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M3 India Expert Review series: Highlighting recent research in Cardiology

M3 India Newsdesk Aug 25, 2017

In an exclusive series of review articles by experts, M3 India brings to you the most significant studies from the world of medicine and research





Today's Expert Reviewer 

Dr Narendra   Kumar, MBBS, MD, PhD, FRCP, FESC, FACC, European board certified invasive cardiac electrophysiologist,
Consultant Cardiologist and Electrophysiologist, Paras HMRI Hospitals, Patna, Bihar

Longer working hours associated with higher risk of Cerebro-Cardiovascular diseases.

According to 2015 annual report of Organization for Economic Co-operation and Development (OECD), Asian workers have much longer working hours compared to their European and North American counterparts. Shin et al. from School of Medicine, the Catholic University of Korea at South Korea in her thesis for Master for Public health program have concluded that prolonging the normal working hours of the week may increase the chances of acquiring cerebrovascular and cardiovascular disease for the workers [1]. The authors in their case-crossover study design paper published in American Journal of Industrial Medicine, further noticed that among all disease types, the insurance payments for work related diseases is the highest. With growing work demand, it may be desirable for the employers to increase the working hours. Quality of work is closely monitored not only at each and every step but also in most of different types of work places right from school/colleges to factory/industries. However, the quantity of work hours being put up to get the work done is often neglected. Work-related cardiovascular diseases include myocardial infarction, and aortic dissection whereas, cerebrovascular diseases include intra cerebrovascular haemorrhage, subarachnoid haemorrhage and cerebral infarction. These diseases are associated with significant morbidity and mortality.

Having right flowchart for compensation of workers assumes significance due to the involvement of huge investments from public and insurance firms. Globally, there are very few countries e.g. Republic of Korea, Japan, and Taiwan that recognize cardio-cerebrovascular diseases secondary to overwork and also compensate their workers accordingly. Several academic publications (Kim and Kang, 2010; Virtanen et al., 2012) have hypothesized that stress from longer working hours and overwork fatigue gets accumulated, leading to rise in blood pressure and sympathetic tone that ultimately results in Cerebrovascular and Cardiovascular diseases.

There has been growing demand for better methodologies to quantify and track longer work hours and irregularity in shifts [2]. A prior study based on data from North American automobile manufacturing company concluded that the employees which had long working hours had a higher risk for development of cardiovascular disease, Hypertension and other psychological disorders [3]. Another similar study by Son et al. showed that longer working hours among the automobile workers is the chief risk factor for their severe sleepiness at work which may further worsen physical and mental fatigue [4].


Cardiovascular benefits with Mediterranean diet may depend on socioeconomic status.

Bonaccio et al. during prospective analysis of almost 19,000 Italian residents concluded that Mediterranean diet is definitely associated with lower cardiovascular disease risk but is limited to individuals with higher socioeconomic groups [5]. The authors attributed the main reason being diet related disparities across the different socioeconomic groups, in spite of sharing similar score of adherence to Mediterranean diet.


Extra virgin olive oil consumption decreases body fat and improves blood pressure.

Cândido et al. in a randomized, double-blinded, placebo-controlled clinical trial concluded that extra virgin olive oil should be used for obesity treatments using the energy restricted programs [6]. They administered high-fat breakfast containing 25 ml of soybean oil to a control group and extra virgin olive oil to the other group as part of energy-restricted normal-fat diets for consecutive 9 weeks. There was significant reduction fat percentage of body, diastolic pressure, HDL-c, IL-10 and serum creatinine.


Early childhood diet affects cardiometabolic health.

It has been a popular thinking that we are what we eat. It seems to have found the scientific proof by academic work of Leermakers ETM, et al. published at Clinical Nutrition journal [7]. The authors examined for a group of nearly 2000 Dutch kids if the diet consumed during early childhood has any significant association with cardiometabolic status of the individual and also investigated whether the difference in body composition may provide an explanation to this association. Food intake was assessed at age of 1 year using a food frequency questionnaire. The overall results obtained by the authors led them to conclude that body composition has a very important role with respect to dietary patterns in infancy and the childhood cardiometabolic health.


