Hemostatic triggers of myocardial infarction

The occurrence of acute ischemia in the coronary circulation, leading to myocardial infarction and sudden cardiac death and numerous other thromboembolic events in different areas of the body, follows a circadian periodic pattern. This pattern is characterized by a major peak in the morning. Numerous circadian rhythms in different compartments of the hemostatic system contribute to this characteristic pattern. The temporal coincidence of vascular rhythms favoring impairment of the coronary circulation, with a morning increase in the activity of platelets in response to stimulation with a hypercoagulable state and a circadian minimum in fibrinolysis, leads to the increased incidence of thromboembolic events at that circadian stage. Direct circadian clock-dependence has been shown for some rhythms, e.g. in fibrinolysis, and circadian rhythm disturbances may favor coronary artery pathology. The circadian transient risk state for myocardial infarctions and other thromboembolic events during the morning hours in diurnally active subjects has to be recognized and may be amenable to possible prevention. If an event has occurred, some of the hemostatic rhythms operative in this condition may also affect treatment.