International Journal of Current Research and Review
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IJCRR - 5(22), November, 2013

Pages: 39-45

Date of Publication: 04-Dec-2013


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EFFECT OF SHIFT WORK ON RISK FACTORS OF CARDIOVASCULAR DISEASES

Author: Hemamalini R.V., Arpita Priyadarshini, Saravanan A.

Category: Healthcare

Abstract:Introduction: Due to rapid technological development, shift workers are continuously increasing. Shift workers are subjected to altered circadian rhythm which might make them prone to cardiovascular disorders. Aim: To examine whether longer duration of shift work increases the risk factors for cardiovascular disorders and also to compare it with day workers. Materials & Methods: 50 male industrial workers and security guards at Burla, who did night shift for atleast 1 year and 50 day workers who did not do night shift in the last 2 yrs were involved in the study. The various risk factors such as body mass index, blood pressure, lipid profile, atherogenic indices were estimated at the beginning of the study in both night and dayshift workers. Dietary pattern was not altered during the period of the study. Result: Study revealed that shift work significantly increase the risk of cardiovascular diseases. BMI, BP & atherogenic indices were found to be significantly increased in night shift workers when compared to day workers. Among the night shift workers, at the end of 3 years follow up, risk further increased to higher level. Conclusion: Night shift workers are at higher risk for developing cardiovascular diseases.

Keywords: Shift workers, body mass index, blood pressure, lipid profile, atherogenic indices, cardiovascular disease

Full Text:

INTRODUCTION 

In this modern environment  life style is changing  the circadian rhythm of  the body by mode of  shift work.shift work involves work at times other than normal daylight hours . The number of persons doing shift work appears to be increasing. [1]  In normal individuals living on a day-oriented schedule, it is hypothesized that a harmonious relationship between homeostatic and circadian processes serves to promote uninterrupted bouts of 8 h of sleep and 16 h of wakefulness per day. When sleep is displaced, the normal phase relationship between the sleep / wake cycle and the endogenous circadian pacemaker is perturbed.[2]

Shift work is accompanied by a greater incidence of many medical disorders, such as cardiovascular, gastro-intestinal, and neurological disorders [3,4]. 

Cardiovascular diseases take a huge toll on our society.   Atherosclerosis is the leading cause of heart attacks, strokes and peripheral vascular disease.

Atherosclerosis starts when high blood pressure or high cholesterol damage the endothelium. LDL 

crosses the damaged endothelium. The cholesterol enters the wall of the artery. Due to focal increase in the content of lipoproteins within the regions of the intima, fatty streak develops which represents the initial lesion of atherosclerosis.[5] Over years, there is formation of  plaque in the wall of the artery. Of the various atherogenic indices, TG/HDL ratio is the best predictor of coronary heart disease.

Atherosclerosis usually causes no symptoms until middle or older age. Once narrowings become severe, they cause pain. Blockages can also suddenly rupture, causing blood to clot inside an artery at the site of the rupture.

In Shift workers lipid metabolism is altered. They develop hyperlipidemia [6,7]. This increases the risk for atherosclerosis.

So, this  study was  primarily undertaken to see  whether longer duration of  shift work  increases the risk factors for cardiovascular diseases such as blood pressure, atherogenic indices ,lipid profile and body mass index or the workers get adapted to this pattern of work in due course of time.

MATERIAL AND METHODS

This cohort  study was conducted on an outpatient basis at Department of Physiology, V.S.S Medical college, Burla with the help of Department of Biochemistry.

Industrial workers and security guards  undergoing shift duties at Burla were involved in the study. 50 were shift workers who did rotating shifts for atleast 1 year and  50  were day workers  who did not undergo  shift duties for the past 2 years.

After getting institutional ethical clearance, informed consent was obtained from all volunteers.

At the beginning of our study, Subjects filled out a  questionnaire with  questions about their working condition ,smoking habit, diet, family history of hypertension, diabetes mellitus, hyperlipidemia, hypothyroidism. Individuals undergoing shift duties were followed for 3 years. Bloodpressure, height, weight, BMI of all subjects were recorded at the beginning & at the end of 3 yrs of follow up.

Blood pressure was measured in the sitting position after 5 minutes rest. Hypertension was defined as having a systolic blood pressure of 140 mmHg or more, or a diastolic blood pressure of 90 mmHg or more. Body weight was measured in light indoor clothing and recorded to the nearest Kg. Height was measured to the nearest centimeter without shoes. Body mass index (BMI) was calculated as weight (Kg) divided by height (m2). Those with a BMI of 30 or more were classified as obese.

EXCLUSION CRITERIA

  1. Subjects suffering from any endocrine, hepatic, renal disease, hypertension, diabetes, cardiopulmonary disease
  2. Those with history of drug intake - beta blockers, lipid lowering drugs, alcohol intake
  3. Those who are chronic smokers and obese were excluded from the study.

SELECTED CASES

Only males within the age group of 25-40 yrs were involved in the study. These individuals were followed up for 3 yrs. During these periods drop outs were 8 in number among shift workers .This is because some got transferred to other place.

