Work-related stress as a cardiovascular risk factor in police officers: a systematic review of evidence

  • N. Magnavita
  • I. CapitanelliEmail author
  • S. Garbarino
  • E. Pira



Several studies suggest that work-related stress in police officers may be associated with an increased risk of cardiovascular diseases. A systematic review of studies is, however, still lacking.


According to PRISMA statement, a systematic search of PubMed, ISI Web of Science, Cinahl and PsychInfo electronic databases was undertaken. Studies published in English between 1/1/2000 and 31/12/2016 were included. A studies quality assessment was performed using the Newcastle Ottawa scale (NOS).


The preliminary search retrieved 752 records. After selection, 16 studies (total population 17,698) were retrieved. The average quality of studies was low. Exposure to stress in cross-sectional studies was inconstantly associated with hypertension, obesity, dyslipidaemia, and impaired glucose metabolism. In addition, there was a prevalence of positive studies showing an association between stress and cardiovascular disease morbidity. Studies of higher quality, such as longitudinal studies on large sample size, were more supportive of a significant positive association between stress and cardiovascular risk factors. Results were, however, often conflicting and inconsistent with regard to definitions and measurement of stress, features of individual study design, study conduct, and conclusions drawn.


A sound precautionary principle would be to adopt worksite health promotion programs designed to implement stress management strategies in this category of workers.


Police officers Cardiovascular disease Cardiovascular risk factors Stress Public safety 


Compliance with ethical standards

Conflict of interest

The study was not funded. The authors declare that they have no conflict of interest.


