Longer working hours increase risk for second CV event after MI
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Patients who returned to work after an MI and worked more than 55 hours per week had elevated risk for having a second CV event, according to a study published in the Journal of the American College of Cardiology.
In a prospective cohort study of 967 men and women aged 35 to 59 years who went back to work after a first MI, 21.2% of patients had a repeat CHD event during a median follow-up of 5.9 years.
“Looking at long working hours and job stressors was helpful in determining how hostile a working environment was and how much potential stress a participant could be under. Once both factors are introduced, there’s a noticeable increase in the risk of recurrent coronary heart disease events,” Xavier Trudel, PhD, a researcher at the CHU de Quebec-Université Laval Research Center in Quebec, said in a press release.
Participants were categorized based on their total weekly working hours: part time (21-34 hours per week; event rate: 2.77 per 100 person-years), full time (35-40 hours per week; event rate: 3.48 per 100 person-years), low overtime (41-54 hours per week; event rate: 3.27 per 100 person-years) and medium/high overtime ( 55 hours per week; event rate: 7.05 per 100-person years).
Long working hours ( 55 hours per week) were linked to a twofold greater risk for recurrent CHD compared with working 35 to 40 hours per week (HR = 2; 95% CI, 1.36-2.95) in an unadjusted analysis, whereas in a fully adjusted model controlling for sociodemographics, lifestyle-related risk factors, clinical risk factors, work environment factors and personality factors, long working hours remained associated with risk for recurrent CHD (HR = 1.67; 95% CI, 1.1-2.53), according to the researchers.
Men tended to work more medium/high overtime hours (10.7%) compared with women (1.9%), they wrote.
Participants who had risk factors such as smoking, alcohol intake, physical inactivity and more stressful jobs were more likely to be in the medium/high overtime category and financially stable younger workers were overrepresented in the highest working hours category, the researchers wrote.
According to an accompanying editorial, the results have important implications for clinical practice, including the need for more comprehensive measures for secondary prevention for patients who had a first MI.
“The study ... provides a new piece of research evidence that work-related factors play an important role in coronary heart disease prognosis. Occupational health services are urgently needed to be incorporated into secondary prevention of CHD.” wrote Jian Li, MD, PhD, a professor in the Fielding School of Public Health and School of Nursing at UCLA, and Johannes Siegrist, PhD, senior professor at the Centre for Health and Society, Faculty of Medicine at Heinrich Heine-University of Dusseldorf, Germany.
“To reduce the risk of coronary heart disease recurrence, secondary prevention interventions aimed at reducing the number of working hours should be evaluated in future studies. Long working hours should be assessed as part of early and subsequent routine clinical follow-up to improve the prognosis of post-heart attack patients,” Trudel said in the release.
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