HHS Public Access Author manuscript Author Manuscript
JAMA. Author manuscript; available in PMC 2017 April 26. Published in final edited form as: JAMA. 2016 April 26; 315(16): 1726–1734. doi:10.1001/jama.2016.4454.
Association between rotating night shift work and risk of coronary heart disease among women Céline Vetter, PhD1,*, Elizabeth E. Devore, ScD1, Lani R. Wegrzyn, ScD2, Jennifer Massa, ScD3, Frank E. Speizer, MD1,4, Ichiro Kawachi, MD, ScD5, Bernard Rosner, PhD1,6, Meir J. Stampfer, MD, DrPH1,2,3, and Eva S. Schernhammer, MD, DrPH1,2,7 1Channing
Author Manuscript
Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
2Department
of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
3Department
of Nutrition, Harvard T.H. Chan School of Public Health, Boston
4Department
of Environmental Health, Harvard T.H. Chan School of Public Health, Boston
5Department
of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health,
Boston 6Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston
7Department
of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna,
Austria
Author Manuscript
Abstract Importance—Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. Objective—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 over 24 years in the Nurses' Health Studies (NHS (1988-2012): N=73,623, and NHS2 (1989-2013): N=115,535). Exposure—Questionnaire-based lifetime history of rotating night shift work (≥3 night shifts/ month, plus day and evening shifts) at baseline; also updated every 2-4yrs in NHS2.
Author Manuscript
Main Outcomes and Measures—Incident CHD, i.e. non-fatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass grafting (CABG), stents, and angioplasty. Results—During follow-up, 7,303 incident CHD cases in NHS (mean age at baseline: 54.5yrs) and 3,519 in NHS2 (34.8yrs) occurred. In multivariable adjusted Cox proportional hazards
*
Corresponding Author: Dr. Céline Vetter, Channing Division of Network Medicine, 181 Longwood Avenue, Boston, MA, 02115, USA, Phone: +1 (617) 525 2088, Fax: +1 (617) 525 2008, [email protected]. Author Contributions: Dr. Vetter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Vetter et al.
Page 2
Author Manuscript Author Manuscript
models, increasing years of baseline rotating night shift work were associated with a significantly higher CHD risk in both cohorts (NHS: age-standardized incidence rate (IR)10,000 incident CHD cases over 24 years of follow-up, and confirmed endpoints of MI and CHD death by medical and death records. Detailed information on a wide range of potential confounding factors was available, and most of them were updated regularly throughout follow up. This study was also based on one of the few cohorts with detailed lifetime shift work exposure information.
Author Manuscript Author Manuscript
Several limitations are also noteworthy. Conclusions can be generalized to women only, and health effects of shift work and pathways may be different in men and women.33 As in all observational studies, even though known potential confounding factors were controlled for, there might have been still uncontrolled confounding due to unmeasured differences in behaviors or other factors. This study relied on self-reports for angiogram confirmed angina pectoris, CABG, angioplasty and stents, but validation studies have demonstrated a high accuracy of self-reports from these participants, all of whom are registered nurses.34,35 The exposure assessments lacked information on intensity of night shift work and physiological measures that may be affected by shift work. Additionally, as information on permanent night shift work over time was not collected, women with such schedules might have been included in the reference group. If permanent night shift workers had a higher CHD risk as compared to never rotating shift workers, this would have biased results towards the null. Future studies should include a more detailed assessment of work hours and job demands, ideally in conjunction with chronotype and sleep timing measures, to enable more detailed studies of circadian strain on coronary health.14 Furthermore, studying CHD-related biomarkers (e.g., triglycerides, cholesterol levels, carotid plaque, or HbA1c)17,36 might be useful in understanding underlying mechanisms.
Conclusions 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.
Author Manuscript
Supplementary Material Refer to Web version on PubMed Central for supplementary material.
Acknowledgments We would like to thank the participants and staff of the Nurses' Health Study cohorts for their valuable contributions. In addition, we would also like to thank Stephanie E. Chiuve, Sc.D. (Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston) for helpful discussions, as well as Jeffrey Pierre-Paul, PharmD
JAMA. Author manuscript; available in PMC 2017 April 26.