  1. Arial M, Gonik V, Wild P, Danuser B (2010) Association of work related chronic stressors and psychiatric symptoms in a Swiss sample of police officers; a cross sectional questionnaire study. Int Arch Occup Environ Health 83:323–331CrossRefGoogle Scholar
  2. Arnetz BB, Arble E, Backman L, Lynch A, Lublin A (2013) Assessment of a prevention program for work-related stress among urban police officers. Int Arch Occup Environ Health 86(1):79–88. CrossRefGoogle Scholar
  3. Babu GR, Jotheeswaran AT, Mahapatra T, Mahapatra S, Kumar A Sr, Detels R, Pearce N (2014) Is hypertension associated with job strain? A meta-analysis of observational studies. Occup Environ Med 71(3):220–227. CrossRefGoogle Scholar
  4. Bellisarii FL, Gallina S, De Caterina R (2001) Tumor necrosis factor-alpha and cardiovascular diseases. Ital Heart J 2(6):408–417Google Scholar
  5. Bergmann N, Gyntelberg F, Faber J (2014) The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect 3(2):R55–R80. CrossRefGoogle Scholar
  6. Bowler RM, Kornblith ES, Li J, Adams SW, Gocheva VV, Schwarzer R, Cone JE. (2016) Police officers who responded to 9/11: Comorbidity of PTSD, depression, and anxiety 10–11 years later. Am J Ind Med. 59(6):425–436. CrossRefGoogle Scholar
  7. Chandola T, Britton A, Brunner E, Hemingway H, Malik M, Kumari M, Badrick E, Kivimaki M, Marmot M (2008) Work stress and coronary heart disease: what are the mechanisms? Eur Heart J 29(5):640–648. CrossRefGoogle Scholar
  8. Chen X, Leng L, Yu H, Yang XL, Dong GH, Yue S, Chen JS, Tang NJ (2015) Psychological distress and dyslipidemia in chinese police officers: a 4-year follow-up study in Tianjin, China. J Occup Environ Med 57(4):400–405. CrossRefGoogle Scholar
  9. Chiorri C, Garbarino S, Bracco F, Magnavita N (2015) Personality traits moderate the effect of workload sources on perceived workload in flying column police officers. Front Psychol 6:1835. CrossRefGoogle Scholar
  10. Collins PA, Gibbs AC (2003) Stress in police officers: a study of the origins, prevalence and severity of stress-related symptoms within a county police force. Occup Med (Lond) 53(4):256–264CrossRefGoogle Scholar
  11. Cuffee Y, Ogedegbe C, Williams NJ, Ogedegbe G, Schoenthaler A (2014) Psychosocial risk factors for hypertension: an update of the literature. Curr Hypertens Rep 16(10):483. CrossRefGoogle Scholar
  12. Dragano N, Siegrist J, Nyberg ST, Lunau T, Fransson EI, Alfredsson L, Bjorner JB, Borritz M, Burr H, Erbel R, Fahlén G, Goldberg M, Hamer M, Heikkilä K, Jöckel KH, Knutsson A, Madsen IE, Nielsen ML, Nordin M, Oksanen T, Pejtersen JH, Pentti J, Rugulies R, Salo P, Schupp J, Singh-Manoux A, Steptoe A, Theorell T, Vahtera J, Westerholm PJ, Westerlund H, Virtanen M, Zins M, Batty GD, Kivimäki M (2017) IPD-Work consortium. Effort-reward imbalance at work and incident coronary heart disease: a multi-cohort study of 90,164 individuals. Epidemiology. Google Scholar
  13. Fishta A, Backé EM (2015) Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews. Int Arch Occup Environ Health 88(8):997–1014. CrossRefGoogle Scholar
  14. Franke WD, Ramey SL, Shelley MC 2nd (2002) Relationship between cardiovascular disease morbidity, risk factors, and stress in a law enforcement cohort. J Occup Environ Med 44(12):1182–1189CrossRefGoogle Scholar
  15. Franke WD, Kohut ML, Russell DW, Yoo HL, Ekkekakis P, Ramey SP (2010) Is job-related stress the link between cardiovascular disease and the law enforcement profession? J Occup Environ Med 52(5):561–565. CrossRefGoogle Scholar
  16. Ganesh KS, Naresh AG, Bammigatti C (2014) Prevalence and risk factors of hypertension among male police personnel in Urban Puducherry, India. Kathmandu Univ Med J (KUMJ) 12(48):242–246Google Scholar
  17. Garbarino S (2014) 24-hour work: the interaction of stress and changes in the sleep-wake cycle in the police force. G Ital Med Lav Ergon 36(4):392–396Google Scholar
  18. Garbarino S, Magnavita N (2015) Work stress and metabolic syndrome in police officers. a prospective study. PLoS One 10(12):e0144318. CrossRefGoogle Scholar
  19. Garbarino S, Magnavita N, Elovainio M, Heponiemi T, Ciprani F, Cuomo G, Bergamaschi A (2011) Police job strain during routine activities and a major event. Occup Med (Lond) 61(6):395–399CrossRefGoogle Scholar
  20. Garbarino S, Chiorri C, Magnavita N, Piattino S, Cuomo G (2012) Personality profiles of special force police officers. J Police Crim Psychol 27(2):99–110. CrossRefGoogle Scholar
  21. Garbarino S, Cuomo G, Chiorri C, Magnavita N (2013) Association of work-related stress with mental health problems in a special police force. BMJ Open. Google Scholar
  22. Garbarino S, Chiorri C, Magnavita N (2014) Personality traits of the Five-Factor Model are associated with work-related stress in special force police officers. Int Arch Occup Environ Health 87(3):295–306. CrossRefGoogle Scholar
