TORONTO — Women with high levels of job strain have a significantly higher risk of suffering a heart attack or other adverse cardiovascular event compared to those who report less stressful work lives, a major study has found.
Researchers presented their findings Monday at the annual meeting of the American Heart Association in Chicago. They found an overall 40 per cent increased risk for heart attack, stroke, the need for invasive procedures like bypass surgery, and death from cardiovascular disease.
Broken down, the risk of heart attack was almost 88 per cent higher in women with sustained on-the-job stress, while the risk of bypass surgery or other procedures, such as balloon angioplasty to open up blocked coronary arteries, was about 43 per cent higher.
Job strain, a form of psychological stress, is defined as having a demanding job but little or no decision-making power or opportunities to use creative skills.
The study also found that job insecurity — the fear of losing one’s livelihood — was linked to risk factors for cardiovascular disease, such as high blood pressure, elevated cholesterol levels and excess body weight. However, job insecurity did not translate into a higher risk of heart attacks and other cardiovascular conditions.
“Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women,” said senior investigator Dr. Michelle Albert of Brigham and Women’s Hospital in Boston.
“Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package.”
To conduct the study, researchers analyzed job strain in 17,415 healthy female health professionals who took part in the landmark Women’s Health Study sponsored by the U.S. National Heart, Lung and Blood Institute.
Participants provided information about heart disease risk factors as well as answering a questionnaire to evaluate job strain and job insecurity, which included such true or false statements as: “My job requires working very fast,” “My job requires working very hard,” and “I am free from competing demands that others make.”
Researchers followed the women, whose average age was 57, for more than 10 years to track the development of cardiovascular disease.
“This is an important study,” said Dr. Andrew Pipe, chief of prevention and rehabilitation at the University of Ottawa Heart Institute.
The findings mirror those of a study of more than 12,000 Danish nurses published earlier this year, said Pipe, noting that a similar relationship between job strain and cardiovascular disease has also been identified in males.
Intense or prolonged stress causes the release of cortisol and other stress hormones that can affect heart rate and blood pressure, and accelerate processes that lead to the buildup of plaque inside blood vessels — setting the stage for a heart attack or stroke, he said.
And the ways that some people deal with on-the-job stress can compound these physiological effects.
“People who have high levels of stress may, for instance, be seeking some solace in eating, so weight goes up, and smoking, the granddaddy of all cardiovascular risk factors,” observed Pipe. “They are already stressed out by work and other responsibilities, and they don’t have time for physical activity, so they become sedentary.”
He agreed that stress tends to be particularly problematic when people have no opportunity to control it.
“The busy employee making widgets on an assembly line 42 hours or 37 hours a week — and that assembly line runs along at 14 miles an hour, no matter what — has no opportunity whatsoever to exert any control over his or her environment.”
“So there are very plausible neurophysiological risk factor explanations for this relationship.”
And it’s not surprising to see the negative effects of job strain on health providers like nurses, Pipe said.
“So all hell’s breaking loose on the floor, you’re going to stay for another half an hour, an hour, 90 minutes, until the particular crisis of the moment is managed.
“That kind of selflessness is laudable, but at the end of the day, one has to be prepared to take time for one’s self.”
“I think it’s a question of all of us being cognizant of those stresses, recognizing what our work environment may induce in us and also how willing we are to induce those things ourselves,” he said.
“But as importantly, I think employers need to be aware of the importance of creating work environments in which job strain, job stresses are addressed in thoughtful, sensitive kinds of ways.”
Albert agreed it’s critical for employers to develop strategies to help workers manage stress “since employee productivity, business competitiveness and societal health are all potentially compromised by job stress.”
Albert, a cardiologist, advises women to be physically active, have a social support network and carve out time for relaxation to offset the effects of job stress.
“We know from the broader literature on stress that how one copes with the stressor very much influences the development of disease.”