute myocardial infarction (AMI) has been reported by some studies and may carry important pathophysiologic implications
Diabetes neuropathy occurs in approximately 16~50% of individuals with long-standing type 1 and type 2 diabetes
Diabetic neuropathy may lead to loss of the normal circadian pattern of autonomic nervous system activity[3], and altered normal circadian variation in some physiological process.[4]
Summary
Circadian variation of the onset of acute myocardial infarction (AMI) has been reported by some studies and may carry important pathophysiologic implications. Diabetes neuropathy occurs in approximately 16~50% of individuals with long-standing type 1 and type 2 diabetes. It may manifest as polyneuropathy, mononeuropathy[2] and/ or autonomic neuropathy. Diabetic neuropathy may lead to loss of the normal circadian pattern of autonomic nervous system activity[3], and altered normal circadian variation in some physiological process.[4] Zarich et al report that time of onset of ischemia in diabetic patients follows a circadian distribution, with a peak incidence in the morning hours, suggesting that alterations in sympathovagal balance may have an effect on the circadian pattern of cardiovascular events.[5] there are conflicting reports regarding circadian variation on the onset of AMI among patients with diabetes. To determine whether diabetes has an impact on the circadian variation of AMI onset, we investigate the circadian pattern in diabetic patients and compare with the controls
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