  23. Gilbert-Ouimet M, Trudel X, Brisson C, Milot A, Vézina M (2014) Adverse effects of psychosocial work factors on blood pressure: systematic review of studies on demand-control-support and effort-reward imbalance models. Scand J Work Environ Health 40(2):109–132. CrossRefGoogle Scholar
  24. Hartley TA, Burchfiel CM, Fekedulegn D, Andrew ME, Knox SS, Violanti JM (2011) Associations between police officer stress and the metabolic syndrome. Int J Emerg Ment Health 13(4):243–256Google Scholar
  25. Janczura M, Bochenek G, Nowobilski R, Dropinski J, Kotula-Horowitz K, Laskowicz B, Stanisz A, Lelakowski J, Domagala T (2015) The relationship of metabolic syndrome with stress, coronary heart disease and pulmonary function–an occupational cohort-based study. PLoS One 10(8):e0133750. CrossRefGoogle Scholar
  26. Juniper B, White N, Bellamy P (2010) A new approach to evaluating the well-being of police. Occup Med (Lond) 60(7):560–565. CrossRefGoogle Scholar
  27. Kamble SV, Phalke DB (2011) Study of occupational stress as a risk factor for various morbidities among policemen. J Indian Med Assoc 109(4):238–240Google Scholar
  28. Kanda T, Takahashi T (2004) Interleukin-6 and cardiovascular diseases. Jpn Heart J 45(2):183–193CrossRefGoogle Scholar
  29. Karasek R (1979) Job control, job decision latitude and mental strain. Implications for job redesign. Adm Sci Q 24:285–306CrossRefGoogle Scholar
  30. Kivimäki M, Kawachi I (2015) Work stress as a risk factor for cardiovascular disease. Curr Cardiol Rep 17(9):630. CrossRefGoogle Scholar
  31. Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Vaananen A, Vahtera J (2006) Work stress in the etiology of coronary heart disease-a meta-analysis. Scand J Work Environ Health 32:431–442. CrossRefGoogle Scholar
  32. Kivimäki M, Singh-Manoux A, Nyberg S, Jokela M, Virtanen M (2015) Job strain and risk of obesity: systematic review and meta-analysis of cohort studies. Int J Obes (Lond) 39(11):1597–1600. CrossRefGoogle Scholar
  33. Körlin J, Alexanderson K, Svedberg P (2009) Sickness absence among women and men in the police: a systematic literature review. Scand J Public Health 37(3):310–319CrossRefGoogle Scholar
  34. Landsbergis PA, Dobson M, Koutsouras G, Schnall P (2013) Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am J Public Health 103(3):e61–e71. CrossRefGoogle Scholar
  35. Leineweber C, Westerlund H, Hagberg J, Svedberg P, Luokkala M, Alexanderson K (2011) Sickness presenteeism among Swedish police officers. J Occup Rehabil 1:17–22. CrossRefGoogle Scholar
  36. Li J, Zhang M, Loerbroks A, Angerer P, Siegrist J (2015) Work stress and the risk of recurrent coronary heart disease events: a systematic review and meta-analysis. Int J Occup Med Environ Health 28(1):8–19. Google Scholar
  37. Magnavita N, Garbarino S (2013a) Is absence related to work stress? A repeated cross-sectional study on a special police force. Am J Ind Med 56(7):765–775. CrossRefGoogle Scholar
  38. Magnavita N, Garbarino S (2013b) Social psychiatry in the waiting room. What a physician can learn about occupational stress from workers waiting to be examined. Psychiatry J 2013:701872. CrossRefGoogle Scholar
  39. Maia DB, Marmar CR, Mendlowicz MV, Metzler T, Nóbrega A, Peres MC, Coutinho ES, Volchan E, Figueira I (2008) Abnormal serum lipid profile in Brazilian police officers with post-traumatic stress disorder. J Affect Disord 107(1–3):259 – 63Google Scholar
  40. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. CrossRefGoogle Scholar
  41. Patterson GT (2001) The relationship between demographic variables and exposure to traumatic incidents among police officers. Austr J Disaster Trauma Stud.
  42. Pira E, Garbarino S, Ciprani F, De Lorenzo G, Mennoia NV, Proto E, Roca A, Magnavita N (2016a) Linee-Guida SIMLII sulla sorveglianza sanitaria delle Forze dell’Ordine italiane: un vuoto da colmare. Mel Lav 107(2):153–158Google Scholar
  43. Pira E, Garbarino S, Magnavita N, Ciprani F, De Lorenzo G, Garzaro G, Mennoia NV, Proto E, Roca A (2016b) Linee Guida per la Sorveglianza Sanitaria degli operatori dei Corpi di Polizia. Nuova Editrice Berti, Piacenza (ISBN 978–88-7643-706-5) Google Scholar
  44. Ramakrishnan J, Majgi SM, Premarajan KC, Lakshminarayanan S, Thangaraj S, Chinnakali P (2013) High prevalence of cardiovascular risk factors among policemen in Puducherry, South India. J Cardiovasc Dis Res 4(2):112–115CrossRefGoogle Scholar
  45. Ramey SL (2003) Cardiovascular disease risk factors and the perception of general health among male law enforcement officers: encouraging behavioral change. AAOHN J 51(5):219 – 26Google Scholar
  46. Ramey SL, Perkhounkova Y, Downing NR, Culp KR (2011) Relationship of cardiovascular disease to stress and vital exhaustion in an urban. Midwest Police Dep AAOHN J 59(5):221–227. Google Scholar