Clinical Implications of the studies for India

India is already world’s heart disease capital and soon to become world’s diabetic capital by overtaking China in coming few years. The findings in all 4 studies about diet and future health conditions assume significance for south Asian countries especially India as she is already world’s fastest growing economy with world’s youngest work force who are fast becoming conscious of their diet and work pattern.

Such population is keen to experiment with environment, lifestyle and almost everything around them including food, drink, behaviour, attitude, work culture etc. So, we also need to test if such clinical trials yield similar results for Indian population before blindly following western traditions including Mediterranean diet.

Private sector in India have better compensation mechanisms for situations of long work shifts. It is highly desired that the public sector companies, being among the largest employers, also bring similar compensation mechanism for the workers and help in providing healthier environment not only for the workers but also for their families. The Indian physicians also need to adopt primary prevention strategies that can help to control the epidemiological pattern at an early stage before they become uncontrollable epidemic monsters. Correlation between risk factor of a disease and dietary pattern is similarly a very important factor [8,9]. Supplementing such preventive strategies with enforcement in form of law may give a tremendous boost to the health of whole society of millions. Moreover, while implementing such policies for a country of one billion lives, it might also be a sensible decision to give due consideration to socioeconomic status of the people as well.


Disclaimer: The opinions, beliefs, and viewpoints expressed by the writers and forum participants on this website do not necessarily reflect the opinions, beliefs, and viewpoints of the editors or publisher of the website. Readers are advised to exercise their own judgment while using the content. 


[1] Shin KS, Chung YK, Kwon YJ, Son JS, Lee SH: The effect of long working hours on cerebrovascular and cardiovascular disease; A case-crossover study. American journal of industrial medicine 2017; 60:753-761.

[2] Johnson JV, Lipscomb J: Long working hours, occupational health and the changing nature of work organization. American journal of industrial medicine 2006; 49:921-929.

[3] Landsbergis PA, Janevic T, Rothenberg L, Adamu MT, Johnson S, Mirer FE: Disability rates for cardiovascular and psychological disorders among autoworkers by job category, facility type, and facility overtime hours. American journal of industrial medicine 2013; 56:755-764.

[4] Son M, Kong JO, Koh SB, Kim J, Harma M: Effects of long working hours and the night shift on severe sleepiness among workers with 12-hour shift systems for 5 to 7 consecutive days in the automobile factories of Korea. Journal of sleep research 2008; 17:385-394.

[5] Bonaccio M, Di Castelnuovo A, Pounis G, Costanzo S, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. High adherence to the Mediterranean diet is associated with cardiovascular protection in higher but not in lower socioeconomic groups: prospective findings from the Moli-sani study. International Journal of Epidemiology. 2017 Aug 1.

[6] Galvão Cândido F, Xavier Valente F, da Silva LE, Gonçalves Leão Coelho O, Gouveia Peluzio MdC, Gonçalves Alfenas RdC: Consumption of extra virgin olive oil improves body composition and blood pressure in women with excess body fat: a randomized, double-blinded, placebo-controlled clinical trial. European Journal of Nutrition 2017.

[7] Leermakers, Elisabeth T.M. et al. A priori and a posteriori derived dietary patterns in infancy and cardiometabolic health in childhood: The role of body composition. Clinical Nutrition.2017.

[8] Shi Z, Taylor AW, Riley M, Byles J, Liu J, Noakes M: Association between dietary patterns, cadmium intake and chronic kidney disease among adults. Clinical nutrition (Edinburgh, Scotland) 2017.

[9] Batis C, Sotres-Alvarez D, Gordon-Larsen P, Mendez MA, Adair L, Popkin B: Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009. The British journal of nutrition 2014; 111:1441-1451.

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