Introduction to special issue

On the clock

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Science  25 Nov 2016:
Vol. 354, Issue 6315, pp. 986-987
DOI: 10.1126/science.354.6315.986

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  • RE: Introduction to Special Issue. On the clock. Ray and Travis 986-987.
    • Tami A. Martino, Associate Professor, Director, Centre for Cardiovascular Investigations, Biomedical Sciences OVC, University of Guelph, Ontario, Canada
    • Other Contributors:
      • Martin E. Young, Professor of Medicine, Vice Director of Research, Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham Alabama USA

    Circadian Medicine
    Congratulations on an excellent, and in our view, overdue special issue on circadian physiology (25 November 2016). One caveat we wish to highlight is that the otherwise comprehensive survey neglected to mention the translational applications to clinical medicine, particularly with respect to cardiovascular disease (CVD). We, and others, actively investigate how the heart’s circadian rhythms impact potential treatment strategies.(1, 2) For example, timing of therapy (chronotherapy) with angiotensin converting enzyme inhibitors (ACEi) at sleep time decreases remodeling in pressure-overload induced cardiac hypertrophy, while restricting food intake to the awake time improves cardiac function, in mice.(3-5) Moreover, the vast majority of best-selling drugs and world health organization essential medicines target the products of circadian genes, and likely benefit from timed dosage.(6) We are also aware of many colleagues performing groundbreaking work in applying chronotherapy to clinical medicine; recent successes relevant to clinical cardiology include administration of evening antihypertensives,(7) aspirin at night,(8) nocturnal hemodialysis,(9) and nocturnal CPAP therapy.(10)

    Evidence is also emerging that circadian disruption in intensive and coronary care units may hamper recovery. Inadvertent noise, constant light, and frequent patient-staff interactions conspire to disturb sleep and circadian rhythms in acutely ill patients.(11, 12) Tol...

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    Competing Interests: None declared.

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