Vetter et al.
Page 10
Author Manuscript
RPh (Massachusetts College of Pharmacy and Health Sciences), for his support in the early stages of the project. Participants did not receive compensation, and staff were not compensated outside of their salaries. Funding/Support: This research was supported by Center for Disease Control and Prevention/The National Institute for Occupational Safety and Health grant 5R01OH009803 (PI: Schernhammer E), and UM1CA186107, UM1CA176726, R01HL034594. Céline Vetter was additionally supported by a fellowship from the German Research Foundation (DFG, VE 835/1-1). Role of the Sponsor: The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
References
Author Manuscript Author Manuscript Author Manuscript
1. Costa G. The impact of shift and night work on health. Appl Ergon. 1996; 27(1):9–16. [PubMed: 15676307] 2. Knutsson A. Shift work and coronary heart disease. Scand J Soc Med Suppl. 1989; 44:1–36. [PubMed: 2683043] 3. Rüger M, Scheer FAJL. Effects of circadian disruption on cardiometabolic system. Rev Endocr Metab Disord. 2009; 10(4):245–260. [PubMed: 19784781] 4. Boggild H, Knutsson A. Shift work, risk factors and cardiovascular disease. Scand J Work Environ Health. 1999; 25(2):85–99. [PubMed: 10360463] 5. Knutsson A. Health disorders of shift workers. Occup Med. 2003; 53(2):103–108. 6. Wang X, Armstrong M, Cairns B, Key T, Travis R. Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond). 2011; 61:78–89. [PubMed: 21355031] 7. Kawachi I, Colditz GA, Stampfer MJ, et al. Prospective Study of Shift Work and Risk of Coronary Heart Disease in Women. Circulation. 1995; 92(11):3178–3182. [PubMed: 7586301] 8. Vyas MV, Garg AX, Iansavichus AV, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012; 345:e4800. [PubMed: 22835925] 9. Colditz GA, Manson JE, Hankinson SE. The Nurses' Health Study: 20-Year Contribution to the Understanding of Health Among Women. J Womens Health. 1997; 6(1):49–62. [PubMed: 9065374] 10. Rose, G.; Blackburn, H. Cardiovascular Survey Method. Geneva, Switzerland: World Health Organization; 1982. 11. Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985; 122(1):51–65. [PubMed: 4014201] 12. Chiuve SE, Fung TT, Rimm EB, et al. Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. J Nutr. 2012; 142(6):1009–1018. [PubMed: 22513989] 13. Kantermann T, Juda M, Vetter C, Roenneberg T. Shift-work research: Where do we stand, where should we go? Sleep Biol Rhyth. 2010; 8(2):95–105. 14. Stevens RG, Hansen J, Costa G, et al. Considerations of circadian impact for defining ‘shift work’ in cancer studies: IARC Working Group Report. Occup Environ Med. 2011; 68(2):154–162. [PubMed: 20962033] 15. Wong ND. Epidemiological studies of CHD and the evolution of preventive cardiology. Nat Rev Cardiol. 2014; 11(5):276–289. [PubMed: 24663092] 16. Bernstein, AB.; Hing, E.; Moss, AJ.; Allen, KF.; Siller, AB.; Tiggle, RB. Health care in America Trends in utilization. Hyattsville, Maryland: National Center for Health Statistics; 2003. 17. Hoffmann B. A look inside the arteries: moving from event rates to subclinical measures of disease. Occup Environ Med. 2015; Epub ahead of print. doi: 10.1136/oemed-2014-102640 18. Fujishiro K, Diez Roux AV, Landsbergis P, Kaufman JD, Korcarz CE, Stein JH. Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Artherosclerosis (MESA). Occup Environ Med. 2014; Epub ahead of print. doi: 10.1136/oemed-2014-102311 19. 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): 315–323. [PubMed: 20229313]
JAMA. Author manuscript; available in PMC 2017 April 26.
Vetter et al.
