Long working hours and the risk of ischemic cardiac death: A systematic review and a meta-analysis

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Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.6252
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Vol. 103 No. 9 (2025): Tunis Med sept 2025

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Marwa Boussaid
Department of Forensic Medicine, Tahar Sfar Teaching Hospital of Mahdia, Technology and medical imaging research laboratory - LTIM-LR12ES06. Faculty of Medicine of Monastir, University of Monastir, Tunisia
Mohamed Ali Chaouch
Department of Surgery, Fattouma Bourguiba University Hospital, Monastir, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Hiba Limem
Department of Forensic Medicine, Tahar Sfar Teaching Hospital of Mahdia, Technology and medical imaging research laboratory - LTIM-LR12ES06. Faculty of Medicine of Monastir, University of Monastir, Tunisia
Imen Mlouki
Department of Preventive Medicine, Tahar Sfar Teaching Hospital of Mahdia,Faculty of Medicine of Monastir, University Of Monastir Tunisia
Mohamed Amine Mesrati
Department of Surgery, Fattouma Bourguiba University Hospital, Monastir, Faculty of Medicine of Monastir, University of Monastir, Tunisia
Sana Mhamdi
Department of Preventive Medicine, Tahar Sfar Teaching Hospital of Mahdia,Faculty of Medicine of Monastir, University Of Monastir ,Tunisia
Abir Aissaoui
Department of Forensic Medicine, Tahar Sfar Teaching Hospital of Mahdia, Technology and medical imaging research laboratory - LTIM-LR12ES06. Faculty of Medicine of Monastir, University of Monastir, Tunisia

Abstract

Introduction: The relationship between occupational stress, particularly long working hours, and health outcomes such as ischemic cardiac death has garnered increasing attention. Myocardial infarction, a primary cause of sudden cardiac death, is significantly influenced by workplace stress. This systematic review and meta-analysis aim to explore the association between long working hours and the risk of ischemic cardiac death, building upon the foundation of previous studies indicating a potential link between prolonged occupational stress and cardiovascular health issues.


Methods: We systematically searched several databases up to 30 November 2022 without language restrictions, using a comprehensive set of keywords related to occupational stress and ischemic heart disease. The selection criteria focused on clinical trials assessing the risk of occupational stress and cardiovascular disease in individuals of working age from diverse industrial settings. Quality assessment was performed using the STROBE scale, and statistical analysis was conducted using RevMan web software, considering hazard ratios and odds ratios as relative risk estimates.


Results: Our search yielded 20 trials, with 18 meeting the inclusion criteria. These studies encompassed a wide range of years (1992-2019) and involved a total of 288,278 individuals. Our meta-analysis revealed no significant risk increase for ischemic heart disease mortality for those working 41 to 49 hours per week compared to 35 to 40 hours. However, working more than 55 hours per week was associated with a 17% increased risk of ischemic heart disease mortality (RR=1.17, 95% CI [1.05 to 1.31]).


Conclusions: Extended working hours are associated with an increased risk of ischemic heart disease mortality, emphasizing the importance of addressing occupational health and safety standards. This study contributes to the growing body of evidence on the health implications of long working hours and underscores the necessity for preventive strategies to protect worker health in the modern work environment.

Keywords:

sudden cardiac death, coronary, myocardial infarction, death, myocardial, occupational stress

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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