Study shows that men with history of stroke, CAD and diabetes have higher risk of premature death if in a demanding job
Having a demanding job and little control over it is associated with an increased risk of premature death.
While this has always been established social wisdom, a study now shows that this is true, especially for men with coronary heart disease, stroke, or diabetes. The 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 has been published in The Lancet Diabetes and Endocrinology.
Interestingly, there was no association between any type of work stress and premature death for women with or without cardiometabolic disease. 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.
He added: “These findings suggest that controlling blood pressure 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 stress management 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 coronary heart disease, stroke, or diabetes.”
Neither type of work stress was associated with increased mortality risk for women with or without cardiometabolic disease
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.
In addition, this increased risk was even present in men with cardiometabolic disease who had achieved their treatment targets. This included 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.