Page 11
Author Manuscript Author Manuscript Author Manuscript
20. Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of obesit and risk of coronary heart disease in women. N Engl J Med. 1990; 322(13):882–889. [PubMed: 2314422] 21. Hubert HB, Feinleib M, McNamara PM, Castelli WP. 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):968–977. [PubMed: 6219830] 22. Eckel RH, Krauss RM. Committee ftAN. American Heart Association Call to Action: Obesity as a Major Risk Factor for Coronary Heart Disease. Circulation. 1998; 97(21):2099–2100. [PubMed: 9626167] 23. Redline S, Foody J. Sleep Disturbances: Time to Join the Top 10 Potentially Modifiable Cardiovascular Risk Factors? Circulation. 2011; 124(19):2049–2051. [PubMed: 22064955] 24. Backé EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Arch Occup Environ Health. 2011; 85(1):67–79. [PubMed: 21584721] 25. Standsfeld, SA.; Marmot, MG. Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease. London: BMJ Books; 2002. p. 21-49. 26. Steptoe A, Kivimäki M. Stress and Cardiovascular Disease: An Update on Current Knowledge. Annu Rev Public Health. 2013; 34(1):337–354. [PubMed: 23297662] 27. Kawachi I, Colditz GA, Ascherio A, et al. A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health. 1996; 50(3):245–251. [PubMed: 8935453] 28. Harrington JM. Health effects of shift work and extended hours of work. Occup Environ Med. 2001; 58(1):68–72. 29. Baron KG, Reid KJ. Circadian misalignment and health. Int Rev Psychiatry. 2014; 26(2):139–154. [PubMed: 24892891] 30. Puttonen S, Härma M, Hublin C. Shift work and cardiovascular disease - pathways from circadian stress to morbidity. Scand J Work Environ Health. 2010; 36(2):96–108. [PubMed: 20087536] 31. Roenneberg T. What is chronotype? Sleep Biol Rhythms. 2012; 10(2):75–76. 32. Juda M, Vetter C, Roenneberg T. Chronotype modulates sleep duration, social jetlag and sleep quality in shift-workers. J Biol Rhythms. 2013; 28:141–151. [PubMed: 23606613] 33. Leclerc A. Shift-work and cardiovascular disease. Eur J Epidemiol. 2010; 25(5):285–286. [PubMed: 20422441] 34. Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and Validity of a Self-Administered Physical Activity Questionnaire. Int J Epidemiol. 1994; 23(5):991–999. [PubMed: 7860180] 35. Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. 1986; 123(5): 894–900. [PubMed: 3962971] 36. Jensen MK, Bertoia ML, Cahill LE, Agarwal I, Rimm EB, Mukamal KJ. Novel metabolic biomarkers of cardiovascular disease. Nat Rev Endocrinol. 2014; 10(11):659–672. [PubMed: 25178732]
Author Manuscript JAMA. Author manuscript; available in PMC 2017 April 26.
Author Manuscript Table 1
Author Manuscript
Author Manuscript
Author Manuscript 4,893 (16)
Parental history of MI under 60 yrs, No. (%, yes)
JAMA. Author manuscript; available in PMC 2017 April 26. 18,518 (62) 18,482 (62) 9,537 (31) 11,110 (37) 20,735 (71)
Multi-vitamin user, No. (%, yes)
Aspirin user, No. (%, yes)
NSAIDs user, No. (%, yes)f,f
Acetaminophen user, No. (%, yes)g
Postmenopausal, No. (%)
45.7 (10.5)
Diet score (AHEI 2010)d 7.9 (2.9-20.2)
1.8 (0-7.6)
Alcohol intake (g/day, median, IQR)c
Physical activity (Met-h/week, median, IQR)e
5,841 (19)
1,235 (4)
BMI ≥35, No. (%)
Graduate school diploma of husband, No. (%)
2,645 (9)
BMI 30-34.9, No. (%)
18 (7-34)
7,926 (27)
BMI 25-29.9, No. (%)
Pack-years of smoking (median, IQR)b
18,206 (61)
BMI
JAMA. Author manuscript; available in PMC 2017 April 26. Published in final edited form as: JAMA. 2016 April 26; 315(16): 1726–1734. doi:10.1001/jama.2016.4454.
