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Shift work and vascular events: systematic review and meta-analysis
Open accessAbstract
OBJECTIVE: To synthesise the association of shift work with major vascular events as reported in the literature. DATA SOURCES: Systematic searches of major bibliographic databases, contact with experts in the field, and review of reference lists of primary articles, review papers, and guidelines. STUDY SELECTION: Observational studies that reported risk ratios for vascular morbidity, vascular mortality, or all cause mortality in relation to shift work were included; control groups could be non-shift ("day") workers or the general population. DATA EXTRACTION: Study quality was assessed with the Downs and Black scale for observational studies. The three primary outcomes were myocardial infarction, ischaemic stroke, and any coronary event. Heterogeneity was measured with the I(2) statistic and computed random effects models. RESULTS: 34 studies in 2,011,935 people were identified. Shift work was associated with myocardial infarction (risk ratio 1.23, 95% confidence interval 1.15 to 1.31; I(2)=0) and ischaemic stroke (1.05, 1.01 to 1.09; I(2)=0). Coronary events were also increased (risk ratio 1.24, 1.10 to 1.39), albeit with significant heterogeneity across studies (I(2)=85%). Pooled risk ratios were significant for both unadjusted analyses and analyses adjusted for risk factors. All shift work schedules with the exception of evening shifts were associated with a statistically higher risk of coronary events. Shift work was not associated with increased rates of mortality (whether vascular cause specific or overall). Presence or absence of adjustment for smoking and socioeconomic status was not a source of heterogeneity in the primary studies. 6598 myocardial infarctions, 17,359 coronary events, and 1854 ischaemic strokes occurred. On the basis of the Canadian prevalence of shift work of 32.8%, the population attributable risks related to shift work were 7.0% for myocardial infarction, 7.3% for all coronary events, and 1.6% for ischaemic stroke. CONCLUSIONS: Shift work is associated with vascular events, which may have implications for public policy and occupational medicine.
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“Although the evidence from observational and intervention studies on meal irregularity and an increased cardiometabolic risk is limited, a number of underlying mechanisms serve to explain the results, mainly related to chrono-biology (5,44,45) .”
From Meal irregularity and cardiometabolic consequences: results from observational and intervention studies (2016) · cites this paper as [44]
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“The increased risk of diabetes and cardiovascular disease documented in epidemiologic studies of shift work (4–9) is thus unlikely to be solely due to sleep loss and would not be fully mitigated by strategies designed to preserve sleep duration.”
From Circadian Misalignment Augments Markers of Insulin Resistance and Inflammation, Independently of Sleep Loss (2014) · cites this paper as [8]
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“Prospective epidemiologic studies indicate that shift work is associated with an increased risk of type 2 diabetes and cardiovascular disease (4–9).”
From Circadian Misalignment Augments Markers of Insulin Resistance and Inflammation, Independently of Sleep Loss (2014) · cites this paper as [8]
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“Observational studies consistently suggest positive associations of night shift work and cardiovascular disease (CVD)2 and cancer risk.3-18”
From Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts (2015) · cites this paper as [2]
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Metadata
- Authors
- Vyas, M. V., Garg, A. X., Iansavichus, A. V., Costella, J., Donner, A., Laugsand, L. E., Janszky, I., Mrkobrada, M., Parraga, G., & Hackam, D. G.
- Affiliations
- Western University (CA)
- Lawson Research Institute (CA)
- Norwegian University of Science and Technology (NO)
- Corresponding author
- Hackam, D. G.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-07-26
- Volume
- 345
- Issue
- jul26 1
- Pages
- e4800-e4800
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3406223
- OpenAlex
- W2119434070
- Cited by
- 840
- References
- 71
- Citations by year
- 2026: 39 · 2025: 43 · 2024: 64 · 2023: 61 · 2022: 74 · 2021: 65 · 2020: 71 · 2019: 78 · 2018: 69 · 2017: 72 · 2016: 66 · 2015: 48 · 2014: 46 · 2013: 34 · 2012: 9
- FWCI
- 6.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Scholarship@Western (Western University) (publishedVersion)
- Scholarship@Western (Western University) (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Canadian Institutes of Health Research
- 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
- shift work, vascular events, myocardial infarction, ischemic stroke, coronary events, vascular death, all-cause mortality, cardiovascular risk, evening shift, population attributable risk, occupational health
- MeSH terms
- Brain Ischemia, Coronary Disease, Humans, Myocardial Infarction, Personnel Staffing and Scheduling, Risk Factors, Work Schedule Tolerance, Odds Ratio, Risk Assessment, Stroke
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