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. 2008 Mar;29(5):640-8.
doi: 10.1093/eurheartj/ehm584. Epub 2008 Jan 23.

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

Tarani Chandola  1 , Annie Britton, Eric Brunner, Harry Hemingway, Marek Malik, Meena Kumari, Ellena Badrick, Mika Kivimaki, Michael Marmot
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Free article

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

Tarani Chandola et al. Eur Heart J. 2008 Mar.
Free article

Abstract

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.

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