Association between rotating night shift work and risk of coronary heart disease among women Céline Vetter, PhD1,*, Elizabeth E. Devore, ScD1, Lani R. Wegrzyn, ScD2, Jennifer Massa, ScD3, Frank E. Speizer, MD1,4, Ichiro Kawachi, MD, ScD5, Bernard Rosner, PhD1,6, Meir J. Stampfer, MD, DrPH1,2,3, and Eva S. Schernhammer, MD, DrPH1,2,7 1Channing
Author Manuscript
Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
2Department
of Epidemiology, Harvard T.H. Chan School of Public Health, Boston
3Department
of Nutrition, Harvard T.H. Chan School of Public Health, Boston
4Department
of Environmental Health, Harvard T.H. Chan School of Public Health, Boston
5Department
of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health,
Boston 6Department
of Biostatistics, Harvard T.H. Chan School of Public Health, Boston
7Department
of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna,
Austria
Author Manuscript
Abstract Importance—Prospective studies linking shift work to coronary heart disease (CHD) have been inconsistent and limited by short follow-up. Objective—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 over 24 years in the Nurses' Health Studies (NHS (1988-2012): N=73,623, and NHS2 (1989-2013): N=115,535). Exposure—Questionnaire-based lifetime history of rotating night shift work (≥3 night shifts/ month, plus day and evening shifts) at baseline; also updated every 2-4yrs in NHS2.
Author Manuscript
Main Outcomes and Measures—Incident CHD, i.e. non-fatal myocardial infarction, CHD death, angiogram-confirmed angina pectoris, coronary artery bypass grafting (CABG), stents, and angioplasty. Results—During follow-up, 7,303 incident CHD cases in NHS (mean age at baseline: 54.5yrs) and 3,519 in NHS2 (34.8yrs) occurred. In multivariable adjusted Cox proportional hazards
*
Corresponding Author: Dr. Céline Vetter, Channing Division of Network Medicine, 181 Longwood Avenue, Boston, MA, 02115, USA, Phone: +1 (617) 525 2088, Fax: +1 (617) 525 2008, [email protected]. Author Contributions: Dr. Vetter had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Vetter et al.
Page 2
Author Manuscript Author Manuscript
models, increasing years of baseline rotating night shift work were associated with a significantly higher CHD risk in both cohorts (NHS: age-standardized incidence rate (IR)10,000 incident CHD cases over 24 years of follow-up, and confirmed endpoints of MI and CHD death by medical and death records. Detailed information on a wide range of potential confounding factors was available, and most of them were updated regularly throughout follow up. This study was also based on one of the few cohorts with detailed lifetime shift work exposure information.
Author Manuscript Author Manuscript
Several limitations are also noteworthy. Conclusions can be generalized to women only, and health effects of shift work and pathways may be different in men and women.33 As in all observational studies, even though known potential confounding factors were controlled for, there might have been still uncontrolled confounding due to unmeasured differences in behaviors or other factors. This study relied on self-reports for angiogram confirmed angina pectoris, CABG, angioplasty and stents, but validation studies have demonstrated a high accuracy of self-reports from these participants, all of whom are registered nurses.34,35 The exposure assessments lacked information on intensity of night shift work and physiological measures that may be affected by shift work. Additionally, as information on permanent night shift work over time was not collected, women with such schedules might have been included in the reference group. If permanent night shift workers had a higher CHD risk as compared to never rotating shift workers, this would have biased results towards the null. Future studies should include a more detailed assessment of work hours and job demands, ideally in conjunction with chronotype and sleep timing measures, to enable more detailed studies of circadian strain on coronary health.14 Furthermore, studying CHD-related biomarkers (e.g., triglycerides, cholesterol levels, carotid plaque, or HbA1c)17,36 might be useful in understanding underlying mechanisms.
Conclusions 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.
Author Manuscript
Supplementary Material Refer to Web version on PubMed Central for supplementary material.
Acknowledgments We would like to thank the participants and staff of the Nurses' Health Study cohorts for their valuable contributions. In addition, we would also like to thank Stephanie E. Chiuve, Sc.D. (Harvard T.H. Chan School of Public Health, and Harvard Medical School, Boston) for helpful discussions, as well as Jeffrey Pierre-Paul, PharmD
JAMA. Author manuscript; available in PMC 2017 April 26.
Vetter et al.
