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Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women
Open accessAbstract
Importance Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. Objective To determine whether rotating night shift work is associated with CHD risk. Design, Setting, and Participants Prospective cohort study of 189 158 initially healthy women followed up over 24 years in the Nurses’ Health Studies (NHS [1988-2012]: N = 73 623 and NHS2 [1989-2013]: N = 115 535). Exposures Lifetime history of rotating night shift work (≥3 night shifts per month in addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2). Main Outcomes and Measures Incident CHD; ie, nonfatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents, and angioplasty. Results During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at baseline, 54.5 years) and 3519 cases in the NHS2 (mean age, 34.8 years). In multivariable-adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work were associated with a significantly higher CHD risk in both cohorts. In the NHS, the age-standardized incidence rate (IR) for less than 5 years of rotating night shift work per 100 000 person-years was 435.1 (hazard ratio [HR], 1.02; 95% CI, 0.97-1.08); the IR for 5 to 9 years of rotating night shift work was 525.7 (HR, 1.12; 95% CI, 1.02-1.22); and the IR for 10 years or more of rotating night shift work was 596.9 (HR, 1.18; 95% CI, 1.10-1.26;P<.001 for trend) vs an IR of 425.5 in women who never worked rotating night shifts. In the NHS2, the IR for less than 5 years was 130.6 (HR, 1.05; 95% CI, 0.97-1.13); the IR for 5 to 9 years was 151.6 (HR,1.12; 95% CI, 0.99-1.26); and the IR for 10 years or more was 178.0 (HR, 1.15; 95% CI, 1.01-1.32;P = .01 for trend) vs an IR of 122.6 in women who never worked rotating night shifts. In the NHS, the association between duration of rotating night shift work and CHD was stronger in the first half of follow-up (IR for <5 years, 382.4; HR, 1.10 [95% CI, 1.01-1.21]; IR for 5-9 years, 483.1; HR, 1.19 [95% CI, 1.03-1.39]; and IR for ≥10 years, 494.4; HR, 1.27 [95% CI, 1.13-1.42];P<.001 for trend) than in the second half (IR for <5 years, 424.8; HR, 0.98 [95% CI, 0.92-1.05]; IR for 5-9 years, 520.7; HR, 1.08 [95% CI, 0.96-1.21]; IR for ≥10 years, 556.2; HR, 1.13 [95% CI, 1.04-1.24];P = .004 for trend;P = .02 for interaction), suggestive of waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in the NHS2 (P<.001 for trend). Conclusions and Relevance Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics.
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“Long-term desynchronization of circadian rhythms is associated with adverse metabolic health effects, including weight gain, increased body fat, obesity, impaired glucose tolerance, insulin resistance, higher blood pressure, and elevated cholesterol levels, as well as elevated risk for cardiovascular diseases, diabetes, and metabolic syndrome (18, 47–54).”
From Meal timing and its role in obesity and associated diseases (2024) · cites this paper as [53]
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Rotating Night Shift Work and Healthy Aging After 24 Years of Follow-up in the Nurses' Health Study
Shi, H., Huang, T., Schernhammer, E. S., Sun, Q., & Wang, M. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.10450 · Cited by 67
Self-citationThe Effect of Circadian and Sleep Disruptions on Obesity Risk
Noh, J. H. (2018) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes.2018.27.2.78 · Cited by 63
Larsen, A. D., Ropponen, A., Hansen, J., Hansen, Å. M., Kolstad, H. A., Koskinen, A., Härmä, M., & Garde, A. H. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103639 · Cited by 59
Reed, J. L., Prince, S. A., Pipe, A., Attallah, S., Adamo, K. B., Tulloch, H. E., Manuel, D. G., Mullen, K., Fodor, G. J., & Reid, R. D. (2018) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2018.02.001 · Cited by 58
Impact of Shift Work on the Circadian Timing System and Health in Women
Kervezee, L., Shechter, A., & Boivin, D. B. (2018) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2018.04.003 · Cited by 60
Circadian Influences on Myocardial Ischemia-Reperfusion Injury and Heart Failure
Eckle, T. D. L. G., Bertazzo, J., Khatua, T. N., Tabatabaei, S. R. F., Bakhtiari, N. M., Walker, L. A., & Martino, T. A. (2024) · Circulation Research · doi:10.1161/circresaha.123.323522 · Cited by 57
“…and gut microbiome composition, 43 all of which play critical roles in post-MI cardiac repair and the progression of HF. Interestingly, despite CLOCK’s involvement in obesity and metabolic functions, Clock Δ 19/ Δ 19 mice resist developing heart disease when challenged with a chronic high-fat diet.”
