Job Stress Strains a Woman's Heart, But No One Knows Why

July 23, 2012

July 23, 2012 (Cambridge, Massachusetts) — A new study has found that women under a lot of stress at work were almost 40% more likely to have a cardiovascular event over a 10-year period than their counterparts who reported low job strain [1]. Dr Natalie Slopen (Harvard University, Cambridge, MA) and colleagues publish their findings online July 18, 2012 in PLoS One.

The higher likelihood of a CVD event applied to both women with high job strain--defined as a highly demanding job but with low control--and those with active job strain--defined as high demand but with high autonomy. This finding is surprising, senior author Dr Michelle A Albert (Brigham and Women's Hospital, Boston, MA) told heartwire , since most prior research--much of which has been conducted in men--has not found an increased CVD risk in those with "active" jobs.

There's a large proportion of the relationship between high job strain and CVD risk that we don't quite understand.

"Both the high-strain and the active-strain women have an almost 40% elevated risk of total CV events. I would expect the high strain [to be associated with increased risk] based on studies involving men, but the active-strain group is not a group where a lot of studies involving men have indicated there is a relationship with cardiovascular events."

Another major surprise was the finding that >70% of the relationship between job strain and cardiovascular events "cannot be explained by traditional risk factors for CVD or anxiety/depression," said Albert. "There's a large proportion of the relationship between high job strain and CVD risk that we don't quite understand," she noted.

Robust, Combined CVD End Point, Validated From Medical Records

Slopen and colleagues say that job-related stressors are known to be associated with CVD risk, but most prior studies have been conducted in men. In women, there have been a few trials, but these have mostly employed single end points, such as coronary heart disease (CHD) or stroke, and the results have been inconsistent.

Information about the effects of job-related stressors on cardiovascular health in women is important, they note, given the dramatic increase in female participation in the work force over the past few decades and the fact that psychosocial stressors may affect women and men differently.

In the new research, they studied more than 22 000 women healthcare workers who were part of the decade-long Women's Health Study. They asked them about the stressors in their jobs, including the pace, amount of work, demands, required skills, and control over decision making. They also asked them about job security.

Albert says one of the strengths of the work is the combined end point of nonfatal MI, stroke, coronary revascularization, and total cardiovascular death, which she notes is "pretty comprehensive and validated from medical records."

During 10 years of follow-up there were 170 MIs, 163 ischemic strokes, 440 coronary revascularizations, and 52 CVD deaths. In Cox proportional-hazard models adjusting for potential confounders, women with high job strain (high demand, low control) were 38% more likely to experience a CVD event than their counterparts who reported low job strain (low demand, high control; rate ratio 1.38; 95% CI 1.08–1.77). Similarly, women with active jobs (high demand, high control) were 38% more likely to experience a CVD event relative to those who reported low job strain (95% CI 1.07-1.77).

No evidence of an association between CVD events and job insecurity was seen, however.

Stress Beyond Normal, Requires Coping Skills

"Our body is able to adjust to normal strains so we are talking about stress beyond normal here, related to the body's inability to adapt to the stress," Albert notes.

"But we can't get rid of job stress, and we can't get rid of our jobs, so we have to find ways to cope. We know that coping plays a very important role in minimizing health effects of stress in the mental-health literature. But we don't know as much about it in the CV health literature, because there aren't terrific data, certainly for women."

We can't get rid of job stress, and we can't get rid of our jobs, so we have to find ways to cope.

She recommends that to help cope with stress, people should ensure they get plenty of exercise, carve out time for relaxation activities, "and not allow jobs to interfere with private time. Because we live in the electronic age, we spend a lot of time on our electronic devices 'off the clock,' and we should try to avoid this." And a social support network is very important too, she adds.

Employers also need to take some responsibility for ensuring their employees are not overburdened, she believes: "They need to realize the productivity of their employees seriously drops if people are stressed out." And doctors, too, should remember to ask their patients about job strain, she emphasizes.

"I'm a cardiologist, and I try to ask my patients about stressors in their life. There are multiple stressors; job strain is just one type. Depending on the stressor, I will try to give them ideas of ways of coping, or I will refer them to appropriate resources that are available in our healthcare systems to deal with them."

The authors declare no conflicts of interest.


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