Work Stress May Raise the Risk for Peripheral Artery Disease

By Linda Carroll

April 30, 2020

(Reuters Health) - People with very demanding jobs but little control are more likely to be hospitalized with peripheral artery disease than those with less work-related stress, a new study finds.

In a pooled analysis of data on nearly 140,000 adults from 11 earlier studies, researchers found during 1,718,132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of peripheral artery disease (PAD), or 3.88 per 10 000 person-years. Job strain was associated with a 1.41-fold increased average risk of hospitalization with PAD, according to the results in the Journal of the American Heart Association.

"We found that people with work-related stress were 1.4 times as likely as those without work-related stress to have a hospital record of peripheral artery disease," said the study's lead author, Katriina Heikkila, a senior researcher at the Karolinska Institute, in Stockholm. "This association was of a similar magnitude as the association of job strain with heart disease and stroke, suggesting that job strain is as important a risk factor for PAD as it is for these other cardiovascular conditions."

The new findings are especially important in light of the prevalence of the disease, said Heikkila, who did the work while at the London School of Hygiene & Tropical Medicine, in the UK.

"Worldwide, peripheral artery disease affects more than 200 million people, including more than 8.5 million in the United States," Heikkila said in an email. "Despite the considerable burden of peripheral artery disease, the evidence on specific risk factors, including potential primary preventive targets, for this disease is scarce."

To look at the impact of job-related stress on the risk of PAD, Heikkila and her colleagues pooled data from 11 prospective cohort studies, which included information on job strain and hospital-treated PAD. Included in those 11 studies were 139,000 men and women from Finland, Sweden, Denmark and the UK. The average age ranged from 39 to 49. None of the participants had a history of PAD when the studies began.

The studies had collected a plethora of health and demographic information, including age, gender, BMI, smoking status, alcohol consumption, physical activity level, diabetes status, socioeconomic position, and hospitalization history. Added to that was the information on job stress, which came from the Copenhagen Psychosocial Questionnaire.

The results of the new study are consistent with prior research showing that people with PAD are more likely to have lower socioeconomic status and lower levels of education, said Dr. Mary McDermott, the Jeremiah Stamler Professor at the Northwestern University Feinberg School of Medicine, in Chicago.

"Both of these characteristics are related to job stress," Dr. McDermott said in an email. "The study does not show that job stress causes peripheral artery disease. However, it is provocative and important."

The findings are in line with other research linking demanding jobs that allow workers little control to heart attacks, cardiovascular disease and other cardiovascular outcomes, said Dr. Alan Rozanski, a professor of medicine at the Icahn School of Medicine at Mount Sinai and a cardiologist at Mount Sinai Morningside in New York City.

Still, Dr. Rozanski said, not all jobs that are characterized as high-demand and low-control are stressful. "That describes many jobs in the military where there is high morale," he added. "What might potentially be missing in this research is how meaningful the job is."

While it's possible stressful jobs and their psychological burden may lead to poor health habits, such as bad diets and low physical activity, it's also possible that the stress could lead to inflammation, which in turn could raise the risk of atherosclerosis, Dr. Rozanski said.

SOURCE: Journal of the American Heart Association, online April 28, 2020.