Willich S N
Institute for Social Medicine and Epidemiology, Charité Hospital, Humboldt University of Berlin, Germany.
Vasc Med. 1999;4(1):41-9. doi: 10.1177/1358836X9900400108.
Myocardial infarction and sudden cardiac death demonstrate a marked circadian variation with an increased risk during the morning after awakening and arising. The recognition of the morning increase of acute cardiovascular events has convinced many that they may be triggered by morning activities. It is of note, however, that cardiovascular events occur throughout the day--even if at lower frequency compared with the morning. There is a strong association between external triggers and the onset of myocardial infarction and sudden cardiac death beyond what is to be expected by chance alone. The magnitude of this association (relative risk two- to threefold) is comparable with the known long-term risk factors of cardiac disease. Trigger factors occur relatively frequently and may play a causative role in up to 20% of cases of acute coronary syndromes. Physical exertion, bursts of anger and sexual activity have been proved to have triggering potential. Other possible triggers include external and environmental events such as earthquakes, war threat and climatic factors. The pathophysiological links between external triggers and the onset of cardiovascular events are important in addressing the question of a causal relationship between triggers and disease onset and in perhaps improving preventive strategies.
心肌梗死和心源性猝死呈现出明显的昼夜节律变化，在醒来起床后的早晨风险增加。对急性心血管事件早晨风险增加的认识使许多人相信，它们可能由早晨的活动引发。然而，值得注意的是，心血管事件在一天中都会发生——即便与早晨相比频率较低。外部触发因素与心肌梗死和心源性猝死的发作之间存在很强的关联，其程度超出了仅靠偶然因素所能预期的范围。这种关联的强度（相对风险为两到三倍）与已知的心脏病长期风险因素相当。触发因素相对频繁出现，在高达20%的急性冠脉综合征病例中可能起致病作用。体力活动、突发愤怒和性活动已被证明具有触发潜力。其他可能的触发因素包括外部和环境事件，如地震、战争威胁和气候因素。外部触发因素与心血管事件发作之间的病理生理联系对于解决触发因素与疾病发作之间的因果关系问题以及可能改善预防策略很重要。