BackgroundThe Case for Permanent Residency for Frontline Workers
Gerver, M. (2021) · American Political Science Review · doi:10.1017/s0003055421000708 · Cited by 54
“Firefighters, soldiers, and even nurses who work night shifts often assume substantial risks while helping citizens (Vetter et al. 2016), as do some nonmigrants abroad.”
BackgroundHo, F. K. W., Celis-Morales, C. A., Gray, S. R., Demou, E., Mackay, D., Welsh, P. I., Katikireddi, S. V., Sattar, N. A., & Pell, J. P. (2021) · International Journal of Epidemiology · doi:10.1093/ije/dyab144 · Cited by 54
“8 However, the mechanisms by which shift work may cause CVD are still elusive.”
BackgroundZhang, H., Wang, J., Zhang, S., Tong, S., Hu, J., Che, Y., Zhuo, L., Wang, P., Geng, R., Zhou, Y., et al. (2023) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-023-02014-2 · Cited by 59
“In the Nurses’ Health Study (NHS), a longer rotating night shift work was associated with the risk of coronary heart disease and type 2 diabetes (Shan et al. 2018; Vetter et al. 2016).”
BackgroundInfluentialSleep and circadian rhythms: pillars of health—a Keystone Symposia report
Cable, J., Schernhammer, E. S., Hanlon, E. C., Vetter, C., Cedernaes, J., Makarem, N., Dashti, H. S., Shechter, A., Depner, C. M., Ingiosi, A. M., et al. (2021) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.14661 · Cited by 51
Self-citationCircadian rhythms in cardiovascular (dys)function: approaches for future therapeutics
Lecacheur, M., Ammerlaan, D. J. M., & Dierickx, P. (2024) · npj Cardiovascular Health · doi:10.1038/s44325-024-00024-8 · Cited by 63
McHill, A. W., Hull, J. T., & Klerman, E. B. (2022) · Nutrients · doi:10.3390/nu14091800 · Cited by 61
The effects of phytochemicals on circadian rhythm and related diseases
Xu, T., & Lu, B. (2018) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2018.1493678 · Cited by 53
“Epidemiological evidence shows that shift-work is a risk factor for coronary heart disease (CHD) (Vetter et al. 2016; Havakuk et al. 2018), stroke (Li, Huang, Tan, Yang, and Tang 2016; Brown et al.”
BackgroundInfluentialNight shift work and abnormal liver function: is non-alcohol fatty liver a necessary mediator?
Wang, F., Zhang, L., Wu, S. Y., Li, W., Sun, M., Feng, W., Ding, D., Wong, S. Y. S., Zhu, P., Evans, G. J., et al. (2018) · Occupational and Environmental Medicine · doi:10.1136/oemed-2018-105273 · Cited by 50
Shift work and ischaemic heart disease: meta-analysis and dose–response relationship
Cheng, M., He, H., Wang, D., Xu, L., Wang, B., Ho, K. M., & Chen, W. (2019) · Occupational Medicine · doi:10.1093/occmed/kqz020 · Cited by 49
Effect of night-shift work on cortisol circadian rhythm and melatonin levels
Brum, M. C. B., Senger, M. B., Schnorr, C. C., Ehlert, L. R., & Rodrigues, T. D. C. (2022) · Sleep Science · doi:10.5935/1984-0063.20220034 · Cited by 47
“In addition, it is implicated in higher rates of metabolic disorders and cardiovascular diseases 2-5 .”
