Letter to the Editor

Dear Editor,

We read the article “The effect of Ramadan fasting on circadian variation of Turkish patients with acute myocardial infarction” written by Turker et al. with interest [1]. The authors [1] aimed to evaluate the effect of Ramadan fasting on circadian variation of acute ST-elevation myocardial infarction (STEMI) in Turkish patients. We believe that these findings will act as a guide for further studies that will assess circadian variation of patients with STEMI.

Rapid restoration of the blood flow in the coronary artery occluded by thrombus is a cornerstone of treatment in patients with STEMI [2]. The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. It is well established that the circadian rhythm influences cardiovascular system physiology, inducing diurnal variations of blood pressure, heart rate, cardiac output and endothelial function among other physiological parameters. Different circadian periodicity in the time of onset of STEMI was found regarding infarction site. This may be related to genetic and demographic characteristics of the Turkish population.

The circadian periodicity may influence the cardiovascular system physiology including the blood pressure, heart rate, cardiac output and endothelial function in fasting patients with STEMI [3]. So, we think that if these features of patients are measured at the same time, there may be different results in this study. A second challenge is that further studies are needed to define the role of Ramadan fasting to affect the circadian clock.

Finally, the time of onset of STEMI may be related to different circadian periodicity. Therefore, it might be useful if the authors provided information about their patients’ time of onset of STEMI.



References  

1. Turker Y, Aydin M, Aslantas Y, et al. The effect of Ramadan fasting on circadian variation of Turkish patients with acute myocardial infarction. Postep Kardiol Inter 2012; 3: 193-198.  2. Madżitow HH, Alimow DA. Assessment of the efficacy of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction based on the ECG analysis. Postep Kardiol Inter 2011; 4: 292-296.  3. Suárez-Barrientos A, López-Romero P, Vivas D, et al. Circadian variations of infarct size in acute myocardial infarction. Heart 2011; 97: 970-976.


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