Circadian and behavioral factors of cardiovascular risk

描述(由申请人提供)：许多流行病学研究已经证实，上午9点左右心血管不良事件的发生率高得不成比例(例如，心脏性猝死、心肌梗死)。这些机制大致被归因于在一天中的特定时间发生的行为应激源(例如，姿势或活动的改变)。但是，体内生物钟(昼夜节律起搏器)在这种昼夜模式中的独立作用从未被用适当的技术研究过。我们的初步数据显示，某些心血管风险标志物存在明显的内源性昼夜节律，这可能与不良心血管事件的昼夜模式有关。因此，我们有两个具体的目标：(1)确定昼夜节律起搏器对心血管危险标记物的影响(独立于行为)；(2)确定昼夜节律和行为对心血管危险标记物的影响之间的交互作用(即，行为应激源在昼夜不同阶段产生不同影响的交互作用)。为了实现这些目标，我们将利用一项为期12天的强化“强制去同步”方案，在该方案中，受试者的标准化行为和睡眠发生在生理周期的所有阶段。由于这将是这一领域的第一项正式研究，我们将首先研究健康人，以确定可能与心血管风险的昼夜模式有关的正常人体生理节律和反应。在协议期间，标准化的行为应激源包括姿势(倾斜桌子)、活动(自行车锻炼)和睡眠/醒来状态的变化。可能导致易患心血管事件的措施包括(I)自主神经系统活动(儿茶酚胺、交感-迷走神经平衡)；(Ii)血液动力学因素(心率、血压)；(Iii)止血因素(血小板聚集性和计数)；以及(Iv)血管内皮功能(血流介导的血管扩张)。根据初步数据，我们预计行为应激源将在昼夜周期的特定阶段产生不同的影响，揭示特定行为的脆弱时间(可能对应于流行病学研究中心血管易损性的峰值)。这个项目可能最终帮助我们在行为改变和定时药物干预方面使心血管疾病的时间生物学治疗合理化。

DESCRIPTION (provided by applicant): Numerous epidemiological studies have established that there is a disproportionately high frequency of adverse cardiovascular events around 9 AM (e.g., sudden cardiac death, myocardial infarction). The mechanisms have been loosely attributed to behavioral stressors occurring at specific times of day (e.g., change in posture or activity). But, the independent role of the internal body clock (circadian pacemaker) in this day/night pattern has never been studied with appropriate techniques. Our preliminary data show a marked endogenous circadian rhythm in some markers of cardiovascular risk that may be implicated in the day/night pattern of adverse cardiovascular events. Thus, we have two Specific Aims: (1) Determine the effect upon cardiovascular risk markers of the circadian pacemaker (independent from behaviors); (2) Determine the interaction between circadian and behavioral influences upon cardiovascular risk markers (i.e., an interaction by which behavioral stressors have different effects at different circadian phases). To achieve these aims, we will utilize an intensive 12-day "Forced Desynchrony" protocol, wherein subjects' standardized behaviors and sleep occur at all phases of the circadian cycle. As this will be the first formal study in this area, we will begin by studying healthy individuals to define the normal human physiological rhythms and responses that could be implicated in the day/night pattern of cardiovascular risk. During the protocol standardized behavioral stressors include changes in posture (tilt table), activity (bicycle exercise) and sleep/wake state. The measures that can be implicated in triggering adverse cardiovascular events in vulnerable individuals, will include (i) autonomic nervous system activity (catecholamines, sympatho-vagal balance); (ii) hemodynamic factors (heart rate, blood pressure); (iii) Hemostatic factors (platelet aggregability and count); and (iv) vascular endothelial function (flow mediated vasodilatation). Based on preliminary data, we anticipate that behavioral stressors will have different effects at specific phases of the circadian cycle revealing vulnerable times for certain behaviors (likely corresponding to the peak in cardiovascular vulnerability from epidemiological studies). This project may ultimately help us to rationalize chronobiological therapies for cardiovascular diseases in terms of modification of behavior and timed pharmacological intervention.