Atherosclerotic coronary artery disease continues to represent a major contributor to worldwide morbidity and mortality. Although conventional cardiovascular risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, and sedentary lifestyle remain central to cardiovascular prevention, increasing attention has been directed toward psychosocial determinants, particularly occupational stress. Work-related stress, commonly conceptualized through the job strain and effort–reward imbalance models, has been associated with a higher incidence of coronary events, although the magnitude and mechanisms of this relationship remain incompletely understood. This review synthesizes current evidence on the relationship between occupational stress and coronary artery disease, drawing on major epidemiological studies and meta-analyses. Persistent occupational stress contributes to cardiovascular dysfunction through multiple interacting mechanisms. These include activation of the hypothalamic–pituitary–adrenal axis and sympathetic nervous system, promotion of systemic inflammatory activity, oxidative stress, autonomic imbalance, and unfavorable behavioral adaptations (e.g., smoking, unhealthy dietary habits, physical inactivity, and excessive alcohol intake). Collectively, these alterations may accelerate endothelial dysfunction, thrombogenicity, and atherosclerotic progression. Key studies, including INTERHEART and meta-analyses by Kivimäki et al., along with prospective data from Chandola et al. on metabolic syndrome, support both independent and cumulative effects of occupational stress on cardiovascular risk. Although its attributable risk is lower than that of traditional risk factors, occupational stress is modifiable, offering significant preventive potential. Intervention strategies include individual approaches (e.g., stress management, lifestyle changes, and psychological support), organizational measures (e.g., improving job control, reducing demands, and enhancing workplace support), and public health policies (e.g., occupational health programs and stress screening). Recognizing occupational stress as a modifiable and clinically relevant contributor to cardiovascular risk has important implications for prevention strategies and public health policies. Future research should prioritize longitudinal studies, biomarker identification, and the evaluation of cost-effective interventions.