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• W2912369781 abstract "We appreciate and thank Drs Takagi and Umamoto for their comments on our recent paper.1Manfredini R. Boari B. Gallerani M. Salmi R. Bossone E. Distante A. et al.Chronobiology of rupture and dissection of aortic aneurysms.J Vasc Surg. 2004; 40: 382-388Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar Speculation on the effects of climate upon health goes back to Hippocrates and his Air, Waters and Places. Considerable evidence supports the existence of a seasonal pattern with a significant winter peak for several vascular diseases, such as myocardial infarction, pulmonary embolism, and stroke.1Manfredini R. Boari B. Gallerani M. Salmi R. Bossone E. Distante A. et al.Chronobiology of rupture and dissection of aortic aneurysms.J Vasc Surg. 2004; 40: 382-388Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar The effects of ambient temperature on cardiovascular diseases have also been investigated. About three decades ago, Rogot and Padgett2Rogot E. Padgett S.J. Associations of coronary and stroke mortality with temperature and snowfall in selected areas of the United States, 1962–1966.Am J Epidemiol. 1976; 103: 565-575Crossref PubMed Scopus (141) Google Scholar analyzed the association of coronary heart disease and stroke mortality with temperature and snowfall in 32 standard metropolitan areas of the United States. They found an inverse relationship between temperature and mortality with differences between area to area, suggesting the importance of a relative as well as an absolute level of temperature. Cold exposure determines an increase in sympathetic activity and blood pressure (BP) values, with a significant negative correlation between ambient temperature and BP.1Manfredini R. Boari B. Gallerani M. Salmi R. Bossone E. Distante A. et al.Chronobiology of rupture and dissection of aortic aneurysms.J Vasc Surg. 2004; 40: 382-388Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar It is not so obvious, however, that BP, temperature, and climatic parameters run together. Daytime temperature and 24-hour temperature, but not barometric pressure, for example, are inversely associated with systolic BP variability.3Jehn M. Appel L.J. Sacks F.M. Miller 3rd, E.R. and DASH Collaborative Research GroupThe effect of ambient temperature and barometric pressure on ambulatory blood pressure variability.Am J Hypertens. 2002; 15: 941-945Crossref PubMed Scopus (79) Google Scholar A French study,4Larcan A. Lambert H. Stoltz J.F. Laprevote-Heuilly M.C. Kempf J.B. Lambert J. Parametètres climatologique et survenue d’accidents vasculaires aigus, neurologiques et cardiaques.Rev Epidèm Santè Pub. 1982; 30: 343-354PubMed Google Scholar investigated the correlation between climate and the occurrence of stroke and myocardial infarction. It analyzed a series of climatologic parameters (atmospheric pressure, air temperature, relative humidity, speed and direction of the winds, hydrometeors and electrometeors) together with parameters of solar and ionospheric activity (daily flare index, index of the geomagnetic activity, daily planetary index, and phases of the moon). The frequency of vascular accidents increased when air temperature was <12°C, when there was hoar-frost with fog, rain, or snow; and when the daily flare index was <550. As for aortic aneurysms, we do know little compared with myocardial infarction or stroke. And probably we do know even less about abdominal compared with thoracic aneurysms. With regard to acute aortic dissection, we know that a seasonal pattern in occurrence with a winter peak exists.1Manfredini R. Boari B. Gallerani M. Salmi R. Bossone E. Distante A. et al.Chronobiology of rupture and dissection of aortic aneurysms.J Vasc Surg. 2004; 40: 382-388Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar Moreover, analysis of the data from the International Registry of Acute Aortic Dissection, which includes 15 centers with wide climate variations from Canada, United States, Norway, Germany, Spain, Italy, Israel, and Japan, showed that this winter peak is independent of the varying climatic conditions at different geographic locations.5Mehta R.H. Manfredini R. Bossone E. Fattori R. Evangelista A. Cooper J.V. The winter peak in the risk of acute aortic dissection is independent of the varying climatic conditions at different geographical locations [abstract]. Circulation, 2004Google Scholar Although the data by Takagi and Umamoto are very interesting, since they first look for a possible relationship between daylight span, BP, and abdominal aortic aneurysm rupture, one needs to recognize that there is significant colinearity between seasons and daylight time. Thus, we feel that the finding of the association of worse outcomes by Takagi and Unamoto is not far from our observation. Furthermore, although the possible effects of daylight on BP have not been extensively investigated so far in humans, the study by Takagi and Unamoto involves a very small number of patients over an extended period of time (130 cases >15 years, average <1 case/month), and it is somewhat difficult to draw a definitive conclusion from it. Further studies on larger samples of cases collected at different geographic areas are needed to confirm the hypothesis generated by their study. Abdominal aortic aneurysm prefers to rupture on a dim dayJournal of Vascular SurgeryVol. 41Issue 4PreviewWe read with great interest the review by Manfredini et al (J Vasc Surg 2004;40:382–8) concerning the chronobiology of acute aortic rupture or dissection. Several investigators have studied the seasonal variation in abdominal aortic aneurysm (AAA) rupture over the last decade, and most available studies indicate a greater occurrence of AAA rupture during the fall, and especially during the winter months. Full-Text PDF Open Archive" @default.
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