Shift work and cardiovascular risk

It is well-known that shift workers have increased risk factors for serious heart disease, for example as reported in Knuttson’s 1986 Lancet paper on papermill workers. They are more likely to smoke and tend to have higher blood pressure, cholesterol and weight and be more likely to have diabetes than  workers whose work pattern is confined to the daytime. They are also more likely to have insomnia, itself an independent risk factor for cardiovascular disease. Clinical pharmacologist Daniel Hackem from Ontario and his colleagues from Norway, Sweden and the USA had now raised further public and health professional interest in this disease link in a paper published in the British Medical Journal.

They looked at 34 previous studies of over 2 million shiftworkers. Together, there were over 17,000 heart events, over 6000 heart attacks and almost 2000 strokes. They concluded that stroke risk was around 5% higher and coronary event risk 24% higher in the shift-workers. Surprisingly, despite their large dataset, the researchers found no associated increase in mortality.

They take care to point out, as with any other observational study, that this is not necessarily a cause and effect relationship. People who take on shift work may be different in some unconnected way that puts up risk of vascular disease. Lower socio-economic status is an obvious important confounder. The work itself may be more stressful, at the same time as their being fewer other staff members in support ‘out of hours’. Shift workers may also take more caffeine to try to stay alert during often long shifts.

Nonetheless there are several key messages reinforced by this report.

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Why worry about high blood pressure?

Listen to blood pressure specialist Donald Singer and pharmacist Ejaz Cheema in discussion with Annie Othen on BBC radio about blood pressure, knowing your numbers, tips on blood pressure measurement, why treatment is important, and how doctors, nurses and pharmacists can help to keep people with high blood pressure as healthy as possible.

High blood pressure is a very common preventable cause of stroke, heart attack and other serious diseases. These complications may at best cause disability and are major causes of preventable premature death in the UK and around the world.

For the public in general, the lower the blood pressure the better: most blood pressure-related heart attacks and strokes occur at blood pressure levels within what many still consider to be normal blood pressure.

A healthy lifestyle will help to keep blood pressure and other cardiovascular risk factors in check. Keeping weight in check, regular exercise, minimising salt intake and moderation in alcohol, as well as eating healthy foods rich in fruit and vegetables all help, as does avoiding or stopping smoking.

For people with raised blood pressure, tests are important to rule out underlying causes and to identify other cardiovascular risk factors.

Blood pressure treatment is well-established as effective in helping to prevent or reduce severity of heart attack, stroke and other serious medical problems. However  blood pressure is still poorly controlled in many patients even in the most developed healthcare systems.

One of several reasons for poor blood pressure control is that many patients find it difficult to keep taking their tablets. Surprisingly, in people newly diagnosed with high blood pressure, as many as half may have stopped their tablets by 12 months.

It is as important to understand and address reasons for poor patient adherence with their medicines. These include not being sure of why blood pressure is important, reasons for choice of medicines, and concerns about possible or actual side effects of tablets.

Other contributory factors includes failure of prescribers to follow established national guidelines for choice of tablets and how they should be used singly or in combination. This risks exposing patients to avoidable side effects without achieving effective lowering of blood pressure.

 

An important element in approaches to improving adherence to blood pressure medicines is continuing education of health professionals and patients about high blood pressure and its treatment. Doctors, nurses and pharmacists can all play important roles in this.

The Cardiovascular Research Trust

The Cardiovascular Research Trust is a healthy heart charity with the aim of informing and educating health professionals, policy makers and the public about advances in understanding effective ways to prevent and treat serious disorders of the heart and the circulation. The Trust has a particular interest in effective healthy heart promotion in the young.

The Trust was founded in 1996.

Activities of our healthy heart charity include:

Healthy Heart Symposia – educational events on how diet, exercise and other aspects of lifestyle can prevent and reduce severity of diseases of the heart and circulation

Healthy Heart Awards for schools

publications aimed at increasing awareness of how to keep the heart healthy

Healthy Heart Poetry in association with the Hippocrates Initiative