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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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Self-citationA Prospective Study of Obesity and Risk of Coronary Heart Disease in Women
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Touitou, Y., Reinberg, A., & Touitou, D. (2017) · Life Sciences · doi:10.1016/j.lfs.2017.02.008 · Cited by 738
“Based on the prospective cohort study of the Nurses' Health Studies, a longer duration of rotating night work was associatedwith a small yet statistically significant absolute increase in the risk of coronary heart disease [136].”
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Disturbance of the Circadian System in Shift Work and Its Health Impact
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“…risk of cardiometabolic disorders (Brum et al., 2015; Kecklund and Axelsson, 2016), including metabolic syndrome (Khosravipour et al., 2021; Wang et al., 2021), type 2 diabetes (Vetter et al., 2018; Gao et al., 2020), and cardiovascular heart diseases (Vetter et al., 2016; Kervezee et al., 2020).”
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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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