Elliot W J
Department of Preventive Medicine, RUSH Medical College of RUSH University at RUSH-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Am J Hypertens. 2001 Sep;14(9 Pt 2):291S-295S. doi: 10.1016/s0895-7061(01)02174-4.
The incidence of many biologic phenomena displays a reproducible and cyclic variation. Cardiovascular disease, the most common cause of death in the United States and other developed countries, also has an intrinsic variation in events. These events are more common in winter, at the beginning of each month, on Mondays (in working people), and during the early morning hours of each day. Recent meta-analyses have quantitated the excess risk of cardiovascular events in the hours around and just after awakening. Between 6 AM and noon, there is a 40% higher risk of heart attack, a 29% increased risk of cardiac death, and a 49% increased risk of stroke (compared with what would be expected if these events happened at random and were evenly distributed throughout the day). These observations have major consequences for emergency medical personnel and medical transport systems. The reasons for these observations are less clear. The circadian pattern of blood pressure (BP) and heart rate may be a major contributor, and long-term "hard end-point" studies designed to test specific pharmacologic interventions targeting the early morning rise in BP and heart rate are underway. Individuals who work night shifts and those whose BP has a different circadian pattern have a higher risk of cardiovascular events, but may be less likely to have an increased risk of cardiovascular events in the morning.
许多生物现象的发生率呈现出可重复的周期性变化。心血管疾病是美国和其他发达国家最常见的死亡原因，其发病情况也存在内在变化。这些发病情况在冬季、每月月初、周一（上班族中）以及每天凌晨时分更为常见。近期的荟萃分析已经对醒来前后数小时内心血管事件的额外风险进行了量化。上午6点至中午之间，心脏病发作风险高出40%，心脏死亡风险增加29%，中风风险增加49%（与这些事件随机发生且全天均匀分布时的预期情况相比）。这些观察结果对急救医疗人员和医疗运输系统有重大影响。这些观察结果背后的原因尚不清楚。血压（BP）和心率的昼夜节律模式可能是一个主要因素，旨在测试针对清晨血压和心率升高的特定药物干预措施的长期“硬终点”研究正在进行中。从事夜班工作的人和血压昼夜节律模式不同的人发生心血管事件的风险较高，但在早晨发生心血管事件风险增加的可能性可能较小。
