Objectives To explore the stability of exposure to work stressors over time and to examine the impact of different approaches of estimating exposure on the cardiovascular disease (CVD) risk estimation.

Methods The Maastricht Cohort Study-Work Stressor Score (MCS-WSS) was used to assess work stressors at three consecutive time points among 6154 employees participating in the MCS. Incident CVD was assessed with questionnaires. Five approaches were used to estimate exposure as: e.g. single exposure assessment, cumulative exposure above a cutoff point, total exposure and average exposure. The association between work stressors and CVD was stepwise adjusted for age, gender, educational level, smoking, body mass index, hypertension, leisure physical activity and negative affectivity.

Results The correlation between the work stressor scores assessed at the first and third time point was 0.58. Employees with a stable exposure above the highest quartile had a fully adjusted HR of 1.58 (95% CI: 0.93–2.72). Employees with the highest quartile total exposure had a fully adjusted HR of 1.22 (95% CI: 0.77–1.95) as compared to employees with the lowest quartile dose. Employees in the upper quartile of the average MCS-WSS had a fully adjusted HR of 1.26 (95% CI: 0.79–2.01) as compared to employees in the lowest quartile of the MCS-WSS. Employees with a single exposure assessment had a fully adjusted HR of 0.91 (95% CI: 0.62–1.33).

Conclusions Employees with a stable exposure above the highest quartile score during a minimum of two years have the highest relative CVD risk.