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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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BackgroundMeal-timing patterns and chronic disease prevalence in two representative Austrian studies
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Self-citationCircadian Deregulation as Possible New Player in Pollution-Induced Tissue Damage
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“An association between shift work and CV disease has been proven [72], further supporting the hypothesis that circadian misalignment (typical in night-shift workers) negatively alters CV risk factors.”
BackgroundEveningness is associated with coronary artery calcification in a middle-aged Swedish population
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Night shift work and myocardial infarction in the UK Biobank
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“In humans, an increased risk of coronary heart disease has been observed in women who work night shifts, further highlighting the impact of circadian misalignment (Patterson & Sears, 2017; Vetter et al., 2016).”
Solymanzadeh, F., Rokhafroz, D., Asadizaker, M., & Dastoorpoor, M. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1936542 · Cited by 7
“Shift workers are exposed to risk factors for chronic non-communicable diseases, such as hypertension, overweight/obesity, hypercholesterolemia, and metabolic syndrome, as well as cardiovascular events, such as acute myocardial infarction, stroke, and coronary artery disease (Vetter et al. 2016).”
BackgroundSwanson, G. R., Schwartz, B. A., Joyce, C., & Keshavarzian, A. (2023) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.15052 · Cited by 9
Agarwal, A. K., Gonzales, R. E., Scott, K. R., & Merchant, R. M. (2024) · JMIR Formative Research · doi:10.2196/51569 · Cited by 7
Duty Rosters and Workloads of Obstetricians in Germany: Results of a Germany-wide Survey
Neimann, J., Knabl, J., Puppe, J., Bayer, C., Gaß, P., Gabriel, L., Seelbach‐Goebel, B., Lermann, J. H., & Schott, S. (2017) · Geburtshilfe und Frauenheilkunde · doi:10.1055/s-0043-110863 · Cited by 7
“Moreover, high workloads at night increase the individualʼs health risk over the longer term [15].”
BackgroundValidity of self-reported night shift work among women with and without breast cancer
Vestergaard, J. M., Haug, J. N. D., Dalbøge, A., Bonde, J. P., Garde, A. H., Hansen, J., Hansen, Å. M., Larsen, A. D., Härmä, M., Costello, S., et al. (2024) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.4142 · Cited by 7
“We decided on this definition because the Nurses’ Health Study has provided several highly influential results on health effects of night shift work ( 4, 18, 19 ).”
BackgroundDong, Y., Wu, X., Dong, Y., Li, Y., & Qiu, K. (2024) · Nursing Open · doi:10.1002/nop2.2118 · Cited by 7
“…shift work was identified to be a significant risk factor for various serious disorders, such as mental disorders (Booker et al., 2020 ), dementia (Ling et al., 2023 ), endocrine disorders (Hansen et al., 2016), and cardiovascular diseases (Vetter et al., 2016), especially for the females.”
BackgroundMaternal rotating night shift work before pregnancy and offspring stress markers
Strohmaier, S., Devore, E. E., Huang, T., Vetter, C., Eliassen, A. H., ROSNER, B. A., Okereke, O. I., Austin, S. B., & Schernhammer, E. S. (2019) · Physiology & Behavior · doi:10.1016/j.physbeh.2019.05.007 · Cited by 7
“Rotating night shift work is a recognized social and biological stressor [30], and studies have previously shown higher risk of several chronic disease outcomes [33,34] as well as altered cortisol [8] and sAA [22] levels among night workers, compared to non-night workers.”
