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Role of the circadian system in cardiovascular disease
Saurabh S. Thosar, … , Matthew P. Butler, Steven A. Shea
Saurabh S. Thosar, … , Matthew P. Butler, Steven A. Shea
Published June 1, 2018
Citation Information: J Clin Invest. 2018;128(6):2157-2167. https://doi.org/10.1172/JCI80590.
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Review

Role of the circadian system in cardiovascular disease

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Abstract

All species organize behaviors to optimally match daily changes in the environment, leading to pronounced activity/rest cycles that track the light/dark cycle. Endogenous, approximately 24-hour circadian rhythms in the brain, autonomic nervous system, heart, and vasculature prepare the cardiovascular system for optimal function during these anticipated behavioral cycles. Cardiovascular circadian rhythms, however, may be a double-edged sword. The normal amplified responses in the morning may aid the transition from sleep to activity, but such exaggerated responses are potentially perilous in individuals susceptible to adverse cardiovascular events. Indeed, the occurrence of stroke, myocardial infarction, and sudden cardiac death all have daily patterns, striking most frequently in the morning. Furthermore, chronic disruptions of the circadian clock, as with night-shift work, contribute to increased cardiovascular risk. Here we highlight the importance of the circadian system to normal cardiovascular function and to cardiovascular disease, and identify opportunities for optimizing timing of medications in cardiovascular disease.

Authors

Saurabh S. Thosar, Matthew P. Butler, Steven A. Shea

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Figure 2

Conceptual model showing interactions between behavioral stressors, circadian timing, and individual susceptibility to cardiovascular risk.

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Conceptual model showing interactions between behavioral stressors, circ...
There is a constant interaction between behavioral stressors (e.g., exercise), circadian phases, and underlying individual risk. This results in resting physiological rhythms (e.g., blood pressure) and reactivity of those rhythms in the presence of stressors. In a healthy individual, the resting physiological rhythms are within normal limits and the reactivity to a stressor (upward-pointing arrows) is modest, such that the theoretical risk threshold for an adverse cardiovascular event is not crossed. However, in an individual susceptible to cardiovascular risk due to existing anatomical or physiological maladaptation, resting physiological rhythms may be elevated. Furthermore, in the presence of a stressor, the reactivity of physiological rhythms may be exaggerated and can cross the theoretical risk threshold for an adverse cardiovascular event such as stroke.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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