BackgroundNapping on night‐shifts among nursing staff: A mixed‐methods systematic review
Li, H., Shao, Y., Xing, Z., Li, Y., Wang, S., Zhang, M., Ying, J., Shi, Y., & Sun, J. (2018) · Journal of Advanced Nursing · doi:10.1111/jan.13859 · Cited by 47
Shift work and incidence of dementia: A Danish Nurse Cohort study
Jørgensen, J. T., Hansen, J., Westendorp, R. G. J., Nabe‐Nielsen, K., Stayner, L. T., Simonsen, M. K., & Andersen, Z. J. (2020) · Alzheimer s & Dementia · doi:10.1002/alz.12126 · Cited by 47
Fritz, J., Phillips, A., Hunt, L., Imam, A., Reid, K., Perreira, K., Mossavar-Rahmani, Y., Daviglus, M., Sotres-Alvarez, D., Zee, P., et al. (2020) · Sleep · doi:10.1093/sleep/zsaa218 · Cited by 36
“Exposure to rotating shift work schedules, which results in irregular sleep schedules and circadian disruption [14], increases the risk of diabetes and GMDs, suggesting regular sleep schedules may be important for metabolic health [15, 16].”
BackgroundSelf-citationVidafar, P., Gooley, J. J., Burns, A. C., Rajaratnam, S. M. W., Rueger, M., Van Reen, E., Czeisler, C. A., Lockley, S. W., & Cain, S. W. (2018) · Sleep · doi:10.1093/sleep/zsy098 · Cited by 46
Extracellular Vesicles: Potential Participants in Circadian Rhythm Synchronization
Tao, S., & Guo, S. (2018) · International Journal of Biological Sciences · doi:10.7150/ijbs.26518 · Cited by 44
“of malignant tumours, diabetes, and cardiomyopathy [19-25].”
Crowther, M. E., Ferguson, S. A., Vincent, G. E., & Reynolds, A. C. (2021) · Clocks & Sleep · doi:10.3390/clockssleep3010009 · Cited by 42
Shift work disorder, mental health and burnout among nurses: A cross‐sectional study
Cheng, H. L., Guangbi, L., Yang, J., Wang, Q., & Yang, H. L. (2022) · Nursing Open · doi:10.1002/nop2.1521 · Cited by 54
“SWD may induce a variety of undesirable health outcomes, such as type 2 diabetes (Anothaisintawee et al., 2016), coronary artery disease (Vetter et al., 2016), abdominal obesity (Sun et al., 2018), breast cancer (Straif et al., 2007), nurses who work shifts and long hours are at risk of fatigue,…”
BackgroundMentzelou, M., Papadopoulou, S. Κ., Papandreou, D., Spanoudaki, M., Dakanalis, A., Vasios, G. K., Voulgaridou, G., Pavlidou, E., Mantzorou, M., & Giaginis, C. (2023) · Metabolites · doi:10.3390/metabo13030370 · Cited by 46
The Impact of the Circadian Genes CLOCK and ARNTL on Myocardial Infarction
Škrlec, I., Milić, J., & Steiner, R. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9020484 · Cited by 41
Association between circadian disruption and diseases: A narrative review
Hou, Y., Liu, L.-M., Chen, X., Li, Q., & Li, J. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.118512 · Cited by 48
Cho, H., Sagherian, K., & Steege, L. M. B. (2021) · Workplace Health & Safety · doi:10.1177/2165079920987543 · Cited by 45
“Night shift nurses experience sleep loss, sleepiness, fatigue, and performance decrements and are at high risk for sickness absences, adverse health outcomes, and drowsy driving incidents (Akerstedt & Wright, 2009; Dall’Ora et al., 2020; Geiger-Brown et al., 2012; Scott et al., 2007; Vetter et al., 2016).”
BackgroundReid, K. J., Weng, J. F., Ramos, A. R., Zee, P. C., Daviglus, M. L., Mossavar‐Rahmani, Y., Sotres‐Alvarez, D., Gallo, L. C., Chirinos, D. A., & Patel, S. R. (2018) · SLEEP · doi:10.1093/sleep/zsy131 · Cited by 42
Loef, B., van Baarle, D., van der Beek, A. J., Beekhof, P., van Kerkhof, L. W., & Proper, K. I. (2019) · PLoS ONE · doi:10.1371/journal.pone.0211557 · Cited by 39
Circadian influence on inflammatory response during cardiovascular disease
Aziz, I. S., McMahon, A. M., Friedman, D., Rabinovich-Nikitin, I., Kirshenbaum, L. A., & Martino, T. A. (2020) · Current Opinion in Pharmacology · doi:10.1016/j.coph.2020.11.007 · Cited by 40
Lu, Y., Ma, X., Zhou, X., & Wang, Y. (2022) · Scientific Reports · doi:10.1038/s41598-022-12393-0 · Cited by 38
Circadian Rhythms in AD Pathogenesis: a Critical Appraisal
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“These benefits are understood to be related to the circadian rhythm; shifting sleep timing decouples the circadian rhythm from the sleep/wake rhythm [11, 12], contributing to adverse health outcomes such as higher rates of cardiovascular disease [13] and breast cancer [14].”
