Sleeping Pills may Increase the Risk of Heart Damage

A common drug that makes patients sleepy and less anxious before surgery is associated with an increased risk of heart damage when operations are performed at night, according to a study published in the journal Frontiers of Cardiovascular Medicine. Researchers at the University of Colorado School of Medicine performed a large dataset analysis and demonstrated that administering midazolam is associated with an increased risk of heart injury when given during the night. This is significant because these findings could have tremendous implications for patient mortality.

Timing of Sedative Drug Matters for Heart Health

Giving drugs at certain times of day to better match with circadian rhythm. Previous studies have shown that intense light can help heal damaged hearts and specific proteins beneficial to health are expressed more strongly at different times of the day.

In this study, researchers used the vast Multicenter Perioperative Outcomes Group to analyze 1,773,118 cases in which the sedative midazolam was given to 951,345 subjects. Of those, 16,404 met the criteria for myocardial injury or MINS.

Although there was no association between giving the drug and the risk of heart damage in the study population as a whole, researchers discovered that the time the drug was given was significant.

“We found a strong association between midazolam administration and risk of MINS when the surgery occurred at night or with healthier patients,” said the study’s senior author Tobias Eckle, MD, Ph.D., professor of anesthesiology at the University of Colorado School of Medicine.

Does Effect of Sedative Drug Given During Surgery on the Heart

The reasons are unclear but may lie within the PER2 gene, a light-regulated protein that Eckle said helps protect the heart from injury. In mouse studies, researchers found a link between midazolam, circadian protein expression, and heart ischemia.

The drug increases the neurotransmitter GABA which inhibits certain brain signals to produce a calming effect. That in turn can lessen the expression of higher nighttime levels of PER2. As the levels decrease, the heart may become more susceptible to injury when the midazolam is given at night rather than during the day.

The timing of the drug is understudied and this new study may hold clues to more effective use of routine therapies. Researchers believe new drugs should be tested for the best time of day to be used. Drugs are often administered according to what’s most efficient. But what is most efficient, may in the end cause damage.

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Source-Eurekalert