Willich S N
Institute for Social Medicine and Epidemiology, Charité Hospital, Humboldt University of Berlin, Germany.
J Cardiovasc Pharmacol. 1999 Aug;34 Suppl 2:S9-13; discussion S29-31. doi: 10.1097/00005344-199908002-00003.
A circadian variation has been observed for acute coronary syndromes (myocardial infarction, sudden cardiac death, angina pectoris) with a peak during the morning and a trough during the night. The previous reports, however, were based primarily on selected patients in clinical studies. The present study has been designed to determine the timing of attacks of angina pectoris in ambulatory patients, the association of wake time and possible external triggers with angina attacks, and the influence of cardiac medication. The European Survey on Circadian Variation of Angina Pectoris is a multicenter international cross-sectional survey of outpatients treated in general medical practice of seven European countries. Inclusion criteria are stable angina pectoris for at least 3 months, average frequency of two or more attacks per week, and treatment with on-demand nitrates. Standardised self-administered questionnaires are provided to all consecutive patients and their physicians. From January to July 1998, 1087 patients (61% male, 64 +/- 9 years; 39% female, 67 +/- 10 years) were enrolled in 196 centers. A total of 3453 angina pectoris attacks were reported, on average 3.2 per patient per week (range 0-48). The occurrence of angina pectoris attacks demonstrates a significant circadian variation (p < 0.001) with a primary morning peak from 9:00 to 12:00 (relative risk 3.0 compared with other times of day) and a secondary afternoon peak from 15:00 to 18:00. Of all attacks, 50% occured within 6 h after awakening. Seventy-four percent of all patients reported possible external triggers of angina such as physical activity or anger. The present multicenter survey in general medical practice demonstrates a marked wake time related circadian variation in angina pectoris attacks. To improve preventive strategies, therefore, type, dosage and particularly timing of cardiac medication appear of importance, as may be behavior modification approaches.
已观察到急性冠状动脉综合征（心肌梗死、心源性猝死、心绞痛）存在昼夜节律变化，上午为高峰，夜间为低谷。然而，先前的报告主要基于临床研究中的特定患者。本研究旨在确定门诊患者心绞痛发作的时间、起床时间及可能的外部触发因素与心绞痛发作的关联，以及心脏药物的影响。欧洲心绞痛昼夜节律变化调查是一项针对七个欧洲国家普通医疗门诊患者的多中心国际横断面调查。纳入标准为稳定型心绞痛至少3个月、每周平均发作两次或更多次以及按需使用硝酸盐类药物治疗。向所有连续就诊的患者及其医生提供标准化的自填问卷。1998年1月至7月，196个中心共纳入1087例患者（男性61%，年龄64±9岁；女性39%，年龄67±10岁）。共报告3453次心绞痛发作，平均每位患者每周3.2次（范围0 - 48次）。心绞痛发作的发生呈现出显著的昼夜节律变化（p < 0.001），主要上午高峰在9:00至12:00（与一天中的其他时间相比相对风险为3.0），次要下午高峰在15:00至18:00。所有发作中，50%发生在醒来后6小时内。74%的患者报告了心绞痛可能的外部触发因素，如体力活动或愤怒。本次普通医疗实践中的多中心调查表明，心绞痛发作存在与起床时间明显相关的昼夜节律变化。因此，为改进预防策略，心脏药物的类型、剂量，尤其是给药时间可能很重要，行为改变方法或许也同样重要。
