OBJECTIVE: Investigate if workers with low physical fitness have an increased risk of ischemic heart disease (IHD) mortality from regular psychological work pressure.

METHODS: Thirty-year follow-up of 5249 middle-aged men without cardiovascular disease.

RESULTS: Men perceiving regular psychological work pressure had no higher risk of IHD mortality than those who did not. Both among men perceiving regular and rare psychological work pressure, the physically fit had a reduced risk of IHD mortality referencing men with low physical fitness. For all-cause mortality, a stronger inverse association was found among men perceiving regular compared to rare psychological pressure at work.

CONCLUSIONS: Physical fitness is equally important for the risk of IHD mortality among men experiencing regular and rare psychological pressure at work, but stronger associated to risk of all-cause mortality among men experiencing regular psychological pressure at work.