  47. Ramey SL, Downing NR, Franke WD, Perkhounkova Y, Alasagheirin MH (2012) Relationships among stress measures, risk factors, and inflammatory biomarkers in law enforcement officers. Biol Res Nurs 14(1):16–26. CrossRefGoogle Scholar
  48. Siegrist J (1996) Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1(1):27–41CrossRefGoogle Scholar
  49. Siegrist J (2001) Psychosocial factors influencing development and course of coronary heart disease. Herz. 26(5):316–325CrossRefGoogle Scholar
  50. Taloyan M, Kecklund G, Thörn L, Kjeldgård L, Westerlund H, Svedberg P, Alexanderson K. (2016) Sickness presence in the Swedish Police in 2007 and in 2010: Associations with demographic factors, job characteristics, and health. Work 54(2):379–387. CrossRefGoogle Scholar
  51. Ueyama T, Senba E, Kasamatsu K, Hano T, Yamamoto K, Nishio I, Tsuruo Y, Yoshida K (2003) Molecular mechanism of emotional stress-induced and catecholamine-induced heart attack. J Cardiovasc Pharmacol 41(Suppl 1):S115–S118Google Scholar
  52. Van Tassell BW, Raleigh JM, Abbate A (2015) Targeting interleukin-1 in heart failure and inflammatory heart disease. Curr Heart Fail Rep 12(1):33–41. CrossRefGoogle Scholar
  53. Violanti JM, Aron F (1994) Ranking police stressors. Psychol Rep 75(2):824–826CrossRefGoogle Scholar
  54. Violanti JM, Fekedulegn D, Hartley TA, Andrew ME, Charles LE, Mnatsakanova A, Burchfiel CM (2006) Police trauma and cardiovascular disease: association between PTSD symptoms and metabolic syndrome. Int J Emerg Ment Health 8(4):227–237Google Scholar
  55. Violanti JM, Fekedulegn D, Hartley TA, Charles LE, Andrew ME, Ma CC, Burchfiel CM (2016) Highly rated and most frequent stressors among police officers: gender differences. Am J Crim Justice 41(4):645–662. CrossRefGoogle Scholar
  56. Violanti JM, Fekedulegn D, Andrew ME, Hartley TA, Charles LE, Miller DB, Burchfiel CM (2017) The impact of perceived intensity and frequency of police work occupational stressors on the cortisol awakening response (CAR): findings from the BCOPS study. Psychoneuroendocrinology 75:124–131. CrossRefGoogle Scholar
  57. Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI, Alfredsson L, Bjorner JB, Borritz M, Burr H, Casini A, Clays E, De Bacquer D, Dragano N, Elovainio M, Erbel R, Ferrie JE, Hamer M, Jöckel KH, Kittel F, Knutsson A, Koskenvuo M, Koskinen A, Lunau T, Madsen IE, Nielsen ML, Nordin M, Oksanen T, Pahkin K, Pejtersen JH, Pentti J, Rugulies R, Salo P, Shipley MJ, Siegrist J, Steptoe A, Suominen SB, Theorell T, Toppinen-Tanner S, Väänänen A, Vahtera J, Westerholm PJ, Westerlund H, Slopen N, Kawachi I, Singh-Manoux A, Kivimäki M (2013) IPD-Work Consortium. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ 347:f4746. CrossRefGoogle Scholar
  58. Walvekar SS, Ambekar JG, Devaranavadagi BB (2015) Study on serum cortisol and perceived stress scale in the police constables. J Clin Diagn Res 9(2):BC10–B4. Google Scholar
  59. West C, Bernard B, Mueller C, Kitt M, Driscoll R, Tak S (2008) Mental health outcomes in police personnel after Hurricane Katrina. J Occup Environ Med 50(6):689 – 95.
  60. Wilson MD, Conroy LM, Dorevitch S (2014) Occupational stress and subclinical atherosclerosis: a systematic review. Int J Occup Environ Health 20(4):271 – 80.
  61. Wright BR, Barbosa-Leiker C, Hoekstra T (2011) Law enforcement officer versus non-law enforcement officer status as a longitudinal predictor of traditional and emerging cardiovascular risk factors. J Occup Environ Med 53(7):730–734. CrossRefGoogle Scholar
  62. Yoo HL, Eisenmann JC, Franke WD (2009) Independent and combined influence of physical activity and perceived stress on the metabolic syndrome in male law enforcement officers. J Occup Environ Med 51(1):46–53. CrossRefGoogle Scholar
  63. Yu H, Liu JC, Fan YJ, Li C, Zhang LX, Chen X, Yue S, Lu WL, Yang XL, Tang NJ (2016) Association between occupational stressors and type 2 diabetes among Chinese police officers: a 4-year follow-up study in Tianjin, China. Int Arch Occup Environ Health 89(2):277–288. CrossRefGoogle Scholar
  64. Zimmerman FH (2012) Cardiovascular disease and risk factors in law enforcement personnel: a comprehensive review. Cardiol Rev 20(4):159–166. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • N. Magnavita
    • 1
  • I. Capitanelli
    • 1
    Email author
  • S. Garbarino
    • 2
    • 3
  • E. Pira
    • 4
  1. 1.Occupational Health Unit, Institute of Public HealthUniversità Cattolica del Sacro CuoreRomeItaly
  2. 2.Central Health Service, State Police, Ministry of InteriorRomeItaly
  3. 3.DINOGMIUniversity of GenoaGenoaItaly
  4. 4.Occupational HealthUniversity of TurinTurinItaly

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