Synopsis on the connection between professional stress and cardiovascular diseases
Keywords:
cardiovascular diseases, professional stress, epidemiology, mechanisms, modifying factors, interventionsAbstract
Professional stress is a widespread phenomenon with significant sequelae for the health status of population and it is increasingly recognized as an important factor for cardiovascular diseases (CVDs). This advanced synoptic review synthesizes findings from systematic reviews, meta-analyses, cohort studies and mechanistic studies. They show sequential connections between adverse working conditions (e.g., high burden at work, low control, imbalance between efforts and rewards) and increased prevalence of coronary artery disease (CAD), insult and cardiovascular mortality after adjustment for traditional risk factors. In this review we are focused on the epidemiology, pathophysiological mechanisms, specific CVDs, models of professional stress, modifying factors, assessment approaches, interventions and clinical implications, as well as the global perspectives and recommendations for prevention and policy. A critical analysis on the connection between professional stress and CVDs in the last five years, the known and unknown facts and recommendations for performance of future research studies was performed. The management of professional stress as a modifiable risk factor is of a significant importance for reduction of global burden of CVDs.
References
Lavigne-Robichaud M, Trudel X, Talbot D et al. Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures. Circ. Cardiovasc. Qual. Outcomes, 2023;16(10):e009700. doi: 10.1161/CIRCOUTCOMES.122.009700.
Taouk Y, Spittal MJ, LaMontagne AD, Milner AJ. Psychosocial work stressors and risk of all-cause and coronary heart disease mortality: A systematic review and meta-analysis. Scand. J. Work Environ. Health, 2020;46(1):19-31. doi: 10.5271/sjweh.3854.
Feng MY, Wang HX, Zhuo LB et al. Work-Related Stress and Occurrence of Cardiovascular Disease: A 13-Year Prospective Study. J. Occup. Environ. Med., 2022;64(11):927-933. doi: 10.1097/JOM.0000000000002645.
Dragano N, Siegrist J, Nyberg ST et al. Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals. Epidemiology, 2017;28(4):619-626. doi: 10.1097/EDE.0000000000000666.
Ogunmoroti O, Osibogun O, Allen NB et al. Work-Related Stress Is Associated With Unfavorable Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis. J. Am. Heart Assoc., 2024;13(22):e035824. doi: 10.1161/JAHA.124.035824.
Torquati L, Mielke GI, Brown WJ, Kolbe-Alexander T. Shift work and the risk of cardiovascular disease. A systematic review and meta-analysis including dose-response relationship. Scand. J. Work Environ. Health, 2018;44(3):229-238. doi: 10.5271/sjweh.3700.
Alhajaji R, Alfahmi MZ, Alshaikhi SA et al. The influence of workplace stressors on the risk of cardiovascular diseases among healthcare providers: a systematic review. Front. Psychiatry, 2025;16:1461698. doi: 10.3389/fpsyt.2025.1461698.
Puttonen S, Härmä M, Hublin C. Shift work and cardiovascular disease – pathways from circadian stress to morbidity. Scandi. J. Work, Environment & Health, 2010, 36, 2, 96-108.
Siegrist J. Effort–reward imbalance model. In: The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. Wiley, 2016, 545-549.
Kivimäki M, Kawachi I. Work Stress as a Risk Factor for Cardiovascular Disease. In: Work and Health: A Multidisciplinary Review. I. Kawachi, M. Kivimäki (Eds.). Oxford University Press, 2015, 123-145.
Cox T, Griffiths A. The nature and measurement of work-related stress: theory and practice. In: Handbook of occupational health psychology. American Psychological Association 2005, 133-148.
Nikolova R, Danev S, Kundurjiev T, Madjarov N. Screening Of Pathophysiological Mechanisms And Psychological And Occupational Factors, Determining Risk Of Cardiovascular Diseases In High-Risk Professions. Acta Medica Bulgarica, 2020, 47(4), 5-10.
Simeonova S, Nikolova R. Significance of the dominant psychological and physiological aspects of the occupational stress models. Acta Medica Bulgarica, 2021, 48(4), 33-42.
