title: Joint effect of shift work and adverse life-style factors on the risk of coronary heart disease.
abstract: OBJECTIVE
  The joint effect of shift work and certain adverse life-style factors on coronary heart disease (CHD) was studied.
  
  
  METHODS
  Base-line measurements were obtained for a 6-year follow-up of an industrially employed cohort (N= 1806), whose shiftwork status was recorded from a questionnaire filled out by a sample of the cohort. The CHD end points (codes 410-414 of the 9th revision of the International Classification of Diseases) were obtained from official Finnish registers. In order that the joint effects of shift work and life-style factors on the risk of CHD could be studied, dichotomized variables and their combinations as a dummy variable system in Cox's proportional hazards models were used.
  
  
  RESULTS
  The relative risks were 1, 1.6[95% confidence interval (95% CI) 1.1-2.5], 1.3(95% CI 0.9-2.1), and 2.7(95% CI 1.8-4.1) for the following combinations of shift work (SW) and smoking (SM): SW-&SM-, SW-&SM+, SW+&SM-, and SW+&SM+, respectively; and the corresponding figures for shift work and obesity (BMI > or =28 kg/m2) were 1, 1.2(95% CI0.8-1.9), 1.3(95% CI0.9-1.9), and 2.3(95% CI1.5-3.6), respectively. In both cases the effect was at least multiplicative. For the shift workers the relative risk for CHD rose gradually with increasing numbers of adverse life-style factors, but for the day workers there was no clear dose-response pattern.
  
  
  CONCLUSIONS
  Shift work seems to trigger the effect of other, lifestyle-related risk factors of CHD and therefore calls for active prevention among shift workers.
authors.affiliation: Helsinki Heart Study, Finland. Leena.Tenkanen@ktl.fi
authors.forename: L
authors.initials: L
authors.lastname: Tenkanen
authors.forename: T
authors.initials: T
authors.lastname: Sjöblom
authors.forename: M
authors.initials: M
authors.lastname: Härmä
mesh_terms: D000328:Adult; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000209:etiology*; D003625:Data Collection; D015444:Exercise; D005387:Finland; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014940:Work Schedule Tolerance
chemical_list: D002784:Cholesterol