CORRESPONDENCE: LETTER TO THE EDITOR
Link Between Arterial Inflammation and Circadian Rhythm: The Oversight Aspect in the Year 2004
Alberto Dominguez-Rodriguez, MD, PhD*,
Martin Garcia-Gonzalez, MD and
Pedro Abreu-Gonzalez, MD
* Hospital Universitario de Canarias, Cardiology, Coronary Care Unit, Ofra s/n, La Cuesta, La Laguna, Tenerife E-38320, Spain (Email: adrvdg{at}hotmail.com).
We read with great interest the recent report by Moreno P et al. (1) concerning inflammation as one of the primary pathophysiologic processes in cardiovascular disease. However, we would like to add two comments.
First, it has also been clearly documented that the occurrence of coronary syndromes during the day are not uniform; rather, they occur with rhythmic variation. The existence of a circadian rhythm in the acute coronary syndrome suggests that the problem might, in some way, be associated with, or started by, physiological rhythms, with peak activity at certain parts of the day or night. Numerous studies have tried to establish the cause for this circadian rhythm and its clinical and therapeutic implications (2). Experimental studies have shown that both immune cell number and immune functions may vary during the 24-h circadian period (3).
Second, the increase in mortality from cardiovascular events in winter might be due to alterations in the biological clocks located in the suprachiasmatic nuclei, whose rhythm is determined by day–night alternation, that is, by the light/darkness cycles. These cycles regulate functions such as the secretion of cortisol (4), blood pressure (5), vasomotor tone (6), tissue plasminogen activator (7), and pro-inflammatory cytokines (8,9).
Therefore, considering the potential association among inflammation and circadian rhythm, the presence of a variability during the 24 h of inflammatory and immunologic functions would permit, hypothetically, one to identify the light/dark times in which any peak of inflammatory activity could be associated with a greater incidence of cardiovascular events.
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Footnotes
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This LE is paired with LR JACC 081705-3080
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References
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1. Moreno PR, Fuster V. The year in atherothrombosis J Am Coll Cardiol 2004;44:2099-2110.[Free Full Text]2. Muller JE, Stone PH, Turi ZG, et al. Circadian variation in the frequency of onset of acute myocardial infarction N Engl J Med 1985;313:1315-1322.[Abstract] 3. Abo T, Kawate K, Itoh K, et al. Studies on the bioperiodicity of the immune response. Circadian rhythms of human T, B and K cell traffic in the peripheral blood J Immunol 1981;126:1360-1366.[Web of Science][Medline] 4. Vernikos-Danellis J, Winget CM. The importance of light, postural and social cues in the regulation of the plasma cortisol rhythms in manIn: Reinberg A, Halberg F, editors. Chronopharmacology. New York, NY: Pergamon; 1979. pp. 101-106. 5. Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood pressure Lancet 1978;1:795-797.[Medline] 6. Panza JA, Epstein SE, Quyyumi AA. Circadian variation in vascular tone and its relation to  -sympathetic vasoconstrictor activity N Engl J Med 1991;325:986-990.[Abstract] 7. Huber K, Rosc D, Resch I, et al. Circadian fluctuations of plasminogen activator inhibitor and tissue plasminogen activator levels in plasma of patients with unstable coronary artery disease and acute myocardial infarction Thromb Haemost 1988;60:372-376.[Web of Science][Medline] 8. Domínguez-Rodriguez A, Abreu-Gonzalez P, García-Gonzalez MJ, et al. Ritmo luz/oscuridad de las citocinas [proinflamatorias en el infarto agudo de miocardio] Rev Esp Cardiol 2003;56:555-560.[Medline] 9. Domínguez-Rodriguez A, Abreu-Gonzalez P, García M, et al. Light/dark patterns of interleukin-6 in relation to the pineal hormone melatonin in patients with acute myocardial infarction Cytokine 2004;26:89-93.[Medline]
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