BIOCHEMICAL ANALYSIS

Estimation of serum lipid & atherogenic ratios

The serum was analysed for lipid profile. Serum Total cholesterol, Triglycerides, LDL, VLDL and HDL-cholesterol concentration were estimated   after 12-hours fasting by using auto analyzer. Risk of dyslipidemia was assessed based on the guidelines followed by American association of clinical endocrinology.

The atherogenic ratios TG/HDL, TC/HDL & LDL/HDL were estimated. The degree of risk was assessed based on Framinghams heart study.

STATISTICAL ANALYSIS

Analysis of data was done with the help of SPSS  version 16 soft ware package. Datas were presented as Mean ± Standard Deviation.

UnPaired student’s t test was done to compare the means between two groups. Paired students’t test was done to compare the means between the same group. Pearson correlation analysis was done to correlate between the two variables.p value <0.05 was considered to be significant.

RESULTS

All subjects were males and they were within the age group of 25-40 yrs.The mean age of shift workers and day workers were 30.56 ± 4.28 & 31.30 ± 4.08 respectively.

Table: 1 represents measurements of variables in shift workers and day workers. Unpaired t test was done between the two groups and difference was found to be significant (p =0.000). There was significant increase in the body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP) among shift workers when compared to day workers.

Table:2 indicates measurement of variables among the shift workers at two different points of time.Paired t test was done between the same group.There was  further significant increase in BMI,SBP,DBP in shift workers at the end of 3 yrs follow up when compared to their initial readings.

Table:3  depicts the significant increase in the total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and decrease in high density lipoprotein (HDL) in shift workers when compared to day workers.

Table:4 represents the significant rise in TC, TG, LDL and drop in HDL among shift workers at the end of their 3 yrs follow up when compared to their initial reading.

Table:5 Pearson correlation analysis was done between BMI and TG/HDL ratio . A weak positive correlation was found between the variables among the shift workers during their initial recording.The correlation was significant at the 0.05 level. At the end of 3 yrs follow up, correlation was found to be significant at the 0.01 level.There was strong positive correlation between the variables.

DISCUSSION

Most of the studies associating shift workers with various risk factors for cardiovascular diseases have been cross sectional[8] or retrospective.[9] As the chances of  bias is more in such design,  we preferred cohort study design in analyzing the role of shift work in affecting  the risk factors for cardiovascular diseases in males.

There are very few cohort studies[10,11] carried out and among those studies they had different observations .some studies indicate that shift work increase the risk factors for cardiovascular disease and other studies find no association between shift work and risk factors of  cardiovascular disease.

In this present study it was found that among the shift workers ,their body mass index increased significantly during the follow up period of 3 yrs.They have started gaining weight  when compared to day workers. Based on the classification of BMI, they fall under over weight category (BMI - 25 to 29). The dietary pattern was strictly monitored in both groups.They were restricted from taking high fat rich foods. overweight is associated with  increased risk of cardiovascular diseases[12] The probable cause of increased weight gain could be due to sleep deprivation  in shift workers.[13,14 ]

Systolic blood pressure & diastolic blood pressure were also found to be significantly increased in shift workers when compared to day workers.  Among the shift workers the systolic blood pressure level increased by 10 mmHg & diastolic blood pressure increased by 3 mmHg from the baseline but not to the level of hypertension range at the end of 3 yrs follow up period. But it can be anticipated that if the duration of shift work prolongs for few more years the values would increase to hypertension range.   Increase in both systolic and diastolic blood pressure is an  important risk for cardiovascular diseases. Two recent and better designed studies found different effects. In a Japanese cohort study, shift workers of a steel company had higher systolic and diastolic blood pressure than day workers[15]. In contrast the Finnish Twin Cohort[16], showed no association between the usual period of work and incidence of hypertension. In our study increase in blood pressure could be due to increase in BMI.

The atherogenic indices which predicts the risk of coronary artery disease was also found to be increased among shift workers during the last 3 yrs. There was significant difference in the values between shift workers and day workers.

Alteration in the circadian rhythm results in hyperlipidemia. Elevated lipid levels increases the risk of atherosclerosis.There was   significant increase in total cholesterol, LDL, TG and decrease in HDL among shift workers when compared to day workers. Also among the shift workers there was further significant increase in TC, LDL, TG and decrease in HDL at the end of 3 years follow up.

Elevated lipid levels causes damage to the vascular endothelium. LDL delivers   cholesterol to peripheral tissues. It is considered as bad cholesterol.HDL is believed to mobilize cholesterol from developing & existing atheromas and transport to liver for excretion in bile. It is considered as good cholesterol. So, increase in LDL and decrease in HDL increases the risk for cardiovascular diseases.[17,18] In our study decrease in HDL levels in shift workers could be due to altered circadian rhythm affecting lipid metabolism and also due to  increased BMI.

