High Job Stress May Boost Stroke Risk

Megan Brooks

October 15, 2015

Working in a highly stressful job may raise the risk for stroke, particularly for women, suggests a meta-analysis of relevant research.

"Epidemiological studies have shown that high strain jobs are associated with an increased risk of coronary heart disease. However, studies regarding the association between job strain categories and the risk of stroke are inconsistent," investigator Dingli Xu, MD, from Southern Medical University in Guangzhou, China, told Medscape Medical News.

"In this meta-analysis, we included data from more than 130,000 individuals and found that being exposed to high-strain jobs was associated with an increased risk of stroke, especially for ischemic stroke. The harmful effect of work stress may be more significant in women," Dr Xu said.

The analysis, which was published online October 14 in Neurology, included six studies on job strain and stroke risk involving a total of 138,782 participants who were followed for 3 to 17 years.

Jobs were classified into 1 of 4 categories according to how much control workers had over their jobs and how hard they worked, or the psychological (but not physical) demands of the job, such as time pressure, mental load, and coordination burdens. They are:

  • Passive jobs with low demand and low control, including the jobs performed by janitors, miners, and other manual laborers.

  • Low-strain jobs with low demand and high control, such as those done by natural scientists and architects.

  • High-strain jobs with high demand and low control, as found in service industry workers (waitresses and nursing aides, for example). This category made up 11% to 27% of participants in all six studies.

  • Active jobs with high demand and high control, including those performed by doctors, teachers, and engineers.

The researchers found that people with high-strain jobs had a 22% higher risk for stroke than those with low-strain jobs (relative risk [RR], 1.22; 95% confidence interval [CI], 1.01 - 1.47). The risk with high-strain work was most pronounced for ischemic stroke (RR, 1.58; 95% CI, 1.12 - 2.23) and in women (RR, 1.33; 95% CI, 1.04 - 1.69). No other job strain types were associated with stroke risk.

The researchers calculated a population attributable risk for stroke with high-strain jobs of 4.4% overall and 6.5% for women.

"Many mechanisms may be involved in the association between high-stress job and the risk of stroke," said Dr Xu. "The most important is that high-stress jobs may lead to more unhealthy behaviors, such as poor eating habits, smoking, and a lack of exercise. So it is of vital importance for subjects with high-stress occupations to address these lifestyle issues."

"Second, psychotherapy methods aiming to help individual to cope with psychological stress, such as cognitive-behavioral therapy, relaxation therapy, and multimodal interventions, may be needed in high-risk subpopulations with high- strain occupations combined with other cardiovascular risk factors, especially in women," Dr Xu added.

The fact that job stress was measured at only one point and that other factors, such as high blood pressure or high cholesterol, were not adequately adjusted for in the original studies are limitations of the meta-analysis, the researchers say.

Major Public Health Impact

Jennifer J. Majersik, MD, MS, from the University of Utah in Salt Lake City and a member of the American Academy of Neurology, comments on the study in a corresponding editorial.

"As a stroke neurologist, my patients or their partners regularly ask me whether stress caused their stroke. This is a particularly common question when the stroke occurred in the midst of a difficult life event, or to someone young, working extra hours at school or work. Up to this point, I really have not known how to answer my worried patients," she writes.

On the basis of this new study, "in answer to my patients' questions as to whether stress caused their stroke, I will now say 'maybe' and then specifically discuss their job type and structure. This is important because there may be ways to reduce job strain, without losing the job," Dr Majersik says.

"Based on this study," she added in a statement, "it is reasonable to consider testing interventions aimed at increasing job control, such as decentralization of decision-making and flexibility in job structure, such as telecommuting. If effective, such workplace changes could have a major public health impact."

The authors have disclosed no relevant financial relationships.

Neurology. Published online October 14, 2015. Abstract Editorial

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