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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 Article has an altmetric score of 429

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 3

Example of a forced desynchrony protocol to separate the effects of the endogenous circadian system from the effects of daily behaviors.

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Example of a forced desynchrony protocol to separate the effects of the ...
(A) Over 15 days, lights are dim during wake periods and off during sleep periods to allow the circadian clock to tick at its own rate (usually slightly longer than 24 hours — shown here by the slowly drifting core body temperature minimum [CBTmin]). During the forced desynchrony portion (boxed in red), participants experience recurrent identical sleep/wake cycles evenly spread across the circadian cycle (here, each sleep episode is 6.67 hours and wake episode is 13.33 hours). Scheduled wake episodes are shown in yellow and sleep episodes are shaded gray. (B) Data are collected across the protocol. Model heart rate data are shown for one trial and plotted as a function of circadian time (left) or of time into each imposed 20-hour sleep/wake cycle (right). Note the relatively high heart rate during the wake episodes versus sleep episodes. (C) Raw data are averaged across different time scales to reveal endogenously rhythmic components and behaviorally elicited components. Here, despite identically scheduled behaviors in each wake episode, there is an overall approximately 24-hour rhythm, with low heart rate at the time of habitual sleep (left). As expected, heart rate is lower during (actual) sleep episodes than during waking episodes (right).

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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