BackgroundSelf-citationTrabalho noturno e alterações de peso corporal autopercebidas pelos profissionais de enfermagem
Mauro, M. Y. C., Rebelo, A. M. D. S., Ferreira, A. D. O. M., Sper, N. P. T., Santos, M. I. S., & Gallasch, C. H. (2019) · Revista Enfermagem UERJ · doi:10.12957/reuerj.2019.31273 · Cited by 7
Rotating Nightshift Work and Hematopoietic Cancer Risk in US Female Nurses
Zhang, Y., Birmann, B. M., Papantoniou, K., Zhou, E. S., Erber, A. C., & Schernhammer, E. S. (2020) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkz106 · Cited by 7
“NHSII participants were first queried about lifetime rotating nightshift work history in 1989, using the same definition, with “never, 1–2, 3–5, 6–9, 10–14, 15–19, and 20 years” as the prespecified response categories and with regular updates thereafter (for each 2-year cycle in prespecified categories of months) (35,…”
MethodSelf-citationOptimizing Classroom Lighting for Enhanced Visual Comfort and Reduced Energy Consumption
Aghajari, S., & Chen, C.-C. (2025) · Buildings · doi:10.3390/buildings15081233 · Cited by 6
Zhao, M., Chen, Y., Shang, J., Zhang, S., Lü, B., Miao, Y., Lei, M., Li, R., Cai, W., & Zhang, C. (2025) · The Lancet Planetary Health · doi:10.1016/s2542-5196(25)00079-8 · Cited by 6
Xie, J., Qian, T., Lin, P., Gao, H., Xu, C., & Xu, L. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf445 · Cited by 6
Chi, S., Zhang, T., Yu, P., Niu, S., Zhao, L., Gu, Z., Liu, Q., Jin, A., Wang, W., & Tan, S. (2023) · Food & Function · doi:10.1039/d3fo02063k · Cited by 6
Work environment and hypertension in industrial settings in Benin in 2019: a cross-sectional study
Adjobimey, M., Houéhanou, C., Cissé, I. M., Mikponhoué, R., Hountohotegbè, E., Tchibozo, C., Adjogou, A., Dossougbété, V., Gounongbe, F., Ayelo, P. A., et al. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-078433 · Cited by 11
dos Reis, F. L., Bertoloto, J. C. F., Rodrigues, T. D. C., Toniasso, S. D. C. C., Baldin, C. P., Rodrigues, J. B., Joveleviths, D., & Brum, M. C. B. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325071 · Cited by 6
Cardiovascular and metabolic risk factors of shift workers within the automotive industry
Travill, A., Soeker, F., Overmeyer, D., & Rickers, F. (2019) · Health SA Gesondheid · doi:10.4102/hsag.v24i0.1227 · Cited by 7
“Vetter et al. (2016) reported that a longer duration of rotating night shift work among registered nurses was associated with an absolute increase in the risk for coronary heart disease.”
BackgroundGalangin reduces vascular endothelial cell dysfunction via Heme oxygenase-1 signaling
Qian, Z., & Suo, R. (2022) · Vascular · doi:10.1177/17085381221084806 · Cited by 6
Differences In Nursing Home Staff COVID-19 Testing Rates And Odds Of Vaccination Across Work Shifts
White, E. M., Travers, J. L., Gouskova, N., Oh, G., Syme, M. L., Yang, X., Montoya, A., Feifer, R. A., Grabowski, D. C., Mor, V., et al. (2023) · Health Affairs · doi:10.1377/hlthaff.2022.01011 · Cited by 6
Effect of Work on Medical Expenditures by Elderly: Findings From the Korean Health Panel 2008–2013
Hyun, M. K. (2018) · Safety and Health at Work · doi:10.1016/j.shaw.2018.01.001 · Cited by 6
Self-Care Posters Serve as a Low-Cost Option for Physical Activity Promotion of Hospital Nurses
Raney, M. A., & Zanten, E. V. (2018) · Health Promotion Practice · doi:10.1177/1524839918763585 · Cited by 6
Continuous Light Does Not Affect Atherosclerosis in APOE*3-Leiden.CETP Mice
Schilperoort, M., van den Berg, R., Coomans, C. P., Khedoe, P. P. S. J., Ramkisoensing, A., Boekestijn, S., Wang, Y., Berbée, J. F. P., Meijer, J. H., Biermasz, N. R., et al. (2020) · Journal of Biological Rhythms · doi:10.1177/0748730420951320 · Cited by 6
“Like exposure to light at night, shift work has been associated with various metabolic disorders including cardiovascular disease (Brown et al., 2009; Vyas et al., 2012; Reutrakul and Knutson, 2015; Vetter et al., 2016).”
BackgroundMahalingaiah, S., Cosenza, C. A., Cheng, J. J., Rodriguez, E., & Aschengrau, A. (2020) · Fertility Research and Practice · doi:10.1186/s40738-020-00088-x · Cited by 6
Yoshizaki, T., Ishihara, J., Kotemori, A., Kokubo, Y., Saito, I., Yatsuya, H., Yamagishi, K., Sawada, N., Iwasaki, M., Iso, H., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-20019-8 · Cited by 7
Sato, Y., Yoshioka, E., & Saijo, Y. (2024) · PeerJ · doi:10.7717/peerj.17253 · Cited by 5
“To gather data on rotating night shift work duration, we used a question from the Nurses ’ Health Studies ( Vetter et al., 2016 ) as follows: ‘ What is the total number of years during which you worked rotating night shifts (at least 3 nights/month in addition to days or evenings in that month)?”
MethodLu, Q., Lian, C., & Chen, X. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1424510 · Cited by 5
Shift Type and Resilience Training Effect on Nurse Outcomes
Montgomery, A. P., Carter, J.-L., Stevens, J. B., Beam, T., Blackburn, C., Dick, T., Layton, S. S., Meese, K. A., Morson, D. M., Polancich, S., et al. (2025) · Western Journal of Nursing Research · doi:10.1177/01939459251340779 · Cited by 6
“12 This may result in gastrointestinal disturbances 13,14 and an increased risk of chronic conditions such as cardiovascular disease, 15,16 obesity, 17 diabetes, 18 and cancer.”
