Job strain linked to increased risk of premature death for men with cardiometabolic disease

June 6, 2018, Lancet

Having a demanding job and little control over it is associated with an increased risk of premature death in men with coronary heart disease, stroke, or diabetes, according to an observational study tracking more than 100000 men and women with and without cardiometabolic disease from Finland, France, Sweden, and the UK for almost 14 years, published in The Lancet Diabetes & Endocrinology journal.

However, there was no association between any type of work and for women with or without cardiometabolic . Men without cardiometabolic disease had a slightly heightened risk of death associated with work that demands a lot of effort for little reward. Some existing treatment guidelines already recommend stress management for people with cardiometabolic disease, but this study is the first large-scale study to investigate the link.

"Work is a common source of stress in adulthood, triggering natural stress responses that were programmed in our bodies generations ago. These can result in physical reactions to situations like work stress, and our findings give evidence for there being a link between job strain and risk of premature death in men with cardiometabolic diseases, such as coronary heart disease, stroke, and diabetes," says Professor Mika Kivimäki, UCL, UK. "These findings suggest that controlling and cholesterol levels alone are unlikely to eliminate the excess risk associated with job strain in men with cardiometabolic disease. Other interventions might be needed at least for some patients—possibly including as part of cardiovascular disease rehabilitation, job redesign, or reducing working hours. However, more research will be needed to identify which specific interventions might improve health outcomes in men with , stroke, or diabetes."

The study, which began in 1985, is the largest of its kind and includes seven cohort studies from Finland, France, Sweden, and the UK. It included 102633 men and women—including 3441 with cardiometabolic disease (1975 men and 1466 women) - who were given a questionnaire on their lifestyle and health at the start of the study. Participants' medical records were tracked for an average of 13.9 years, and during this time 3841 participants died.

The study included two types of work stress; job strain (having high work demands and low control over them) and effort-reward imbalance (putting in lots of effort, but getting little reward in return).

After controlling for socioeconomic status and several conventional and lifestyle risk factors (including high blood pressure, high cholesterol, smoking, obesity, physical inactivity, and high alcohol consumption), the authors found that, among men with cardiometabolic disease, those experiencing job strain had a 68% greater risk of premature death than men who had no job strain [2].

In addition, this increased risk was even present in men with cardiometabolic disease who had achieved their treatment targets, including those with a healthy lifestyle (including not being obese, being physically active, not smoking, and not drinking heavily), blood pressure, and cholesterol levels.

There was no association between risk of premature death and effort-reward imbalance in men with cardiometabolic disease, but men without cardiometabolic disease had a slightly heightened risk associated with this type of work stress.

Neither type of work stress was associated with increased mortality risk for women with or without cardiometabolic disease.

The authors say that job stress may affect the body in a number of ways to cause this association, including hijacking natural responses to stress, through heightened levels of the , which increases glucose production and limits the effect of insulin, potentially leading to worse prognosis in diabetes. In addition, increased inflammation and increased activation of the 'fight-or-flight' response can elevate blood pressure and affect blood clotting, potentially increasing the risk of cardiac events in individuals who already have high levels of hardening of the arteries.

The authors note some limitations, including that the study only measured cardiometabolic disease and work stress at the start of the study, meaning it does not account for severity of disease or how it changes over time. The study did not control for blood pressure or in all cohorts due to missing data, and this could lead to a small overestimation of the effect of .

Equally, the authors note that people with more severe cardiometabolic disease tend to shorten their working hours, and this reduced effort may explain why there is no association between effort-reward imbalance and risk of premature mortality in men with cardiometabolic disease.

Writing in a linked Comment, Yulong Lian, Nantong University, China, says: "Although the authors argue that the difference in findings between the models might be related to different sources of stress and reduced effort in people with severe illness, other important prognostic factors associated with cardiometabolic disease might have biased these findings. The prevalence of , such as psychological distress, clinical depression, and anxiety, is higher among patients with cardiometabolic disease than in the general population. Furthermore, compared with people with no stress, those with work stress tend to have a higher prevalence of poor mental health... Nevertheless, their results are provocative and encourage careful attention to work stress reduction among patients with cardiometabolic diseases... Further research into the mechanisms responsible for the these differences in the effects of would not only improve understanding of the prognosis of cardiometabolic disease, but also inform health policy makers and guideline committees about the need for sex-specific workplace interventions for the treatment and management of cardiometabolic disease."

Explore further: Higher BMI linked with increased risk of high blood pressure, heart disease, type 2 diabetes

More information: The Lancet Diabetes & Endocrinology, www.thelancet.com/journals/lan … (18)30140-2/fulltext

Related Stories

Higher BMI linked with increased risk of high blood pressure, heart disease, type 2 diabetes

July 5, 2017
Results of a new study add to the evidence of an association between higher body mass index (BMI) and increased risk of cardiometabolic diseases such as hypertension, coronary heart disease, type 2 diabetes, according to ...

Inadequate sleep predicts risk of heart disease, diabetes in obese adolescents

March 6, 2014
Obese adolescents not getting enough sleep? A study in today's The Journal of Pediatrics, shows they could be increasing their risk for developing diabetes, heart disease and stroke.

Cardiometabolic risk, HOMA-IR up with increasing BMI in young

September 27, 2017
(HealthDay)—Cardiometabolic risk and homeostatic model assessment (HOMA) of insulin resistance (IR) increase with increasing body mass index (BMI) categories among children, and cardiorespiratory fitness (CRF) may attenuate ...

Direct fitness measures better predict cardiometabolic risk

February 21, 2014
(HealthDay)—Directly measured fitness is more strongly associated with cardiovascular risk than self-reported physical activity level, according to research published in the Feb. 15 issue of The American Journal of Cardiology.

High-intensity interval training helps combat high insulin resistance—a warning sign for diabetes

August 16, 2017
A new study published in Frontiers in Physiology suggests that High-Intensity Interval Training is an efficient, effective way of cutting people's risk of developing type-2 diabetes, regardless of their levels of insulin ...

Sleep patterns contribute to racial differences in disease risk

August 18, 2017
Poor sleep patterns could explain, in part, the differences in the risk of cardiometabolic disease between African-Americans and European-Americans, according to a new study published in Proceedings of the National Academy ...

Recommended for you

Gout could increase heart disease risk

August 17, 2018
Having a type of inflammatory arthritis called gout may worsen heart-related outcomes for people being treated for coronary artery disease, according to new research.

Stroke patients treated at a teaching hospital are less likely to be readmitted

August 17, 2018
Stroke patients appear to receive better care at teaching hospitals with less of a chance of landing back in a hospital during the early stages of recovery, according to new research from The University of Texas Health Science ...

Cardiovascular disease related to type 2 diabetes can be reduced significantly

August 16, 2018
Properly composed treatment and refraining from cigarette consumption can significantly reduce the risk of cardiovascular disease resulting from type 2 diabetes, according to a study published in the New England Journal of ...

Genomic autopsy can help solve unexplained cardiac death

August 15, 2018
Molecular autopsies can reveal genetic risk factors in young people who unexpectedly die, but proper interpretation of the results can be challenging, according to a recent study published in Circulation.

Neonatal pig hearts can heal from heart attack

August 15, 2018
While pigs still cannot fly, researchers have discovered that the hearts of newborn piglets do have one remarkable ability. They can almost completely heal themselves after experimental heart attacks.

Fifty percent of cardiovascular patients suffer from multiple diseases

August 15, 2018
New research led by The University of Western Australia has revealed that one in two patients admitted to hospital with a cardiovascular disease is suffering from multiple chronic medical conditions which required complex ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.