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Currently cardiovascular diseases due to overwork are only officially recognised by workers’ compensation systems in Japan, South Korea and Taiwan.1 ,2 The fatal cases are known in Asia as ‘karoshi’. The biomedical mechanism might be perturbations of the hypothalamic-pituitary-adrenal axis and the autonomic nervous system caused by excessively long working hours (eg, 90 or more overtime hours during the month prior to the event) and associated work stress. These pathways may contribute to accelerated progression of atherosclerosis and increase the risk of cardiovascular events, majorly subarachnoid haemorrhage, intracerebral haemorrhage, intracerebral infarction, myocardial infarction, heart failure, etc.1–3 In mainland China, karoshi has …
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
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