Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis

  • Jian LiEmail author
  • Min Zhang
  • Adrian Loerbroks
  • Peter Angerer
  • Johannes Siegrist
Review Paper


Though much evidence indicates that work stress increases the risk of incident of coronary heart disease (CHD), little is known about the role of work stress in the development of recurrent CHD events. The objective of this study was to review and synthesize the existing epidemiological evidence on whether work stress increases the risk of recurrent CHD events in patients with the first CHD. A systematic literature search in the PubMed database (January 1990–December 2013) for prospective studies was performed. Inclusion criteria included: peer-reviewed English papers with original data, studies with substantial follow-up (> 3 years), end points defined as cardiac death or nonfatal myocardial infarction, as well as work stress assessed with reliable and valid instruments. Meta-analysis using random-effects modeling was conducted in order to synthesize the observed effects across the studies. Five papers derived from 4 prospective studies conducted in Sweden and Canada were included in this systematic review. The measurement of work stress was based on the Demand-Control model (4 papers) or the Effort-Reward Imbalance model (1 paper). According to the estimation by meta-analysis based on 4 papers, a significant effect of work stress on the risk of recurrent CHD events (hazard ratio: 1.65, 95% confidence interval: 1.23–2.22) was observed. Our findings suggest that, in patients with the first CHD, work stress is associated with an increased relative risk of recurrent CHD events by 65%. Due to the limited literature, more well-designed prospective research is needed to examine this association, in particular, from other than western regions of the world.

Key words

Work stress Recurrence Coronary heart disease Meta-analysis Epidemiology Prospective studies 


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Copyright information

© Versita Warsaw and Springer-Verlag Wien 2014

Authors and Affiliations

  • Jian Li
    • 1
    • 2
    Email author
  • Min Zhang
    • 3
  • Adrian Loerbroks
    • 1
  • Peter Angerer
    • 1
  • Johannes Siegrist
    • 4
  1. 1.Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of MedicineUniversity of DüsseldorfDüsseldorfGermany
  2. 2.Institute of Medical Sociology, Centre for Health and Society, Faculty of MedicineUniversity of DüsseldorfDüsseldorfGermany
  3. 3.Department of Cardiology, First Affiliated HospitalKunming Medical UniversityKunmingChina
  4. 4.Senior Professorship on Work Stress Research, Life-Science CentreUniversity of DüsseldorfDüsseldorfGermany

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