Cited by 673Workplace Health and Well-beingCardiac Health and Mental HealthHeart Rate Variability and Autonomic Control

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

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Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., Badrick, E., Kivimaki, M., Marmot, M.·2008·European Heart Journal

DOI 10.1093/eurheartj/ehm584

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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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Authors: Chandola, T., Britton, A., Brunner, E., Hemingway, H., Malik, M., Kumari, M., Badrick, E., Kivimaki, M., & Marmot, M.
Affiliations: University College London (GB)
Corresponding author: Chandola, T.
ORCID: Chandola, T.
Britton, A.
Brunner, E.
Hemingway, H.
Badrick, E.
Marmot, M.
Venue: European Heart Journal
Publisher: Oxford University Press (OUP)
Published: 2008-03-01
Volume: 29
Issue: 5
Pages: 640-648
ISSN: 0195-668X (ISSN-L)
1522-9645
DOI: 10.1093/eurheartj/ehm584
OpenAlex: W2106056426
Cited by: 673
References: 34
Citations by year: 2026: 9 · 2025: 23 · 2024: 22 · 2023: 31 · 2022: 29 · 2021: 24 · 2020: 35 · 2019: 36 · 2018: 49 · 2017: 51 · 2016: 33 · 2015: 48 · 2014: 49 · 2013: 51 · 2012: 42
FWCI: 88.69
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: European Heart Journal (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (submittedVersion, other-oa)
UCL Discovery (University College London) (submittedVersion)
Funders: John D. and Catherine T. MacArthur Foundation (HS06516)
British Heart Foundation (HS06516, RG/07/008/23674)
Health and Safety Executive
Academy of Finland
National Institutes of Health
Agency for Healthcare Research and Quality (HS06516)
Medical Research Council (HS06516)
Economic and Social Research Council
National Institute on Aging (AG 13196)
National Heart, Lung, and Blood Institute (HL36310, R01HL036310)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords: occupational stress, coronary artery disease, metabolic syndrome, heart rate variability, cortisol, health behavior, physical activity, diet, Whitehall II study, public sector employees
MeSH terms: Adult, Coronary Disease, Epidemiologic Methods, Female, Humans, Job Satisfaction, London, Male, Middle Aged, Occupational Diseases, Social Isolation, Socioeconomic Factors, Stress, Psychological

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