Madjarov N, Nikolova R, Kundurzhiev T et al. Expansion of psychosocial distress in nurses working in hemodialysis during exposure to COVID-19 pandemic in Bulgaria. Acta Medica Bulgarica, 2024, 51(1), 43-49.
Diffo TE, Lavigne-Robichaud M, Milot A et al. Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18-Year Prospective Study. J. Am. Heart Assoc., 2024;13(16):e032414. doi: 10.1161/JAHA.123.032414.
Rodrigues LA, Rodrigues AFM, Brunetti MN et al. Association between occupational stress, markers of inflammation, and oxidative stress in intensive care unit workers: a cross-sectional study. Rev. Bras. Med. Trab., 2024; 22(2):e20221049. doi: 10.47626/1679-4435-2022-1049.
Mohammed J, Kaware M, Maksoud MA et al. Occupational stress and cardiovascular risk among healthcare workers: a crosssectional survey study. J. Prevent. Populat. Health, 2025, 1(1), 002-010.
Todorova M, Harizanova S, Bakova D. Nutritional behavior and associated health risk in shift work: a literature review. J. IMAB, 2024;30(2):5522-5526. DOI: 10.5272/jimab.2024302.5522.
Kivimäki M, Nyberg ST, Batty GD et al.; IPD-Work Consortium. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. Lancet, 2012;380(9852):1491-7. doi: 10.1016/S0140-6736(12)60994-5.
World Health Organization, International Labour Organization. Long working hours increasing deaths from heart disease and stroke: WHO/ILO joint estimates. Geneva: WHO, 2021.
Härenstam A, Theorell T. Work stress and health in a globalized economy. Springer, 2020, 1-378.
Kivimäki M, Steptoe A. Effects of stress on the development and progression of cardiovascular disease. Nature Reviews Cardiology, 2018, 15(4):215-229.
Landsbergis PA, Dobson M, Koutsouras G, Schnall P. Job strain and ambulatory blood pressure: a meta-analysis and systematic review. Am. J. Public Health, 2013;103(3):e61-71. doi: 10.2105/AJPH.2012.301153.
World Health Organization. Healthy workplaces: a model for action – for employers, workers, policymakers and practitioners. WHO, 2010.
Steptoe A, Kivimäki M. Stress and cardiovascular disease. Nature Reviews Cardiology, 2012, 9(6):360-370.
Brotman DJ, Golden SH, Wittstein IS. The cardiovascular toll of stress. J. Am. Coll. Cardiol., 2023, 81(6):557-569. https://doi.org/10.1016/j.jacc.2022.11.025
Steptoe A, Kivimäki M. Stress and cardiovascular disease: an update on current knowledge. Ann. Rev. Public Health, 2013, 34:337-354.
Black PH, Garbutt LD. Stress, inflammation and cardiovascular disease. J. Psychosom. Res., 2002, 52(1):1-23.
McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol. Rev., 2007, 87(3):873-904.
Rozanski A, Blumenthal JA, Davidson KW et al. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J. Am. Coll. Cardiol., 2005;45(5):637-51. doi: 10.1016/j.jacc.2004.12.005.
Libby P, Ridker PM, Hansson GK. Inflammation in atherosclerosis: from pathophysiology to practice. J. Am. Coll. Cardiol., 2011, 54(23):2129-2138.
Kivimäki M, Jokela M, Nyberg ST et al. IPD-Work Consortium. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals. Lancet, 2015;386(10005):1739-46. doi: 10.1016/S0140-6736(15)60295-1.
Virtanen M, Heikkilä K, Jokela M et al. Long working hours and coronary heart disease: a systematic review and meta-analysis. Am J Epidemiol., 2012;176(7):586-96. doi: 10.1093/aje/kws139.
Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ, 2006, 332(7540):521-525.
Pickering TG, Hall JE, Appel LJ et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the 35. American Heart Association Council on High Blood Pressure Research. Circulat., 2005;111(5):697-716. doi: 10.1161/01.CIR.0000154900.76284.F6.
