Association Between Rotating Night Shift Work and Risk of Coronary Heart Disease Among Women

Overview

Journal JAMA

Publisher American Medical Association

Specialty General Medicine

Date 2016 Apr 27

PMID 27115377

Citations 195

Authors

Celine Vetter

Elizabeth E Devore

Lani R Wegrzyn

Jennifer Massa

Frank E Speizer

Ichiro Kawachi

Bernard Rosner

Meir J Stampfer

Eva S Schernhammer

Affiliations

Soon will be listed here.

Abstract

Importance: Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up.

Objective: To determine whether rotating night shift work is associated with CHD risk.

Design, Setting, And Participants: Prospective cohort study of 189,158 initially healthy women followed up over 24 years in the Nurses' Health Studies (NHS [1988-2012]: N = 73,623 and NHS2 [1989-2013]: N = 115,535).

Exposures: Lifetime history of rotating night shift work (≥3 night shifts per month in addition to day and evening shifts) at baseline (updated every 2 to 4 years in the NHS2).

Main Outcomes And Measures: Incident CHD; ie, nonfatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass graft surgery, stents, and angioplasty.

Results: During follow-up, 7303 incident CHD cases occurred in the NHS (mean age at baseline, 54.5 years) and 3519 in the NHS2 (mean age, 34.8 years). In multivariable-adjusted Cox proportional hazards models, increasing years of baseline rotating night shift work was associated with significantly higher CHD risk in both cohorts. In the NHS, the association between duration of shift work and CHD was stronger in the first half of follow-up than in the second half (P=.02 for interaction), suggesting waning risk after cessation of shift work. Longer time since quitting shift work was associated with decreased CHD risk among ever shift workers in the NHS2 (P<.001 for trend). [table: see text]

Conclusions And Relevance: Among women who worked as registered nurses, longer duration of rotating night shift work was associated with a statistically significant but small absolute increase in CHD risk. Further research is needed to explore whether the association is related to specific work hours and individual characteristics.

Citing Articles

An innovative approach based on health surveillance for the prevention and early detection of cardiovascular diseases in a large cohort of healthcare workers.

Vimercati L, Sponselli S, Delvecchio G, Giannelli G, Caputi A, Sole S Sci Rep. 2025; 15(1):8942.

PMID: 40089576 DOI: 10.1038/s41598-025-93527-y.

Global, regional, and national trends in chronic kidney disease burden (1990-2021): a systematic analysis of the global burden of disease in 2021.

Chen J, Deng M, Zheng R, Chen Y, Pang W, Zhang Z Trop Med Health. 2025; 53(1):26.

PMID: 39980046 PMC: 11843816. DOI: 10.1186/s41182-025-00703-x.

Acute night shift work is associated with increased blood pressure and reduced sleep duration in healthy adults.

Seward S, Kishman E, Rynders C, Broussard J Physiol Rep. 2025; 13(3):e70231.

PMID: 39936461 PMC: 11815480. DOI: 10.14814/phy2.70231.

Endothelial Dysfunction and Hemostatic System Activation in Relation to Shift Workers, Social Jetlag, and Chronotype in Female Nurses.

Saharov G, Salti B, Bareya M, Keren-Politansky A, Fodi M, Shochat T Int J Mol Sci. 2025; 26(2).

PMID: 39859197 PMC: 11764714. DOI: 10.3390/ijms26020482.

A good night's rest: A contemporary review of sleep and cardiovascular health.

Amin K, Thakkar A, Budampati T, Matai S, Akkaya E, Shah N Am J Prev Cardiol. 2025; 21():100924.

PMID: 39830936 PMC: 11742591. DOI: 10.1016/j.ajpc.2024.100924.