Hyperlipdemia causes atherosclerosis. In chronic hyperlipidemia, lipoproteins accumulate within the intima. These lipids are oxidized through the action of oxygen free radicals which are locally generated by macrophages. Oxidized LDL is cytotoxic to endothelial cells and smooth muscle cells and can induce endothelial cell dysfunction. The importance of oxidized LDL in atherogenesis is suggested by the fact that it accumulates within macrophages in all stages of plaque formation.[19]

TG/HDL ratio which is the best predictor of heart disease was found to be significantly increased.[20] Many studies have not considered this ratio in analysing the risk factor among shift workers. Other indices like TC/HDL and LDL/HDL was also found to be elevated in shift workers when compared to day workers. Shift workers were at low risk for developing atherosclerosis but after 3 yrs of follow up they entered either into moderate or high risk category for developing atherosclerosis. This alteration in their risk status could be due to difference in their age group. Those in the age group of 36-40 years, were at high risk for developing atherosclerosis.

By pearson correlation analysis, there was significant strong positive correlation between atherogenic index TG / HDL and BMI at the end of 3 yrs follow up among shift workers. Shift workers were found to be at increased risk for developing atherosclerosis when compared to day workers. Longer the duration of shift work higher is the risk for developing atherosclerosis.

CONCLUSION

It was observed that the shift workers do not get adapted to this pattern of work in due course of time instead they are at increased risk for cardiovascular diseases. Shift work is a danger in sustaining normal physiological parameters. It increases the body mass index, blood pressure. It  also alters the  lipid metabolism and increases the risk for atherosclerosis. Longer the duration of shift work higher is the risk for cardiovascular diseases.

A chronoclinic should be established at their work place and their health status has to be assessed periodically and they should be counseled for lifestyle and dietary modifications. Individuals at higher risk may shift to day work. This may improve their coping ability and minimize occupational health hazards.

ACKNOWLEDGEMENT

I wish to thank all volunteers who participated in the study. My special thanks to the statistician Ms. Bridgitte Akila and to the staffs of physiology and biochemistry departments for their timely help and cooperation.

Conflicts of Interest: None

References:

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  2. Pati AK,Chandrawshi A, Reinberg A. Shift work: consequence and management. Curr Sci. 2002;81:32–4
  3. Williams C: Social factors, work, stress and cardiovascular disease prevention in the European Union Brussels: The European Heart Network;1998
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  5. Harrison et al.Principles of  Internal  Medicine,18Ed; Page 1983- 1985.
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  7. Nakamura K, Shimai S, Kikuchi S, Tominaga K,Takahashi H, Tanaka M, Nakano S, Motohashi Y, Nakadaira H, Yamamoto M (1997) Shift work and risk factors for coronary heart disease in Japanese blue-collar workers: serum lipids and anthropometric characteristics. Occup Med ( Lond) 47, 142.
  8. Koller M. Health risks related to shift work. Int Arch Environ Health.1983;53:59-75.
  9. Angersbach D, Knauth P, Loskant H, Karvonen MJ, Undeutsch K, Rutenfranz J. A retrospective cohort study comparing complaints and diseases in day and shift workers. Int Arch Occup Environ Health. 1980;45:127-140
  10. Taylor PJ, Pocock SJ. Mortality of shift and day workers, 1956-68. Br J Ind Med. 1972;29:201-207.
  11. Knutsson A, Akerstedt T, Jonsson BG, Orth-Gomer K. Increased risk of ischaemic heart disease in shift workers. Lancet. 1986;2:89-92.
  12. Lamon-Fava S, Wilson PW, Schaefer EJ: Impact of body mass index on coronary heart  disease risk factors in men and women. The Framingham Offspring Study.Arterioscler Thro     Vasc Biol. 1996 Dec;16(12):1509-15.
  13. Short sleep duration andweight gain: a systematic review. Obesity (Silver Spring). 2008; 16:643-536.
  14. Pickering TG (2006) Could hypertension be a consequence of the 24/7 society? The effects of sleep deprivation and shift work. J Clin Hypertens 8: 819–822
  15. Suwazono Y, Dochi M, Sakata K, Okubo Y, Oishi M, et al. (2008) Shift work is a risk factor for increased blood pressure in Japanese men: a 14-year historical cohort study. Hypertension 52: 581–586. Hublin C, Partinen M, Koskenvuo K, Silventoinen K, Koskenvuo M, et al.(2010) Shift-work and cardiovascular disease: a population-based 22-year follow-up study. Eur J Epidemiol 25: 315–323.
  16. Drexel H, Aman FW, Rentschk, et al. Relation of the level of high density Lipoprotein subfraction to the presence and extent of coronary artery disease. Am J Cardiol. 1992;70:436–440.
  17. Dobiasova M, Frohlich JJ. Structural and functional assessment of high density lipoprotein heterogenicity. Clin Chem. 1994;40:1554–1558.
  18. Gau G, Wright R: Pathophysiology, diagnosis, and management of dyslipidemia.  Curr Probl Cardiol  2006; 31:445.
  19. Dobiasova M. AIP—atherogenic index of plasma as a significant predictor of cardiovascular risk: from research to practice. Vnitr Lek. 2006;52(1):64–71

 

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A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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