Page 10
Author Manuscript
RPh (Massachusetts College of Pharmacy and Health Sciences), for his support in the early stages of the project. Participants did not receive compensation, and staff were not compensated outside of their salaries. Funding/Support: This research was supported by Center for Disease Control and Prevention/The National Institute for Occupational Safety and Health grant 5R01OH009803 (PI: Schernhammer E), and UM1CA186107, UM1CA176726, R01HL034594. Céline Vetter was additionally supported by a fellowship from the German Research Foundation (DFG, VE 835/1-1). Role of the Sponsor: The sponsor had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
References
Author Manuscript Author Manuscript Author Manuscript
1. Costa G. The impact of shift and night work on health. Appl Ergon. 1996; 27(1):9–16. [PubMed: 15676307] 2. Knutsson A. Shift work and coronary heart disease. Scand J Soc Med Suppl. 1989; 44:1–36. [PubMed: 2683043] 3. Rüger M, Scheer FAJL. Effects of circadian disruption on cardiometabolic system. Rev Endocr Metab Disord. 2009; 10(4):245–260. [PubMed: 19784781] 4. Boggild H, Knutsson A. Shift work, risk factors and cardiovascular disease. Scand J Work Environ Health. 1999; 25(2):85–99. [PubMed: 10360463] 5. Knutsson A. Health disorders of shift workers. Occup Med. 2003; 53(2):103–108. 6. Wang X, Armstrong M, Cairns B, Key T, Travis R. Shift work and chronic disease: the epidemiological evidence. Occup Med (Lond). 2011; 61:78–89. [PubMed: 21355031] 7. Kawachi I, Colditz GA, Stampfer MJ, et al. Prospective Study of Shift Work and Risk of Coronary Heart Disease in Women. Circulation. 1995; 92(11):3178–3182. [PubMed: 7586301] 8. Vyas MV, Garg AX, Iansavichus AV, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012; 345:e4800. [PubMed: 22835925] 9. Colditz GA, Manson JE, Hankinson SE. The Nurses' Health Study: 20-Year Contribution to the Understanding of Health Among Women. J Womens Health. 1997; 6(1):49–62. [PubMed: 9065374] 10. Rose, G.; Blackburn, H. Cardiovascular Survey Method. Geneva, Switzerland: World Health Organization; 1982. 11. Willett WC, Sampson L, Stampfer MJ, et al. Reproducibility and validity of a semiquantitative food frequency questionnaire. Am J Epidemiol. 1985; 122(1):51–65. [PubMed: 4014201] 12. Chiuve SE, Fung TT, Rimm EB, et al. Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease. J Nutr. 2012; 142(6):1009–1018. [PubMed: 22513989] 13. Kantermann T, Juda M, Vetter C, Roenneberg T. Shift-work research: Where do we stand, where should we go? Sleep Biol Rhyth. 2010; 8(2):95–105. 14. Stevens RG, Hansen J, Costa G, et al. Considerations of circadian impact for defining ‘shift work’ in cancer studies: IARC Working Group Report. Occup Environ Med. 2011; 68(2):154–162. [PubMed: 20962033] 15. Wong ND. Epidemiological studies of CHD and the evolution of preventive cardiology. Nat Rev Cardiol. 2014; 11(5):276–289. [PubMed: 24663092] 16. Bernstein, AB.; Hing, E.; Moss, AJ.; Allen, KF.; Siller, AB.; Tiggle, RB. Health care in America Trends in utilization. Hyattsville, Maryland: National Center for Health Statistics; 2003. 17. Hoffmann B. A look inside the arteries: moving from event rates to subclinical measures of disease. Occup Environ Med. 2015; Epub ahead of print. doi: 10.1136/oemed-2014-102640 18. Fujishiro K, Diez Roux AV, Landsbergis P, Kaufman JD, Korcarz CE, Stein JH. Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Artherosclerosis (MESA). Occup Environ Med. 2014; Epub ahead of print. doi: 10.1136/oemed-2014-102311 19. 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): 315–323. [PubMed: 20229313]
JAMA. Author manuscript; available in PMC 2017 April 26.
Vetter et al.
