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Cardiovascular Disease and Work

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There are 10 work-related factors that cause 5-8% of healthcare costs and 120,000 deaths (including CVD) in the U.S each year:1 (AI) Image for illustration purposes
There are 10 work-related factors that cause 5-8% of healthcare costs and 120,000 deaths (including CVD) in the U.S each year:1 (AI) Image for illustration purposes
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Cardiovascular diseases (CVDs) are health conditions that involve the heart or blood vessels.

Many things can cause CVD, including:

  • Unhealthy behaviors, such as smoking and excessive alcohol use.
  • Medical conditions, like diabetes or high blood pressure.
  • Exposure to certain social, organizational, and environmental conditions at work.

A person’s job can affect cardiovascular disease risk factors, like:

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  • Smoking
  • Blood pressure, glucose, and cholesterol levels
  • Obesity
  • Unhealthy diet
  • Burnout, depression
  • Excessive alcohol use
  • Fatigue and problems sleeping
  • Not exercising

Among working-age populations, work is linked to about 10-20% of all CVD deaths.

There are 10 work-related factors that cause 5-8% of healthcare costs and 120,000 deaths (including CVD) in the U.S each year:1

  1. Long working hours (55 hours or more per week)2
  2. Working nights, rotating shifts, or other non-standard shifts 2,3
  3. High job demand4,5
  4. Low job control4,5
  5. Low job security (worried about losing one’s job)
  6. Work-family imbalance
  7. Low organizational justice (feeling of being treated unfairly at work)
  8. Low workplace social support
  9. Unemployment
  10. No health insurance

There is also evidence that these factors related to work increase CVD risk:6

  • High efforts, low reward6
  • Bullying or violence4,5
  • Lower income4,5
  • Heavy physical activity at work7
  • Exposure to dust, fumes, or chemicals, including secondhand smoke8-10

Occupation Groups with the Poorest Cardiovascular Health Measures

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  • Transportation and material moving employees,
  • Food preparation and serving employees,
  • Personal care and service employees, and
  • Farming, fishing, and forestry employees.11,12

Use the NIOSH Worker Health Charts (WHC) to examine CVD risk factors.

  • Professional drivers, including long-haul truck drivers
  • First responders, including police officers and firefighters
  • Food and drink preparatory workers13
  • Fishery workers13
  • Cargo workers13
  • Civil engineer workers13
  • Plant and machine operators and assemblers14

Workplace health programs exist to help reduce CVD risk and include worksite-based health promotion, wellness, or stress management. CDC has a Workplace Health Resource Center for employers. The NIOSH Total Worker Health® Program integrates protection from work-related safety and health hazards with the promotion of injury and illness-prevention efforts to advance worker well-being.

Workplace programs and activities may help reduce CVD risk:

Work-related sources of stress and fatigue can be lowered through organizationalcollective bargaining and legislative interventions, such as

  • Reducing mandatory overtime15
  • Providing paid sick and family leave 16, 17
  • Increasing staff in healthcare settings (e.g., to provide better nurse-to-patient staffing ratios). 6,18
  • Forming workplace committees to identify and reduce job stressors. This includes developing labor-management committees.19

Researchers continue to study the relationship between CVD and work. More studies could help us better understand how work impacts cardiovascular health.


Search the NIOSHTIC-2 database to find additional occupational safety and health publications on this topic from NIOSH or a NIOSH-supported project.


