TY - JOUR
T1 - Seasonal Variations in the Pathogenesis of Acute Coronary Syndromes
AU - Kurihara, Osamu
AU - Takano, Masamichi
AU - Yamamoto, Erika
AU - Yonetsu, Taishi
AU - Kakuta, Tsunekazu
AU - Soeda, Tsunenari
AU - Yan, Bryan P.
AU - Crea, Filippo
AU - Higuma, Takumi
AU - Kimura, Shigeki
AU - Minami, Yoshiyasu
AU - Adriaenssens, Tom
AU - Boeder, Niklas F.
AU - Nef, Holger M.
AU - Kim, Chong Jin
AU - Thondapu, Vikas
AU - Kim, Hyung Oh
AU - Russo, Michele
AU - Sugiyama, Tomoyo
AU - Fracassi, Francesco
AU - Lee, Hang
AU - Mizuno, Kyoichi
AU - Jang, Ik-Kyung
PY - 2020
Y1 - 2020
N2 - Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (P=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (P=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
AB - Background Seasonal variations in acute coronary syndromes (ACS) have been reported, with incidence and mortality peaking in the winter. However, the underlying pathophysiology for these variations remain speculative. Methods and Results Patients with ACS who underwent optical coherence tomography were recruited from 6 countries. The prevalence of the 3 most common pathologies (plaque rupture, plaque erosion, and calcified plaque) were compared between the 4 seasons. In 1113 patients with ACS (885 male; mean age, 65.8±11.6 years), the rates of plaque rupture, plaque erosion, and calcified plaque were 50%, 39%, and 11% in spring; 44%, 43%, and 13% in summer; 49%, 39%, and 12% in autumn; and 57%, 30%, and 13% in winter (P=0.039). After adjusting for age, sex, and other coronary risk factors, winter was significantly associated with increased risk of plaque rupture (odds ratio [OR], 1.652; 95% CI, 1.157-2.359; P=0.006) and decreased risk of plaque erosion (OR, 0.623; 95% CI, 0.429-0.905; P=0.013), compared with summer as a reference. Among patients with rupture, the prevalence of hypertension was significantly higher in winter (P=0.010), whereas no significant difference was observed in the other 2 groups. Conclusions Seasonal variations in the incidence of ACS reflect differences in the underlying pathobiology. The proportion of plaque rupture is highest in winter, whereas that of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence. Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT03479723.
KW - optical coherence tomography
KW - plaque erosion
KW - plaque rupture
KW - season
KW - optical coherence tomography
KW - plaque erosion
KW - plaque rupture
KW - season
UR - http://hdl.handle.net/10807/166636
U2 - 10.1161/JAHA.119.015579
DO - 10.1161/JAHA.119.015579
M3 - Article
SN - 2047-9980
VL - 9
SP - e015579-N/A
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
ER -