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Work-Related Psychosocial Factors and the Development of Ischemic Heart Disease: A Systematic Review

Eller, Nanna H. MD*; Netterstrøm, Bo MD, DMSc*; Gyntelberg, Finn MD, DMSc; Kristensen, Tage S. DMSc; Nielsen, Finn MD, DMSc§; Steptoe, Andrew MA, DPhil, DSc; Theorell, Töres MD, DMSc

doi: 10.1097/CRD.0b013e318198c8e9
Review Article

The literature on the relationship between work-related psychosocial factors and the development of ischemic heart disease (IHD) was systematically reviewed: 33 articles presented 51 analyses of studies involving male participants, 18 analyses involving female participants, and 8 analyses with both genders. Twenty of the studies originated in the Nordic countries, and the major dimensions of the Demand-Control Model were the focus of 23 articles. A balanced evaluation of the studies indicates moderate evidence that high psychologic demands, lack of social support, and iso-strain are risk factors for IHD among men. Studies performed during recent years have not shown evidence for lack of control as a risk factor for IHD. Several studies have shown that job strain is a risk factor, but in the more recent ones, these associations can be fully explained by the association between demands and disease risk. Insufficient evidence was found for a relationship between IHD and effort-reward imbalance, injustice, job insecurity, or long working hours. Studies involving women are too few to draw any conclusion concerning women, work stress, and IHD.

From the *Clinic of Occupational Medicine, Hillerød Hospital, Hillerød, Denmark; †Clinic of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen, Denmark; ‡Task-Consult, Gilleleje, Denmark; §Department of Cardiology, Herlev Hospital, Herlev, Denmark; ¶Department of Epidemiology and Public Health, University College London, London, England; and ∥Institute of Stress Research, Karolinska Institute, Stockholm, Sweden.

Correspondence: Nanna H. Eller, MD, Clinic of Occupational Medicine, Hillerød Hospital, Helsevej 2, DK 3400 Hillerød, Denmark. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.