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1. Coronary physiology
2. Exercise physiology
3. Events that precipitate acute coronary syndrome and angina
Acute coronary syndromes
Decreased exercise tolerance and worsening of angina symptoms during the winter months is a well-documented phenomenon among patients with coronary artery disease (CAD).1 There is a significant increased risk of acute myocardial infarction (AMI) with cold temperatures,2 even when taking into account confounding factors such as altered glucose and cholesterol levels and higher incidence of respiratory infections.3 ,4 When comparing seasonal differences in the northern and southern hemispheres, a higher incidence of AMI correlates with periods of cold weather in both hemispheres (figure 1).5 ,6 The risk of AMI in cold temperatures is further increased if exercise is being performed. Notable examples are shovelling snow7 and downhill skiing,8 which involve significant isometric exercise and dynamic exercise components. While epidemiological studies suggest a strong link between exercising in the cold and AMI, a causal relationship is yet to be demonstrated.
The exact mechanism by which cold increases the risk of AMI remains unclear. Proposed mechanisms include a myocardial oxygen supply and demand mismatch or an …
Contributors VM-S, RPW and CDG were involved in the writing and initial critical review of the manuscript. MSM, SRR and TP were involved in subsequent critical review.
Funding British Heart Foundation Clinical Training Fellowship awarded to Dr Williams grant number FS/11/90/29087. National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas’ National Health Service Foundation Trust and King's College London.
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.