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Shift workers at greater cardiovascular risk

Comment by Dirk De Bacquer, EACPR Prevention, Epidemiology & Population Science Section


According to the 4th European Working Conditions Survey, 20 percent of all European employees work either in shifts or during the night. In Eastern European countries, this prevalence is even higher. Given the accumulating evidence linking rotating shift work to higher incidences of cardiovascular and metabolic diseases, a group of Canadian researchers recently undertook a systematic review and meta-analysis synthesising the available literature on the association between shift work and the onset of vascular diseases to date.

In pooling data from 34 cohort and case-control studies according to random effects analyses, including over 2 million employees, they observed a significantly increased risk for myocardial infarction (+23%), ischaemic stroke (+5%) and coronary events (+24%) in shift workers the latter with significant heterogeneity across studies. The highest incidence of coronary events was found in people working in night shifts (+41%). Shift work was however not associated with raised total or cause-specific mortality rates.
But given the large number of people currently engaged in shift work throughout Europe, even a smaller relative risk confers a high population attributable risk of 5% or more.
To address the challenges of today’s economy in a rapidly changing society, an increasing number of people are subjected to more demanding work schedules. Despite the fact that observational studies are limited in their ability to establish causality and that more research is needed to further explore pathophysiological pathways, the results presented in this paper may warrant regular cardiovascular screening in people doing shift work in order to reduce the health burden associated with their job.