Willich S N, Löwel H, Lewis M, Hörmann A, Arntz H R, Keil U
Department of Medicine, Klinikum Steglitz, Free University of Berlin, Germany.
Circulation. 1994 Jul;90(1):87-93. doi: 10.1161/01.cir.90.1.87.
Seasonal and circadian variations in the occurrence of myocardial infarction and sudden cardiac death have been documented, suggesting that triggering factors may play a role in the causation of cardiac events. However, there are only sparse and conflicting data on the weekly distribution of the disorders.
To determine the weekly variation of acute myocardial infarction and sudden cardiac death, 5596 consecutive patients (71% men; age, 63 +/- 1 years) were analyzed in a regionally defined population (n = 330,000; age, 25 to 74 years) monitored from 1985 to 1990. The exact time of onset of symptoms was used to determine the day of the event. Patients with myocardial infarction (n = 2636) demonstrated a significant weekly variation (P < .01) with a peak on Monday, whereas patients with sudden cardiac death (n = 2960) were evenly distributed throughout the week. A similar weekly pattern was observed in subgroups of patients with myocardial infarction defined with respect to age, sex, cardiac risk factors, prior cardiac medication, and infarct characteristics. The working population demonstrated a weekly variation of myocardial infarction as opposed to the nonworking population, with a 33% increase in relative risk of disease onset on Monday (P < .05) and a trough on Sunday compared with the expected number of cases, if homogeneity was assumed.
The onset of acute myocardial infarction demonstrates a peak on Monday primarily in the working population. If this finding is confirmed in other communities, it may aid in identifying acute triggering events of myocardial infarction and perhaps in improving prevention of the disease.
心肌梗死和心源性猝死的发生存在季节性和昼夜节律变化，这表明触发因素可能在心脏事件的病因中起作用。然而，关于这些疾病的每周分布情况，只有稀少且相互矛盾的数据。
为了确定急性心肌梗死和心源性猝死的每周变化情况，我们对1985年至1990年期间在一个区域定义的人群（n = 330,000；年龄25至74岁）中连续纳入的5596例患者（71%为男性；年龄63±1岁）进行了分析。症状出现的确切时间用于确定事件发生的日期。心肌梗死患者（n = 2636）显示出显著的每周变化（P <.01），周一为峰值，而心源性猝死患者（n = 2960）在一周内分布均匀。在根据年龄、性别、心脏危险因素、先前的心脏用药情况和梗死特征定义的心肌梗死患者亚组中，观察到了类似的每周模式。在职人群与非在职人群相比，心肌梗死存在每周变化，与假设同质性时预期的病例数相比，周一发病的相对风险增加33%（P <.05），周日为低谷。
急性心肌梗死的发病主要在在职人群中呈现周一峰值。如果这一发现能在其他社区得到证实，可能有助于识别心肌梗死的急性触发事件，并可能有助于改善疾病的预防。
