166 The Open Nutraceuticals Journal, 2010, 3, 166-173 1876-3960/10 2010 Bentham Open Open Access Potential Chonobiological Triggering Factors of Acute Heart Attack M. Chibisov Sergey 1 , Semen I Rapoport 2 , Radjhesh K Agarval 2 , Ram B Singh 3, * , Fabien De Meester 3 , Agnieszka Wilkzynska 3 , Viola Vargova 4 , Daniel Pella 4 and Kuniaki Otsuka 5 1 Department of Internal Medicine, People’s Friendship University of Russia, Moscow, Russia 2 Department of Internal Medicine, Academician of Russian Medical Technical Academy, Moscow, Russia 3 Department of Internal Medicine, Tsim Tsoum Institute, Krakow, Poland 4 Faculty of Medicine, Safaric University, Kosice, Slovakia 5 Department of Internal Medicine, Tokyo Womens Medical University Medical Centre, Tokyo, Japan Abstract: The immediate triggers of acute heart attack or acute coronary syndrome (ACS) are not known exactly. There is a marked increase in sympathetic activity, neuroendocrino- logical dysfunction, oxidative stress and deficiency of 3 fatty acids, vitamins, minerals, as well as antioxidants during ACS. Energy intake and expenditure have diurnal variation throughout 24- hour cycle and any disturbance in this cycle may result into disruption of the endogenous clock and neuro- humoral dysfunctions. Clinical studies have reported an increased incidence of reinfarction, sudden death, coronary con- striction, myocardial ischaemia, vascular variability disorders and angina, during second quarter of the 24 hour cycle, at the point where there is rapid withdrawal of vagal activity and increase in sympathetic tone. In several studies, among pa- tients with heart attack, there was a significant 2-3 fold increase in cardiac events in the second quarter of the day (6-12 hours) compared to other quarters respectively. Triggers of heart attack were noted in up to 80.0% of patients in various studies. Brain related and psychological mechanisms, i.e., emotional stress, sleep deprivation, cold climate, hot climate, large meals and physical exertion were observed among 30-50% of patients. Such triggers have also been reported in Europe, North America and Asia. These triggering factors are known to enhance sympathetic activity and decrease vagal tone, resulting into increased secretion of plasma cortisol, noradrenaline, aldosterone, angiotensin converting enzyme, interleukin-1, 2, 6, 18 and tumor necrosis factor-alpha, that are proinflammatory. There is also a deficiency in the serum levels of 3 fatty acids, vitamin A, E, C, coenzyme Q10, magnesium, potassium, melatonin, interleukin-10 (anti- inflammatory) and increase in TBARS, MDA, diene conjugates, TNF-alpha and IL-6, which are indicators of oxidative damage and inflammation, respectively. It is not clear whether the predisposition of ACS is due to size of the meals or other proinflammatory factors of meals. Keywords: Large meals, breakfast, trans fatty acids, cytokines, lipoproteins, glucose, acute coronary syndrome, myocardial infarction, immediate triggers. INTRODUCTION Life on earth is governed by the 24 hour day, and the continuous 24-hour cycle of light and darkness, which may be associated with marked diurnal variations in energy intake and expenditure, throughout this 24-hour cycle [1-3]. Any disturbance in this environmental cycle and/or in the molecu- lar mechanisms that sustain this cycle may add a third dimension to the equation. Apart from these mechanisms, there are seasonal variations in the functioning of the endogenous clock, which may have a role in metabolic responses to seasonal availability of food and the develop- ment of obesity, acute coronary syndrome (ACS), stroke and possibly metabolic syndrome in the winters, which may be *Address correspondence to this author at the Halberg Hospital and Research Institute, Civil Lines, Moradabad-10(UP) 244001, India; Tel/Fax: 0091 591 2417437; E-mails: icn2005@sancharnet.in, drkk@dataone.in, rbs@tsimtsoum.net due to short term adaptation aimed at keeping the organism alive when food was not available during winters in the an- cient time [2-7]. The exact mechanism and the immediate triggers of ACS and stroke are not known [2-8]. Clinical manifestations of these attacks also do not occur at random clock times, but according to a time structure [1-7]. Adverse effects of the diet were known to Indians from the ancient times, which is evident from the following verse from an ancient scripture Bhagwatgeeta. ”Foods which are bitter, acid, salted, burnt, fried and punjent give rise to pain, mental stress and diseases”(3100BC). Charaka (600BC), a great physician of India, knew about the role of diet and lifestyle in the pathogenesis of heart attack, which would be clear from the following verse: “Heart attack is born by the intake of fatty meals, overeating, excess of sleep, lack of exercise and anxiety”. Charaka Sutra, 600BC. While Charaka belonged to a family of mainly preists, Sushruta was from a family of warriors. Charaka was supposed to live