CIRCADIAN VARIATIONS IN CORONARY HEART-DISEASE

There is no doubt on circadian rhythm of coronary events. They depend upon rhythmic changes in the function of endothelium, of blood-cell clotting, aggregation of platelets and rheological behaviour of blood, all influenced by circadian rhythm of catecholamine levels. Epinephrine- and norepinephrine increase is caused by body activity in the morning, again according to sleep-awake-rhythm by interrelation of prostaglandin D2 and E2. As seen in other fields of internal medicine referring chronopharmacological aspects treatment of coronary heart disease should involve those forms of drug application. Most important for CHD patients is to take beta-blockers and nitrates after sleep before moving into an upright position. Other drugs as calcium antagonists, molsidomine, ACE inhibitors and aspirin are able to be taken individually over the active day phase. Application form ,,before coming into upright position" is independent of day time, especially considering shift workers.