Work environment and cardiovascular diseases. A short review of the literature

The main purpose of this short review has been to present and evaluate the epidemiological evidence on CVD and environmental factors at work. It is indeed a difficult task to compare the scientific evidence in relation to the above mentioned risk factors. In some areas we find many studies, but with low overall methodological quality (noise is an example), while in others there are few, but good studies (e.g. carbon disulphide and nitroglycerine/glycol). We have to realize that in empirical sciences there is no such thing as a final proof. It would be easy if science dealt with what we know, while religion dealt with what we believe. It is more realistic however to say that science deals with what we believe we know, while religion deals with what we know we believe. Keeping this in mind the following classification of risk factors in the work environment seems to be well justified: Very probable causal relationships: Physical inactivity at work Nitroglycerine/nitroglycol Carbon disulphide Probable causal relationships: Monotonous high-paced work Shift work Noise Cobalt Arsenic Lead Possible causal relationships: Passive smoking Heat Dinitrotoluene Organophosphates Antimony Electromagnetic waves and fields No causal relationships: Cadmium Carbon monoxide One of the important questions raised by a list of this kind is whether we know enough to act, that is to use this knowledge in a preventive effort. Some might argue that we should wait until we have harder evidence. Another position would be that in many situations we have to act without such hard evidence. In my view fear of making mistakes should not prevent us from acting. If we always choose to wait until the evidence is 100% convincing, we will be very likely to make many - and often serious - mistakes.