BackgroundAssociation between shift work and risk of metabolic syndrome: A systematic review and meta-analysis
Yang, X., Di, W., Zeng, Y., Liu, D., Han, M., Qie, R., Huang, S., Zhao, Y., Feng, Y., Hu, D., et al. (2021) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2021.06.007 · Cited by 36
Short Sleep, Insomnia, and Cardiovascular Disease
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Self-citationAssessment and Management of Sleep Disturbance in Cirrhosis
Formentin, C., Garrido, M., & Montagnese, S. (2018) · Current Hepatology Reports · doi:10.1007/s11901-018-0390-1 · Cited by 35
Adverse Effect of Circadian Rhythm Disorder on Reparative Angiogenesis in Hind Limb Ischemia
Tsuzuki, K., Shimizu, Y., Suzuki, J., Pu, Z., Yamaguchi, S., Fujikawa, Y., Kato, K., Ohashi, K., Takefuji, M., Bando, Y., et al. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.121.020896 · Cited by 35
Working against the biological clock: a review for the Occupational Physician
Copertaro, A., & Bracci, M. (2019) · Industrial Health · doi:10.2486/indhealth.2018-0173 · Cited by 35
Amano, H., Fukuda, Y., Yokoo, T., & Yamaoka, K. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.42036 · Cited by 33
Night shift work and cardiovascular disease biomarkers in female nurses
Johnson, C. Y., Tanz, L. J., Lawson, C. C., Schernhammer, E. S., Vetter, C., & Rich-Edwards, J. W. (2019) · American Journal of Industrial Medicine · doi:10.1002/ajim.23079 · Cited by 37
Self-citationLi, X., Li, L., Yang, L., Yang, J., & Lu, H. (2021) · Scientific Reports · doi:10.1038/s41598-021-95207-z · Cited by 33
Work Exposures and Development of Cardiovascular Diseases: A Systematic Review
Anfossi, C. M., Ahumada, M., Fredes, C. T., Rojas, F. P., Ross, J., Head, J. A., & Britton, A. R. (2022) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxac004 · Cited by 33
Metadata
- Authors
- Vetter, C., Devore, E. E., Wegrzyn, L. R., Massa, J., Speizer, F. E., Kawachi, I., Rosner, B., Stampfer, M. J., & Schernhammer, E. S.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- Corresponding author
- Vetter, Céline
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-04-26
- Volume
- 315
- Issue
- 16
- Pages
- 1726
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5102147
- OpenAlex
- W2342969444
- Cited by
- 517
- References
- 39
- Citations by year
- 2026: 42 · 2025: 61 · 2024: 59 · 2023: 51 · 2022: 64 · 2021: 53 · 2020: 57 · 2019: 44 · 2018: 44 · 2017: 27 · 2016: 13
- FWCI
- 60.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- National Heart, Lung, and Blood Institute (R01HL034594)
- National Cancer Institute (UM1CA176726, UM1CA186107)
- National Institute for Occupational Safety and Health (5R01OH009803, R01OH009803)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- rotating night shift work, shift work, coronary artery disease, women, myocardial infarction, angina pectoris, coronary artery bypass grafting, Nurses' Health Study, cardiovascular risk, occupational exposure, coronary CT angiography, coronary artery calcification, coronary microvascular dysfunction
- MeSH terms
- Adult, Coronary Artery Disease, Female, Follow-Up Studies, Humans, Middle Aged, Nurses, Personnel Staffing and Scheduling, Prospective Studies, Surveys and Questionnaires, Time Factors, United States, Work Schedule Tolerance, Incidence, Proportional Hazards Models, Risk Assessment
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