Night shift work and breast cancer risk in healthcare workers: a systematic review and meta-analysis
Esposito, G., Bravi, F., Santucci, C., Zunarelli, C., Violante, F. S., Vecchia, C. L., Negri, E., & Turati, F. (2025) · Occupational Medicine · doi:10.1093/occmed/kqaf040 · Cited by 5
Harm of circadian misalignment to the hearts of the adolescent wistar rats
Wang, Y., Hou, Y., Song, S., Zuo, Y., Yu, Y., Chi, Y., & Zhang, T. (2022) · Journal of Translational Medicine · doi:10.1186/s12967-022-03546-w · Cited by 5
“Furthermore, under similar conditions of CM, the probability of cardiovascular disease is lower in young individuals including adolescents compared to the middle-aged adults and the elderly [5, 8].”
BackgroundDong, Y., Wu, X., Zhou, Y., & Qiu, K. (2024) · Journal of Integrative Neuroscience · doi:10.31083/j.jin2301009 · Cited by 5
Massage therapy for hospital-based nurses: A proof-of-concept study
Hulett, J. M., Spotts, R. A., Narkthong, N., & Scott, S. D. (2024) · Complementary Therapies in Clinical Practice · doi:10.1016/j.ctcp.2024.101846 · Cited by 5
Hebl, J. T., Velasco, J., & McHill, A. W. (2024) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2024.07.006 · Cited by 6
Seward, S. L., Kishman, E. E., Rynders, C. A., & Broussard, J. L. (2025) · Physiological Reports · doi:10.14814/phy2.70231 · Cited by 6
“People who conduct shift work have a 40% higher risk for developing cardiovascular disease (CVD) compared to people who work day shifts (Bøggild & Knutsson, 1999; Kawachi et al., 1995; Tenkanen et al., 1997; Vetter et al., 2016).”
Duggan, N. M., Hasdianda, M. A., Baker, O., Jambaulikar, G. D., Goldsmith, A. J., Condella, A. L., Azizoddin, D. R., Landry, A. I., Boyer, E. W., & Eyre, A. J. (2021) · JMIR Formative Research · doi:10.2196/28353 · Cited by 5
“Sleep deficiency in shift workers has been associated with obesity, type 2 diabetes, stroke, multiple types of cancers, and cardiovascular disease [21-24].”
BackgroundHung, A.-Y., Chien, L.-C., & Lin, R. (2022) · Industrial Health · doi:10.2486/indhealth.2021-0278 · Cited by 5
Light-induced circadian rhythm disorder leads to microvascular dysfunction via up-regulating NETs
Wang, Z., Yang, F., He, Z., & Liang, C. (2023) · Microvascular Research · doi:10.1016/j.mvr.2023.104592 · Cited by 5
Brennan, A. M., & Green, J. F. (2023) · International Journal of Nursing Studies Advances · doi:10.1016/j.ijnsa.2023.100157 · Cited by 5
Age at job initiation and risk of coronary heart disease: findings from the UK biobank cohort study
Zhang, Z., Zeng, C.-R., Chen, Z., Liu, P., Gao, J., Guo, Q., Wu, M., He, W., Gao, Q., Guo, D., et al. (2023) · BMC Public Health · doi:10.1186/s12889-023-17034-3 · Cited by 6
“Distinct differences in CHD risk profiles have been recognized between young and old patients [44, 45], with recent studies suggesting that work-related factors such as shift work, night shifts, and stress contribute to the future risk of CHD [5, 18, 46].”
BackgroundHu, B., Xie, Y., Yin, H., Yang, S., You, X., Ma, J., & Yang, L. (2024) · QJM · doi:10.1093/qjmed/hcae068 · Cited by 5
Zhan, T., Wei, X., Zhang, Z., Shi, Z., Xie, H., Ma, X., Pan, S., & Zha, D. (2024) · BMC Nursing · doi:10.1186/s12912-024-02563-y · Cited by 5
“Research indicates that working night shifts is associated with an increased risk of developing coronary heart disease (CHD) and a modest reduction in the likelihood of healthy aging in nurses [5–7].”
Chronobiology in the wild: toolkit to study daily rhythms in free-living animals
Silvério, J. T., & Tachinardi, P. (2020) · Sleep Science · doi:10.5935/1984-0063.20200020 · Cited by 5
Night work and incidence of Parkinson’s disease in the Danish Nurse Cohort
Jørgensen, J. T., Schernhammer, E. S., Papantoniou, K., Hansen, J., Westendorp, R. G. J., Stayner, L. T., Simonsen, M. K., & Andersen, Z. J. (2020) · Occupational and Environmental Medicine · doi:10.1136/oemed-2020-107067 · Cited by 5
Self-citation
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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