References

Willett W, Sampson L, Stampfer M, Rosner B, Bain C, Witschi J . Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985; 122(1):51-65. DOI: 10.1093/oxfordjournals.aje.a114086. View

Eckel R, Krauss R . American Heart Association call to action: obesity as a major risk factor for coronary heart disease. AHA Nutrition Committee. Circulation. 1998; 97(21):2099-100. DOI: 10.1161/01.cir.97.21.2099. View

Hubert H, Feinleib M, MCNAMARA P, CASTELLI W . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation. 1983; 67(5):968-77. DOI: 10.1161/01.cir.67.5.968. View

Baron K, Reid K . Circadian misalignment and health. Int Rev Psychiatry. 2014; 26(2):139-54. PMC: 4677771. DOI: 10.3109/09540261.2014.911149. View

Wong N . Epidemiological studies of CHD and the evolution of preventive cardiology. Nat Rev Cardiol. 2014; 11(5):276-89. DOI: 10.1038/nrcardio.2014.26. View

Kawachi I, Colditz G, Stampfer M, Willett W, Manson J, Speizer F . Prospective study of shift work and risk of coronary heart disease in women. Circulation. 1995; 92(11):3178-82. DOI: 10.1161/01.cir.92.11.3178. View

Steptoe A, Kivimaki M . Stress and cardiovascular disease: an update on current knowledge. Annu Rev Public Health. 2013; 34:337-54. DOI: 10.1146/annurev-publhealth-031912-114452. View

Boggild H, Knutsson A . Shift work, risk factors and cardiovascular disease. Scand J Work Environ Health. 1999; 25(2):85-99. DOI: 10.5271/sjweh.410. View

Wang X, Armstrong M, Cairns B, Key T, Travis R . Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond). 2011; 61(2):78-89. PMC: 3045028. DOI: 10.1093/occmed/kqr001. View

10.

Juda M, Vetter C, Roenneberg T . Chronotype modulates sleep duration, sleep quality, and social jet lag in shift-workers. J Biol Rhythms. 2013; 28(2):141-51. DOI: 10.1177/0748730412475042. View

11.

Leclerc A . Shift-work and cardiovascular disease. Eur J Epidemiol. 2010; 25(5):285-6. PMC: 2892517. DOI: 10.1007/s10654-010-9456-2. View

12.

Fujishiro K, Diez Roux A, Landsbergis P, Kaufman J, Korcarz C, Stein J . Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Atherosclerosis (MESA). Occup Environ Med. 2014; 72(10):690-8. PMC: 4560665. DOI: 10.1136/oemed-2014-102311. View

13.

Jensen M, Bertoia M, Cahill L, Agarwal I, Rimm E, Mukamal K . Novel metabolic biomarkers of cardiovascular disease. Nat Rev Endocrinol. 2014; 10(11):659-72. DOI: 10.1038/nrendo.2014.155. View

14.

Hublin C, Partinen M, Koskenvuo K, Silventoinen K, Koskenvuo M, Kaprio J . Shift-work and cardiovascular disease: a population-based 22-year follow-up study. Eur J Epidemiol. 2010; 25(5):315-23. DOI: 10.1007/s10654-010-9439-3. View

15.

Ruger M, Scheer F . Effects of circadian disruption on the cardiometabolic system. Rev Endocr Metab Disord. 2009; 10(4):245-60. PMC: 3026852. DOI: 10.1007/s11154-009-9122-8. View

16.

Chiuve S, Fung T, Rimm E, Hu F, McCullough M, Wang M . Alternative dietary indices both strongly predict risk of chronic disease. J Nutr. 2012; 142(6):1009-18. PMC: 3738221. DOI: 10.3945/jn.111.157222. View

17.

Vyas M, Garg A, Iansavichus A, Costella J, Donner A, Laugsand L . Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012; 345:e4800. PMC: 3406223. DOI: 10.1136/bmj.e4800. View

18.

Hoffmann B . A look inside the arteries: moving from event rates to subclinical measures of disease. Occup Environ Med. 2015; 72(10):687-8. DOI: 10.1136/oemed-2014-102640. View

19.

Manson J, Colditz G, Stampfer M, Willett W, Rosner B, Monson R . A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990; 322(13):882-9. DOI: 10.1056/NEJM199003293221303. View

20.

Colditz G, Manson J, Hankinson S . The Nurses' Health Study: 20-year contribution to the understanding of health among women. J Womens Health. 1997; 6(1):49-62. DOI: 10.1089/jwh.1997.6.49. View