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European Heart Journal Advance Access originally published online on January 23, 2008
European Heart Journal 2008 29(5):640-648; doi:10.1093/eurheartj/ehm584
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Work stress and coronary heart disease: what are the mechanisms?

Tarani Chandola1,*, Annie Britton1, Eric Brunner1, Harry Hemingway1, Marek Malik2, Meena Kumari1, Ellena Badrick1, Mika Kivimaki1 and Michael Marmot1

1 Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
2 Department of Cardiac and Vascular Sciences, St George’s University of London, London, UK

Received 1 August 2007; revised 14 November 2007; accepted 22 November 2007; online publish-ahead-of-print 23 January 2008.

* Corresponding author. Tel: +44 20 7679 5629, Fax: +44 20 7813 0242. Email: t.chandola{at}ucl.ac.uk

See page 579 for the editorial comment on this article (doi:10.1093/eurheartj/ehm641)

Aims: To determine the biological and behavioural factors linking work stress with coronary heart disease (CHD).

Methods and results: A total of 10 308 London-based male and female civil servants aged 35–55 at phase 1 (1985–88) of the Whitehall II study were studied. Exposures included work stress (assessed at phases 1 and 2), and outcomes included behavioural risk factors (phase 3), the metabolic syndrome (phase 3), heart rate variability, morning rise in cortisol (phase 7), and incident CHD (phases 2–7) on the basis of CHD death, non-fatal myocardial infarction, or definite angina. Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 (RR 1.68, 95% CI 1.17–2.42). There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability. Cross-sectionally, work stress was associated with a higher morning rise in cortisol. Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome.

Conclusion: Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.

Key Words: Work stress • Autonomic nervous system • Myocardial infarction • Angina • Coronary heart disease • Psychosocial


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