2009; Kivimäki et al. 2006; Netterstrøm and Kristensen 2005; Belkic et al. 2004; Hemingway and Marmot 1999). Unique in the presented review is the inclusion of additional databases beside MEDLINE. This approach retrieved additional publications that did not appear in the other systematic reviews (Chandola et al. 2005, 2008; Fauvel et al. CH5424802 purchase 2003; Hibbard and Pope 1993; Markovitz et al. 2004; Matthews

and Gump 2002; Tsutsumi et al. 2006, 2009). The authors restricted the selection to prospective cohort studies and randomised trials (none of the latter was identified in the literature search) in order to avoid selection bias and recall bias particularly present in case–control studies. Most of the existing reviews focus on the job strain and the effort–reward imbalance models, whereas the presented review included several studies based on less-known approaches. These latter studies tended to be less sophisticated and lacked a theoretical foundation. However, this finding could not be anticipated beforehand. Furthermore, hypertension besides myocardial infarction and stroke was included. Thus, some studies and/or analyses that have not been considered in Acalabrutinib ic50 the previous reviews were included here. Chandola et al. (2005, 2008) analysed data of the Whitehall cohort taking into account exposure measurements at two points in time, and both analyses support the association

of stress and cardiovascular disease. Hibbard and Pope (1993) as well as Matthews and Gump (2002) used exposure models depending on sum scores of different items. Results of the MRFIT study (Matthews and Gump 2002) indicate that job stress is a risk factor for cardiovascular

disease. Data from the Jichi Medical cohort (Tsutsumi et al. 2006, 2009) indicate a significant association between job strain and stroke in men. Of the two studies investigating hypertension (Fauvel et al. 2003; Markovitz et al. 2004), the study by Markovitz et al. (2004) found significant results. Even with these additional data, the presented findings are in agreement with the previous systematic reviews or meta-analyses confirming the association between job stress and cardiovascular disease especially in men. All reviews support the European guidelines for the prevention of SPTBN5 cardiovascular diseases in clinical practice (Orth-Gomer et al. 2005) that name the importance of work stress-related questions when counselling patients with cardiovascular risk. Future research Since work life is changing continuously, the relative importance of a single stress factor will also change. New types of stressors are emerging and need to be considered in exposure models describing psychosocial burden. A recent prospective study (Virtanen et al. 2010) describes the association of overtime work and incident coronary heart disease. More detailed models requesting different issues related to the experience of stress (e.g.