The book starts with a comprehensive review of the evidence of an association between shift work, job-related stress and cardiovascular disease (CVD). It concludes that both shift work and job strain are associated with an increased risk of heart disease (CVD). The role of the central nervous system as a bridge between the external milieu and the cardiovascular system is duscussed in another chapter. Different mechanisms and causal pathways are postulated. Yet another interesting chapter describes how to measure psychosocial workplace exposure variables. Self-report questionnaires and external assessments of job characteristics are the major tools.

Different scientific measurement techniques are discussed, for example, ambulatory blood pressure measurements, heart rate variability and 24-hour eclectrocardiology.

A practical guide for the clinicial is provided in one chapter, which gives advice on how to perform a clinical evaluation of occupational stressors relevant to the cardiovascular system. It is recommended that blood pressure be measured at the workplace so that the diagnostis and treatment of the patient can be improved.

Karasek's job-strain model is extensively discussed in the book. This model postulates that strain occurs when there are excessive psychological work demands, together with low job-decision latitude. Thus the model is 2-dimensional and interactive. One problem is how to assess the evidence in support of the job-strain model. For example, if a study shows that job control is associated with heart disease, does its findings support the job-strain model? In keeping with the criteria stipulated previously, the answer is no. My concern is that the authors lump the job-strain model together with its singular components. This approach makes it difficult for the reader to evaluate the evidence supporting the job-strain model.

Yet another problem concerns inconsistent inclusion criteria when the literature is reviewed. When shift work is discussed in relation to heart disease, cross-sectional studies and studies using ecological exposure variables are excluded. On the other hand, when job strain is reviewed, cross-sectional studies are included and ecological exposure variables are accepted.

Despite its weak points, The Workplace and Cardiovascular Disease is an important book and useful reading for both researchers and clinicians. Hopefully, the book will increase interest in the potential to use the workplace to prevent cardiovascular disease.