  1. Goh J, Pfeffer J, Zenios SA [2015]. The Relationship Between Workplace Stressors and Mortality and Health Costs in the United States. Manage Sci. 62(2):608-628.
  2. Li J, Pega F, Ujita Y, Brisson C, Clays E, Descatha A, Ferrario M, Godderis L, Iavicoli S, Landsbergis P, Metzendorf M-I, Morgan RL, Pachito D, Pikhart H, Richter B, Roncaioli M, Rugulies R, Schnall PL, Sembajwe G, Trudel X, Tsutsumi A, Woodruff T, Siegrist J. [2020]. The effect of exposure to long working hours on ischaemic heart disease: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-Related Burden of Disease and Injury. Environment International (9); 142:105739.
  3. Rivera AS, Akanbi M, O’Dwyer LC, McHugh M [2020]. Shift work and long work hours and their association with chronic health conditions: a systematic review of systematic reviews with meta-analyses. PloS One 15(4), e0231037. https://doi.org/10.1371/journal.pone.0231037.
  4. Niedhammer I, Bertrais S, Witt K [2021]. Psychosocial work exposures and health outcomes: a meta-review of 72 literature reviews with meta-analysis. Scand J Work Environ Health 1;47(7):489-508.
  5. Taouk Y, Spittal MJ, LaMontagne AD, Milner AJ [2020]. Psychosocial work stressors and risk of all-cause and coronary heart disease mortality: A systematic review and meta-analysis. Scand J Work Environ Health 46(1), 19-31.
  6. Landsbergis P, Garcia-Rivas J, Juarez A, Choi BK, Dobson M, Gomez V, Krause N, Li J, Schnall PL. Occupational Psychosocial Factors and Cardiovascular Disease. In Tetrick LE, Fisher GG, Ford MT, Quick JC (Eds.) Handbook of Occupational Health Psychology, Volume 3. Washington, DC: American Psychological Association, 2023
  7. Cillekens B, Huysmans MA, Holtermann A, van Mechelen W, Straker L, Krause N, van der Beek AJ, Coenen P [2022] Physical activity at work may not be health enhancing. A systematic review with meta-analysis on the association between occupational physical activity and cardiovascular disease mortality covering 23 studies with 655 892 participants. Scand J Work Environ Health 1;48(2):86-98.
  8. Bulka CM, Daviglus ML, Persky VW, Durazo-Arvizu RA, Lash JP, Elfassy T, Argos M [2019]. Association of occupational exposures with cardiovascular disease among US Hispanics/Latinos. Heart 105(6):439-448.
  9. Carreón T, Hein MJ, Hanley KW, Viet SM, Ruder AM [2014]. Coronary artery disease and cancer mortality in a cohort of workers exposed to vinyl chloride, carbon disulfide, rotating shift work, and o‐toluidine at a chemical manufacturing plant. AJIM 57(4): 398-411.
  10. Cohen HW, Zeig-Owens R, Joe C, et al. [2019]. Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster. JAMA Netw Open 2(9):e199775.
  11. MacDonald LA, Bertke S, Hein MJ, Judd S, Baron S, Merritt R, Howard VJ [2017]. Prevalence of cardiovascular health by occupation: A cross-sectional analysis among U.S. workers aged ≥45 years. Am J Prev Med 53(2):152-161.
  12. Shockey TM, Sussell AL, Odom EC. Cardiovascular health status by occupational group – 21 states, 2013 [2016]. MMWR 65(31):793-798.
  13. Fukai K, Furuya Y, Nakazawa S, Kojimahara N, Hoski K, Toyota A, Tatemichi M [2021]. A case control study of occupation and cardiovascular disease risk in Japanese men and women. Sci Rep. 11(23983).
  14. Barnes LA, Eng A, Corbin M, Denison HJ, Mannetje A, Haslett S, McLean D, Jackson R, Douwes J [2020]. The prevalence of cardiovascular risk factors in different occupational groups in New Zealand. Ann Work Expo Health 64(6):645-658.
  15. Health Work Campaign [2020]. Healthy Work Strategies: Laws prohibiting mandatory overtime for nurses.
  16. Miller K, Williams C, Yi Y [2011]. Paid Sick Days and Health:
    Cost Savings from Reduced Emergency Department Visits. 
     Institute for Women’s Policy Research, Washington, DC.
  17. Gault B, Hartmann H, Hegewisch A, Milli J, Reichlin L [2014]. Paid Parental Leave in the United States. Institute for Women’s Policy Research, Washington, DC.
  18. Healthy Works Campaign. [2019]. Health Work Strategies: Laws to improve nursing staffing levels in hospitals.
  19. Trudel, X., Gilbert-Ouimet, M., Vezina, M., Talbot, D., Masse, B., Milot, A., Brisson, C. [2021]. Effectiveness of a workplace intervention reducing psychosocial stressors at work on blood pressure and hypertension. Occup Environ Med, 78(10), 738-744.
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