来源：ACC CV News Digest（August 20，2015）
8月19日《柳叶刀》在线发表一项荟萃分析结果显示，长时间工作（≥55小时/周）员工的卒中危险高于标准工作时间（35~40小时/周）者，但与冠心病的这种相关性较弱。该结果表明，应多注意管理长时间工作者的血管危险因素。
长时间工作或增加心血管疾病危险，但相关的前瞻性证据还很少，而且不准确，大部分仅限于冠心病。本研究旨在评估作为危险因素的长时间工作对冠心病和卒中发生情况的影响。研究者纳入来自欧洲、美国和澳大利亚24个队列的25项研究，对近60.4万基线时无冠心病者的数据进行冠心病的荟萃分析，同时对近53万基线时无卒中者的数据进行卒中荟萃分析。
对冠心病随访510万人-年（平均8.5年）期间共记录到4768个事件，以及对卒中随访380万人-年（平均7.2年）期间共记录到1722个事件。在校正了年龄、性别和社会经济地位后的累计荟萃分析结果显示，与标准工作时间相比，长时间工作与冠心病发生危险（RR：1.13，P=0·02）以及卒中发生危险（RR：1.33，P=0·002）增高相关。在阐述反向因果关系、多变量校正了其他危险因素以及不同方法确认卒中的荟萃分析中，卒中危险增加仍保持不变（RR：1.30~1.42）。研究者记录到工作时间与卒中的一种剂量-反应相关性：与标准工作时间相比，每周工作41~48小时、49~54小时和≥55小时的卒中RR分别为1.10、1.27和1.33（趋势P值<0·0001）。
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（英文原文）Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
Background Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke.
Methods We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data.
Findings We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35–40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02–1·26; p=0·02) and incident stroke (1·33, 1·11–1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30–1·42). We recorded a dose–response association for stroke, with RR estimates of 1·10 (95% CI 0·94–1·28; p=0·24) for 41–48 working hours, 1·27 (1·03–1·56; p=0·03) for 49–54 working hours, and 1·33 (1·11–1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001).
Interpretation Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.
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