CAN HEAVY MEALS AND BREAKFAST PREDISPOSE HEART ATTACK ?

Acute myocardial infarction (AMI) is a highly dynamic event, which is associated with marked neuroendocrinological dysfunction apart form heart damage. The immediate trigger for heart attack is not known exactly. There is a marked increase in sympathetic activity, oxidative stress and deficiency of minerals as well as antioxidants, during heart attack. Clinical studies have reported an increased incidence of reinfarction, sudden death, coronary constriction, myocardial ischaemia and angina, during first quarter of the day when there is rapid withdrawal of vagal activity and increase in sympathetic tone. In one case control study, among 202 patients of heart attack, there was a significant (P<0.02) increase in cardiac events in the second quarter of the day (6-12hours) compared to other quarters respectively (16.8%, 41.0%, 13.8%,28.2%). This characteristic remained common in both men and women and among patients with and without known heart attack (n=52), diabetes (n=53) and hypertension (n=75). Triggers of heart attack were noted among 162 (82.2%) of the patients. Brain related and psychological mechanisms were; emotional stress (45.5%), sleep deprivation (27.7%), cold climate (29.2%), hot climate (24.7%), large meals (47.5%) and physical exertion (31.2%). These triggering factors are known to enhance sympathetic activity and decrease vagal tone, resulting into increased secretion of plasma cortisol, noradrenaline, aldosterone, angiotension converting enzyme, interleukin-1,2,6,18 and tumor necrosis factor-alpha, that are pro-inflammatory. There is also a deficinency in the serum levels of vitamin A, E, C, coenzyme Q10 and magnesium, potassium, melatonin, interleukin-10 (anti-inflammatory) and increase in TBARS, MDA and diene conjugates, TNF- alpha and IL-6 which are indictors of oxidative damage and pro-inflammatory respectively. It is not clear whether the predisposition of ACS is due to size of the meals or proinflammatory content of meals. Keywords: Large meals, breakfast, trans fatty acids, cytokines, lipoproteins, glucose.