Chronobiology in Aortic Diseases – “Is This Really a Random Phenomenon?”
Section snippets
Circadian rhythm and cardiovascular diseases
Chronobiology is a branch of biomedical sciences aimed at the study of biological rhythms. Biological rhythms exist at many levels in living organisms and, according to their cycle length, may be divided into: a) circadian (period of ~ 24 hours), b) ultradian (period < 24 hours), c) infradian (period > 24 hours). Circadian rhythms are the widely studied, and are driven by circadian clocks. Circadian clocks can be defined as a transcriptionally based molecular mechanism, based on both positive and
Circadian clocks and their role in cardiovascular diseases
The principal role of cellular biological clocks is driving circadian rhythms to adapt the organism to further needs in an anticipatory manner, thus providing selective advantage.9 However, it has been recently shown that external or internal disruption (dyssinchrony) of circadian control may result in overt diseases. For example, mice exposed to a 20-hour instead of 24-hour circadian rhythm show a complete disruption of sleep/wake behavior and a marked progression of myocyte hypertrophy and
Circadian variation
Our group observed a circadian variation, characterized by a main peak in the morning hours (at about 8 a.m.) and a secondary one in the evening) both for acute spontaneous rupture of abdominal aortic aneurysms26 and acute dissection of thoracic aorta.27 A few years after these first findings in a limited number of patients in the small town of Ferrara, Italy, the existence of a morning peak in the acute dissection of the aorta was confirmed also in Japan28 and in the twelve worldwide centers
Pathophysiology: possible insights of morning cardiovascular events
The similarity of temporal patterns of different acute cardiovascular and cerebrovascular events seems to suggest the possibility that they share common underlying pathophysiologic mechanisms. Several pathophysiologic phenomena, i.e., increase in blood pressure (BP), heart rate, sympathetic activity, basal vascular tone, vasoconstrictive hormones, prothrombotic tendency, platelet aggregability, plasma viscosity, and hematocrit, exhibit prominent circadian rhythms with phases positively
Other than circadian variation: seasons of the year
“Whoever wishes to investigate medicine properly, should proceed thus: in the first place to consider the seasons of the year, and what effects each of them produces for they are not all alike, but differ much from themselves in regard to their changes”…Hippocrates wrote, in 400 b.c., in his masterpiece treatise on Air, Waters and Places. According to a series of studies, fall and winter months represent a high-risk temporal frame for occurrence of aortic rupture or dissection,56., 57., 58., 59.
Other than circadian variation: day of the week
A few studies have investigated this temporal aspect (Table 3). Sumiyoshi28 found a small peak on Monday and a trough on Thursday and Friday, but the distribution was homogenous as a whole. The IRAD Registry study29 did not find any significant daily variation. Lasica31 and Benouaich69 reported peaks on Wednesday, but this was not statistically significant.
The only positive study was one that analyzed more than 4600 cases in the Emilia-Romagna region of Italy.93 A daily pattern, characterized
Dangerous weekends: myth or reality?
Bell & Redelmeier105 analyzed all acute care admissions from emergency departments in Ontario, Canada, between 1988 and 1997 (near four million admissions), and found that rupture of abdominal aortic aneurysms was associated with a significantly higher mortality in patients admitted during the weekend vs. patients hospitalized during the weekdays (42% vs. 36%, respectively; adjusted O.R 1.28). More recently, our group confirmed a highly significantly increased risk of death during
Conclusions
We have reviewed the growing evidence dealing with temporal aspects of onset of acute cardiovascular events, as well as the newest intriguing information about peripheral circadian clocks. Among these, the cardiomyocyte circadian clock has emerged as a molecular mechanism influencing multiple critical myocardial processes, since it appears to regulate heart rate, growth, triglyceride and glycogen metabolism, and contractility, as well as modulate the responsiveness of the myocardium to
Statement of Conflict of Interest
All authors declare that there are no conflict of interest.
Acknowledgments
The Authors thank Prof. Walter Ageno, MD, Dr. Francesco Dentali, MD, and Dr. Josè Vitale, MD, from the University of Insubria, Varese, Italy, for their precious help in providing anticipations of original unpublished material.
This work was supported, in part, by a scientific grant (FAR – Fondo Ateneo Ricerca) from the University of Ferrara, Italy.
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Meta-Analysis of Circadian Variation in the Onset of Acute Aortic Dissection
2017, American Journal of CardiologyDiurnal and twenty-four hour patterning of human diseases: Cardiac, vascular, and respiratory diseases, conditions, and syndromes
2015, Sleep Medicine ReviewsCitation Excerpt :Occurrence of IS and HS displays prominent 24 h variation, with major morning and in some studies minor late-afternoon/early-evening peaks, both in groups of persons diagnosed, based on daytime clinic cuff measurements, as hypertensive and normotensive. Dissection of abdominal, aortic, and thoracic arteries displays comparable substantial morning peak/nocturnal nadir 24 h variability [78–84]. COVI occurs in ∼30% of males employed in ‘standing’ occupations, causing in ∼80% leg edema (2.6–3.6% increase in leg volume), discomfort/pain, and fatigue [85,86], and with one study reporting greater leg volume increase following the morning vs. afternoon shift [87].
Seasonal pattern in acute aortic diseases: US results confirm Italian findings
2015, International Journal of CardiologyCalcineurin and its regulator, RCAN1, confer time-of-day changes in susceptibility of the heart to ischemia/reperfusion
2014, Journal of Molecular and Cellular CardiologyCitation Excerpt :Clinical and experimental studies have demonstrated repeatedly the importance of circadian rhythms in cardiovascular health and the need to maintain proper coordination of rhythmic processes. For instance, in humans, the incidence of myocardial infarction (MI) [7,8], sudden cardiac death [9,10], ventricular tachyarrhythmias [11], and rupture of aortic aneurysms [12–14] peaks in the morning around the time of transition from sleep to waking [15,16]. The strength and persistence of the intrinsic circadian clock is such that the incidence of sudden cardiac death in long distance travelers peaks at a time corresponding to the early morning in the time zone from which the traveler originated [17].
Air Pollutants and Mortality Risk in Patients with Aortic Dissection: Evidence from a Clinical Cohort, Single-Cell Sequencing, and Proteomics
2024, Environmental Science and Technology
Statement of Conflict of Interest: see page 121.