Page 11
Author Manuscript Author Manuscript Author Manuscript
20. Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of obesit and risk of coronary heart disease in women. N Engl J Med. 1990; 322(13):882–889. [PubMed: 2314422] 21. Hubert HB, Feinleib M, McNamara PM, Castelli WP. 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):968–977. [PubMed: 6219830] 22. Eckel RH, Krauss RM. Committee ftAN. American Heart Association Call to Action: Obesity as a Major Risk Factor for Coronary Heart Disease. Circulation. 1998; 97(21):2099–2100. [PubMed: 9626167] 23. Redline S, Foody J. Sleep Disturbances: Time to Join the Top 10 Potentially Modifiable Cardiovascular Risk Factors? Circulation. 2011; 124(19):2049–2051. [PubMed: 22064955] 24. Backé EM, Seidler A, Latza U, Rossnagel K, Schumann B. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review. Int Arch Occup Environ Health. 2011; 85(1):67–79. [PubMed: 21584721] 25. Standsfeld, SA.; Marmot, MG. Stress and the Heart: Psychosocial Pathways to Coronary Heart Disease. London: BMJ Books; 2002. p. 21-49. 26. Steptoe A, Kivimäki M. Stress and Cardiovascular Disease: An Update on Current Knowledge. Annu Rev Public Health. 2013; 34(1):337–354. [PubMed: 23297662] 27. Kawachi I, Colditz GA, Ascherio A, et al. A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health. 1996; 50(3):245–251. [PubMed: 8935453] 28. Harrington JM. Health effects of shift work and extended hours of work. Occup Environ Med. 2001; 58(1):68–72. 29. Baron KG, Reid KJ. Circadian misalignment and health. Int Rev Psychiatry. 2014; 26(2):139–154. [PubMed: 24892891] 30. Puttonen S, Härma M, Hublin C. Shift work and cardiovascular disease - pathways from circadian stress to morbidity. Scand J Work Environ Health. 2010; 36(2):96–108. [PubMed: 20087536] 31. Roenneberg T. What is chronotype? Sleep Biol Rhythms. 2012; 10(2):75–76. 32. Juda M, Vetter C, Roenneberg T. Chronotype modulates sleep duration, social jetlag and sleep quality in shift-workers. J Biol Rhythms. 2013; 28:141–151. [PubMed: 23606613] 33. Leclerc A. Shift-work and cardiovascular disease. Eur J Epidemiol. 2010; 25(5):285–286. [PubMed: 20422441] 34. Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and Validity of a Self-Administered Physical Activity Questionnaire. Int J Epidemiol. 1994; 23(5):991–999. [PubMed: 7860180] 35. Colditz GA, Martin P, Stampfer MJ, et al. Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol. 1986; 123(5): 894–900. [PubMed: 3962971] 36. Jensen MK, Bertoia ML, Cahill LE, Agarwal I, Rimm EB, Mukamal KJ. Novel metabolic biomarkers of cardiovascular disease. Nat Rev Endocrinol. 2014; 10(11):659–672. [PubMed: 25178732]
Author Manuscript JAMA. Author manuscript; available in PMC 2017 April 26.
Author Manuscript Table 1
Author Manuscript
Author Manuscript
Author Manuscript 4,893 (16)
Parental history of MI under 60 yrs, No. (%, yes)
JAMA. Author manuscript; available in PMC 2017 April 26. 18,518 (62) 18,482 (62) 9,537 (31) 11,110 (37) 20,735 (71)
Multi-vitamin user, No. (%, yes)
Aspirin user, No. (%, yes)
NSAIDs user, No. (%, yes)f,f
Acetaminophen user, No. (%, yes)g
Postmenopausal, No. (%)
45.7 (10.5)
Diet score (AHEI 2010)d 7.9 (2.9-20.2)
1.8 (0-7.6)
Alcohol intake (g/day, median, IQR)c
Physical activity (Met-h/week, median, IQR)e
5,841 (19)
1,235 (4)
BMI ≥35, No. (%)
Graduate school diploma of husband, No. (%)
2,645 (9)
BMI 30-34.9, No. (%)
18 (7-34)
7,926 (27)
BMI 25-29.9, No. (%)
Pack-years of smoking (median, IQR)b
18,206 (61)
BMI