Nyberg ST, Fransson EI, Heikkilä K et al. IPD-Work Consortium. Job strain and cardiovascular disease risk factors: meta-analysis of individual-participant data from 47,000 men and women. PLoS One, 2013;8(6):e67323. doi: 10.1371/journal.pone.0067323.
Siegrist J, Marmot M. Social determinants of health: the solid facts, 2nd ed. World Health Organization, 2006.
Chandola T, Britton A, Brunner E et al. Work stress and coronary heart disease: what are the mechanisms? Eur. Heart J., 2008;29(5):640-8. doi: 10.1093/eurheartj/ehm584.
Bambra C, Gibson M, Sowden A et al. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J. Epidemiol. Community Health, 2010;64(4):284-91. doi: 10.1136/jech.2008.082743.
Siegrist J, Wege N, Pühlhofer F, Wahrendorf M. A short generic measure of work stress in the era of globalization: effort-reward imbalance. Int. Arch. Occup. Environ. Health, 2009;82(8):1005-13. doi: 10.1007/s00420-008-0384-3.
Thayer JF, Yamamoto SS, Brosschot JF. The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int. J. Cardiol., 2010, 141(2):122-131.
Lamontagne AD, Keegel T, Louie AM et al. A systematic review of the job-stress intervention evaluation literature, 1990-2005. Int. J. Occup. Environ. Health, 2007;13(3):268-80. doi: 10.1179/oeh.2007.13.3.268.
WHO. Workplace health promotion: policy recommendations. World Health Organization, 2019.
Richardson KM, Rothstein HR. Effects of occupational stress management intervention programs: a meta-analysis. J. Occupat. Health Psychol., 2008, 13(1):69-93.
Ulguim FO, Renner JDP, Pohl HH et al. Health workers: cardiovascular risk and occupational stress. Rev. Bras. Med. Trab., 2020;17(1):61-68. doi: 10.5327/Z1679443520190302.
Dong H, Yang LS, Yan ZY et al. Work Stress and Its Association with Cardiovascular Events in Occupational Populations: A Systematic Review and Meta-analysis. Asian J. Soc. Health and Behav., 2025, 8(2):47-58. doi: 10.4103/shb.shb_286_24.
Fishta A, Backé EM. Psychosocial stress at work and cardiovascular diseases: an overview of systematic reviews. Int. Arch. Occup. Environ. Health, 2015, 88:997-1014. https://doi.org/10.1007/s00420-015-1019-0
Lecca LI, Campagna M, Portoghese I et al. Work Related Stress, Well-Being and Cardiovascular Risk among Flight Logistic Workers: An Observational Study. Int. J. Environ. Res. Public Health, 2018;15(9):1952. doi: 10.3390/ijerph15091952.
Kivimäki M, Virtanen M, Elovainio M et al. Work stress in the etiology of coronary heart disease--a meta-analysis. Scand. J. Work Environ. Health, 2006;32(6):431-42. doi: 10.5271/sjweh.1049.
Dickson VV, Zhanay J, Leon A et al. Measurement of stress amongst working adults with cardiovascular disease. Eur. J. Cardiovasc. Nurs., 2022;21(8):848-856. doi: 10.1093/eurjcn/zvac018.
Schaufeli WB, Kompier MAJ. Managing Job Stress in the Netherlands. Int. J. Stress Management, 2001;8:15-34. https://doi.org/10.1023/A:1009549312628
Diebig M, Dragano N, Körner U et al. Development and Validation of a Questionnaire to Measure Psychosocial Work Stressors in Modern Working Environments. J. Occup. Environ. Med., 2020;62(3):185-193. doi: 10.1097/JOM.0000000000001779.
Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat. Rev. Cardiol., 2024;21:603-616. https://doi.org/10.1038/s41569-024-01024-y.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 R. Nikolova, L. Hristova (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
You are free to share, copy and redistribute the material in any medium or format under these terms.
Journal Bulgarian Medical Journal (Български медицински журнал / Bulgarian Medical Journal)
