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Long work hours and physical fitness: 30-year risk of ischaemic heart disease and all-cause mortality among middle-aged Caucasian men
  1. Andreas Holtermann1,
  2. Ole Steen Mortensen1,2,
  3. Hermann Burr1,
  4. Karen Søgaard3,
  5. Finn Gyntelberg2,
  6. Poul Suadicani2
  1. 1National Research Centre for the Working Environment, Denmark
  2. 2The Copenhagen Male Study, Epidemiological Research Unit, Dept. of Occupational and Environmental Medicine, Bispebjerg University Hospital, Denmark
  3. 3Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
  1. Correspondence to Andreas Holtermann, National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen Ø 2100, Denmark; aho{at}


Background No previous long-term studies have examined if workers with low physical fitness have an increased risk of cardiovascular mortality due to long work hours. The aim of this study was to test this hypothesis.

Methods The study comprised 30-year follow-up of a cohort of 5249 gainfully employed men aged 40–59 years in the Copenhagen Male Study. 274 men with cardiovascular disease were excluded from the follow-up. Physical fitness (maximal oxygen consumption, Vo2max) was estimated using the Åstrand bicycle ergometer test, and number of work hours was obtained from questionnaire items; 4943 men were eligible for the incidence study.

Results 587 men (11.9%) died because of ischaemic heart disease (IHD). Cox analyses adjusted for age, blood pressure, smoking, alcohol, body mass index, diabetes, hypertension, physical work demands, and social class, showed that working more than 45 h/week was associated with an increased risk of IHD mortality in the least fit (Vo2max range 15–26; HR 2.28, 95% CI 1.10 to 4.73), but not intermediate (Vo2max range 27–38; HR 0.94, 95% CI 0.59 to 1.51) and most fit men (Vo2max range 39–78; HR 0.91, 95% CI 0.41 to 2.02) referencing men working less than 40 h/week.

Conclusions The findings indicate that men with low physical fitness are at increased risk for IHD mortality from working long hours. Men working long hours should be physically fit.

  • Community cardiology
  • epidemiology
  • public health

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  • Competing interests None.

  • Ethical approval When the Copenhagen Male Study (CMS) was initiated as a closed cohort study in 1970–71 no ethics committee for medical research had been established in Denmark. However, in 1985–86, when survivors from the first baseline were re-examined, the study was approved by the ethics committee for medical research in the county of Copenhagen, and all participants in the study gave informed consent to participate, as stated in many previous publications from the CMS based on analyses using the 1985–86 baseline.

  • Provenance and peer review Not commissioned; externally peer reviewed.