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Work stress and coronary heart disease: what are the mechanisms?
Open accessAbstract
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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“For example, both women and men of lower socio-economic status and/or with chronic stress are more likely to be depressed, hostile, and socially isolated.116,117”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [117]
In the citing paper
“Mechanisms that link psychosocial factors to increased CVD risk include unhealthy lifestyle (more frequent smoking, unhealthy food choice, and less physical exercise), increased healthcare utilization, and low adherence to behaviour-change recommendations or cardiac medications.88,90,116 -119”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [117]
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“In addition, persons and patients with depression and/or chronic stress show alterations in autonomic function (including reduced heart rate variability) in the hypothalamic-pituitary axis and in other endocrine markers, which affect haemostatic and inflammatory processes, endothelial function, and myocardial perfusion.117,118,120”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [117]
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“For example, scoring in the highest quartile of work stress increases cardiovascular disease risk up to 3.6 times (Bosma et al., 1998) in a dose response fashion (Chandola et al., 2008), with follow-up times of between 4 and 12 years.”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Chandola et al., 2008
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Metadata
- 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.
- 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
- 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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