Circadian Pattern of Acute Myocardial Infarction and Atrial Fibrillation in a Mediterranean Country: A study in Diabetic Patients

The circadian pattern seems to play a crucial role in cardiovascular events and arrhythmias. Diabetes mellitus is a complex metabolic disorder associated with autonomic nervous system alterations and increased risk of microvascular and macrovascular disease. We sought to determine whether acute myoc...

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Published in:	Medicina (Kaunas, Lithuania) Vol. 57; no. 1; p. 41
Main Authors:	Daios, Stylianos, Savopoulos, Christos, Kanellos, Ilias, Goudis, Christos Argyrios, Nakou, Ifigeneia, Petalloti, Stergiani, Hadjidimitriou, Nicolas, Pilalas, Dimitrios, Ziakas, Antonios, Kaiafa, Georgia
Format:	Journal Article
Language:	English
Published:	Switzerland MDPI 06-01-2021 MDPI AG
Subjects:	acute myocardial infarction Adult Aged atrial fibrillation Atrial Fibrillation - complications Atrial Fibrillation - epidemiology Autonomic Nervous System circadian rhythm Diabetes Mellitus Humans Mediterranean country Middle Aged Myocardial Infarction - complications Myocardial Infarction - epidemiology Retrospective Studies atrial fibrillation diabetes mellitus Mediterranean country acute myocardial infarction circadian rhythm
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Summary:	The circadian pattern seems to play a crucial role in cardiovascular events and arrhythmias. Diabetes mellitus is a complex metabolic disorder associated with autonomic nervous system alterations and increased risk of microvascular and macrovascular disease. We sought to determine whether acute myocardial infarction (AMI) and atrial fibrillation (AF) follow a circadian pattern in diabetic patients in a Mediterranean country. This retrospective study included 178 diabetic patients (mean age: 67.7) with AMI or AF who were admitted to the coronary care unit. The circadian pattern of AMI and AF was identified in the 24-h period (divided in 3-h and 1-h intervals). Patients were also divided in 3 groups according to age; 40-65 years, 66-79 years and patients older than 80 years. A chi-square goodness-of-fit test was used for the statistical analysis. AMI seems to occur more often in the midnight hours (21:00-23:59) ( < 0.001). Regarding age distribution, patients between 40 and 65 years were more likely to experience an AMI compared to other age groups ( < 0.001). Autonomic alterations, working habits, and social reasons might contribute to this phenomenon. AF in diabetic patients occurs more frequently at noon (12:00-14:59) ( = 0.019). Diabetic patients with AMI and AF seem to follow a specific circadian pattern in a Mediterranean country, with AMI occurring most often at midnight hours and AF mostly at noon. Autonomic dysfunction, glycemic fluctuations, intense anti-diabetic treatment before lunch, and patterns of insulin secretion and resistance may explain this pattern. More studies are needed to elucidate the circadian pattern of AMI and AF in diabetic patients to contribute to the development of new therapeutic approaches in this setting.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1648-9144 1010-660X 1648-9144
DOI:	10.3390/medicina57010041