Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Vascular Surgery Department, Royal Blackburn Teaching Hospital, Blackburn, United Kingdom.
J Card Surg. 2021 Jul;36(7):2496-2501. doi: 10.1111/jocs.15548. Epub 2021 Apr 2.
Aortic aneurysm (AA) is a common atherosclerotic condition, accounting for nearly 6000 deaths in England and up to 175,000 deaths globally each year. The pathological outward bulging of the aorta typically results from atherosclerosis or hereditary connective tissue disorders. AAs are usually asymptomatic until spontaneous rupture or detected on incidental screening. Eight in 10 patients do not survive the rupture and die either before reaching hospital or from complications following surgery. Similar to other cardiovascular pathologies, AA is thought to be subject to chronobiological patterns of varying incidence.
We performed a literature review of the current literature to evaluate the association between circadian rhythms, seasonal variations, and genetic factors and the pathogenesis of AA, reviewing the impact of chronobiology.
The incidence of AA is found to peak in the early morning (6-11 a.m.) and colder months, and conversely troughs towards the evening and warmer months, exhibiting a similar pattern of chronobiological rhythm as other cerebrovascular pathologies, such as myocardial infarcts, or cerebrovascular strokes.
Literature suggests there exists a clear relationship between chronobiology and the incidence and pathogenesis of ruptured AA; incidence increases in the morning (6-11 a.m.), and during colder months (December-January). This is more pronounced in patients with Marfan syndrome, or vitamin D deficiency. The underlying pathophysiology and implications this has for chronotherapeutics, are also discussed. Our review shows a clear need for further research into the chronotherapeutic approach to preventing ruptured AA in the journey towards precision medicine.
主动脉瘤（AA）是一种常见的动脉粥样硬化疾病，每年仅在英格兰就有约 6000 人因此死亡，全球则多达 17.5 万人。主动脉病理性向外膨出通常是由动脉粥样硬化或遗传性结缔组织疾病引起的。AA 通常在自发破裂或偶然筛查时才会出现症状。10 个患者中有 8 个在破裂后无法存活，这些患者要么在到达医院之前死亡，要么在手术后死于并发症。与其他心血管疾病一样，AA 被认为存在不同发病率的昼夜节律模式。
我们对当前文献进行了综述，以评估昼夜节律、季节性变化和遗传因素与 AA 发病机制之间的关系，同时评估了生物钟生物学的影响。
AA 的发病率在清晨（6-11 点）和寒冷月份达到高峰，而在傍晚和温暖月份则下降，这与其他脑血管疾病（如心肌梗死或脑血管中风）的生物钟节律模式相似。
文献表明生物钟生物学与破裂性 AA 的发病率和发病机制之间存在明显关系；发病率在早晨（6-11 点）和寒冷月份（12 月至 1 月）增加。这种情况在马凡综合征或维生素 D 缺乏症患者中更为明显。本文还讨论了潜在的病理生理学及其对时间治疗学的影响。我们的综述表明，需要进一步研究时间治疗学方法，以预防精准医学时代破裂性 AA 的发生。
