Circadian rhythms in cardiac gene expression.

Circadian rhythms in blood pressure, heart rate, and cardiac output have been intensely studied, largely due to the well-documented phenomenon of increased cardiovascular death in the early hours of the morning. Circadian rhythmicity in both cardiovascular physiology and pathophysiology has been attributed primarily to diurnal variations in neurohumoral factors, such as sympathetic activity. It has become increasingly apparent that the intrinsic properties of the heart (seen at the level of gene and protein expression, energy metabolism, and contractile function) show significant fluctuations during the course of the day. These changes might be due to extracardiac (eg, neurohumoral factors) and/or intracardiac (eg, circadian clocks) influences. Circadian clocks are transcriptionally based, molecular mechanisms that enable the cell to anticipate diurnal variations in environmental stimuli. The cardiac circadian clock synchronizes responsiveness of the heart to diurnal variations in its environment, and impairment of this mechanism might contribute to the pathogenesis of cardiovascular disease.