Mental strain at work boosts cardiac risk

UCL (UK) — People who have highly demanding jobs and little freedom to make decisions are 23 percent more likely to have a heart attack than those without stress, a new study shows.

Previous studies examining the impact of job strain on coronary heart disease (CHD) have been inconsistent in their findings, limited in scope, and plagued by methodological shortcomings including publication bias and reverse causation bias, researchers of the new study write.

“The pooling of published and unpublished studies allowed us to investigate the association between coronary heart disease and exposure to job strain—defined as high work demands and low decision control—with greater precision than has been previously possible,” says Mika Kivimäki of University College London Epidemiology & Public Health.


“Our findings indicate that job strain is associated with a small, but consistent, increased risk of experiencing a first CHD event such as a heart attack.”

The study, published in the journal The Lancet, included nearly 200,000 people from seven European countries.

In the collaborative meta-analysis, Kivimäki and colleagues analyzed job strain in employees without CHD who participated in 13 European national cohorts conducted in Belgium, Denmark, Finland, France, Netherlands, Sweden, and the UK between 1985 and 2006. All participants completed questionnaires at the start of the studies to assess job demands, excessive workload, the level of time-pressure demands, and their freedom to make decisions.

The researchers recorded 2,356 events of incident CHD (first non-fatal heart attack or coronary death) during the average 7.5 year course of follow-up. The 23 percent higher risks for people who reported job strain remained the same even after taking into account factors such as lifestyle, age, gender, and socioeconomic status.

“The overall population attributable risk (PAR) for CHD events was around 3.4 per cent, suggesting that if the association were causal, then job strain would account for a notable proportion of CHD events in working populations,” says Kivimäki.

“As such, reducing workplace stress might decrease disease incidence. However, this strategy would have a much smaller effect than tackling standard risk factors such as smoking (36 percent) and physical inactivity (12 percent).”

In a linked comment piece, also in The Lancet, Bo Netterstrøm from Bispebjerg Hospital, Copehagen, Denmark writes “Job strain is a measure of only part of a psychosocially damaging work environment, which implies that prevention of workplace stress could reduce incidence of coronary heart disease to a greater extent than stated in the authors’ interpretation of the calculated population-attributable risk for job strain.

“Exposures such as job insecurity and factors related to social capital and emotions, are likely to be of major importance in the future. The present economic crisis will almost certainly increase this importance.”

Source UCL