Circadian Rhythm in Sudden Cardiac Death: A Retrospective Study of 2,665 Cases

Abstract

Several studies have reported a circadian variation in sudden cardiac death. The aim of this study was to determine whether in northern Greece sudden cardiac death shows a circadian rhythm and/or a weekly and seasonal distribution. We studied 2,665 sudden deaths due to coronary heart disease from 13,832 sudden deaths that merited autopsy; 1,429 (53.6%) of them were due to acute myocardial infarction (AMI) and 1,236 (46.4%) to chronic ischemic heart disease (IHD). The time of death was determined on the basis of autopsy results and witness interviews. There was a circadian rhythm of sudden cardiac death (p<0.010), with a low incidence during the hours 04.00-08.00 (13.1%) and an increased incidence during 20.00-24.00 (19.8%) (p<0.05). Women did not show the same significant circadian variation. Time of occurrence of sudden cardiac death attributed either to AMI or to IHD showed a similar 24-hour distribution (lowest incidence during 04.00-08.00 hours, 12.8% and 13.5%, respectively, and higher during 20.00-24.00, 19.5% and 20.3%, respectively). Weekday distribution of sudden cardiac death showed a significant statistical variation (p<0.005) with the highest frequency on Monday (21.1%) and the lowest on Sunday (7.5%). The same distribution was observed in men, whereas in women the lower frequency was also on Sunday but the higher was on Tuesday. Sudden cardiac death was evenly distributed over the months of the year, with the highest incidence in summer (27.3%) and the lowest in autumn (22%). Sudden cardiac death shows a circadian rhythm and a significant variation during the week.

Get full access to this article

View all access options for this article.

References

Muller JE , Ludmer PL , Willich SN , et al : Circadian variation in the frequency of sudden cardiac death. Circulation 75:131-138, 1987.

Davies M : Pathological view of sudden cardiac death. Br Heart J 45:88-96, 1981.

Aronow W , Ahn C : Circadian variation of primary cardiac arrest of sudden cardiac death in patients aged 62-100 years (mean 82). Am J Cardiol 71: 1455-1456, 1993.

Willich SN , Levy D , Rocco MB , et al : Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study Population. Am J Cardiol 60:801-806, 1987.

Goldstein S , Landis JR , Leighton R , et al : Characteristics of the resuscitated out of hospital cardiac arrest victim with coronary heart disease. Circulation 64:977-984, 1981.

Myers A , Dewar HA : Circumstances attending 100 sudden deaths from coronary artery disease with coroner’s necropsies. Br Heart J 37:1133-1143, 1975.

Mitler M , Hajdukovic R , Shafor R , et al : When people die. Am J Med 82:266-273, 1987.

Arntz HR , Willich SN , Schreiber C , et al : Diurnal, weekly and seasonal variation of sudden death. Eur Heart J 21:315-320, 2000.

Goldstein S , Zoble RG , Akiyama T , et al : Relation of circadian ventricular ectopic activity to cardiac mortality. Am J Cardiol 78:881-885, 1996.

10.

Peters RW : Circadian patterns and triggers of sudden cardiac death. Cardiol Clin 14:185-194, 1996.

11.

Muller JE : Circadian variation and triggering of acute coronary events. Am Heart J 137 (4 Pt 2):S1-S8, 1999.

12.

Thakur RK , Hoffmann RG , Olson DW , et al : Circadian variation in sudden cardiac death: Effects of age, sex, and initial cardiac rhythm. Ann Emerg Med 53:363-373, 1985.

13.

Peckova M , Fahrenbruch C , Cobb L , et al : Circadian variations in occurrence of cardiac arrests. Circulation 98:31-39, 1998.

14.

Willich SN : Circadian variation and triggering of cardiovascular events. Vasc Med 4:41-49, 1999.

15.

Muller JE , Stone PH , Turi ZG , et al : Circadian variation in the frequency of onset of acute myocardial infarction. N Engl J Med 313:1315-1322, 1985.

16.

Kannel W , Doyle J , McNamara PM , et al : Precursors of sudden coronary death. Factors related to the incidence of sudden death. Circulation 51:606-613, 1975.

17.

Davies M , Thomas A : Plaque fissuring—the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina. Br Heart J 53:363-373, 1985.

18.

Willich SN , Lowel H , Lewis M , et al : Weekly variation of acute myocardial infarction. Circulation 90:87-93, 1994.

19.

Spielberg C , Falkenhahn D , Wiilich SN , et al : Circadian, day-of-week, and seasonal variability in myocardial infarction: Comparison between working and retired patients. Am Heart J 132:579-585, 1996.

20.

Kawamura T , Kondo H , Hirai M , et al : Sudden death in the working population: A collaborative study in central Japan. Eur Heart J 20:338-343, 1999.

21.

Thompson PD , Funk EJ , Carleton RA , et al : Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535-2538, 1982.

22.

Douglas AS , Al-Sayer H , Rawles JM , et al : Seasonality of disease in Kuwait. Lancet 337:1393-1397, 1991.

23.

The Eurowinter Group : Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. Lancet 349:1341-1346, 1997.

24.

Lundberg GP , Liebson PR , Calvin JE : Circadian variation in cardiac disease: Clinical implications. Current strategies for preventing MI, dysrhythmias, sudden death. J Crit Illn 10:693-696, 699-700, 705-707, 1995.

25.

Behrens S , Ney G , Fisher SG , et al : Effects of amiodarone on the circadian pattern of sudden cardiac death. Am J Cardiol 80:45-48, 1997.

26.

Mittleman MA , Maclure M , Toffler GH , et al : Triggering of acute myocardial infarction by heavy physical exertion. N Engl J Med 329:1677-1683, 1993.

27.

Willich SN , Lewis M , Lowel H , et al : Physical exertion as trigger of acute myocardial infarction. N Engl J Med 329:1684-1690, 1993.

28.

Kolovou GD , Daskalova DCh , Mikhailidis DP : Apolipoprotein E polymorphism and atherosclerosis. Angiology 54:59-71, 2003.