Work-Related Stress Linked to Poor Cardiovascular Health

Those with work-related stress were more likely to have unfavorable cardiovascular health (CVH), according to a study published in the Journal of the American Heart Association.¹

Work-related stress is a psychosocial risk factor resulting in harmful physical and emotional responses due to an imbalance in work requirements and the employee’s resources, needs, or capabilities. About 10% to 40% of employees experience work-related stress and have a subsequently higher risk of adverse cardiovascular disease (CVD) outcomes, like coronary heart disease.

One in 3 US adults has some form of CVD, which cost $407.3 billion between 2018 and 2019.² The researchers noted that this heavy socioeconomic burden must be diminished by the identification and management of at-risk groups, like those experiencing work-related stress.¹ Because the current literature is sparse, the researchers aimed to estimate the association between work-related stress and unfavorable CVH among men and women without known CVD at baseline.

They created their study population using the Multi-Ethnic Study of Atherosclerosis. This community-based cohort study investigated risk factors that may predict the progression of subclinical CVD to clinically overt CVD.³

Baseline data were collected through physical examinations, standardized questionnaires, and fasting laboratory blood tests between July 2000 and August 2002 from 6814 men and women aged 45 to 84 years who were free of clinical CVD or heart failure.¹ Participants were recruited from field centers in Baltimore, Maryland; Los Angeles, California; Forsyth County, North Carolina; New York, New York; Chicago, Illinois; and St Paul, Minnesota.

Work-related stress was evaluated using a self-administered questionnaire at baseline. Participants were asked, “Are you experiencing ongoing difficulties with your job or ability to work?” Those who responded yes had work-related stress. They further investigated work-related stress through the follow-up question, “Has this been a problem for 6 months or more?”

Additionally, CVH was assessed using Life’s Simple 7, modifiable health behaviors and factors that indicate optimal CVH.⁴ Those with the following factors were considered to have ideal CVH: nonsmoking, body mass index less than 25 kg/m^2, weekly physical activity of 75 minutes of vigorous exercise or 150 minutes of moderate exercise, untreated cholesterol less than 200 mg/dL, a healthy diet consistent with recommended guidelines, untreated blood pressure less than 120/80 mm Hg, and untreated fasting blood glucose less than 100 mg/dL.

Each metric contributed 0, 1, or 2 points if in the poor, intermediate, or ideal range, respectively, with the aggregated CVH score ranging from 0 to 14 points.¹ Based on total scores, participants’ CVH was considered inadequate (0-8 points), average (9-10 points), or optimal (11-14 points).

The study population consisted of 3579 participants, 48% of whom were women; the mean (SD) age was 57 (8) years. Of the study population, 716 (20%) had work-related stress, especially women and those younger than 65.

Also, participants with work-related stress had lower odds of having an average (OR, 0.75; 95% CI, 0.62-0.92) or optimal (OR, 0.73; 95% CI, 0.58-0.92) CVH score. Additionally, compared with having 0 to 1 ideal metrics, those with work-related stress had lower odds of having 2 to 3 (OR, 0.64; 95% CI, 0.46-0.89), 4 to 5 (OR, 0.56; 95% CI, 0.40-0.78), or 6 to 7 (OR, 0.52; 95% CI, 0.32-0.85) ideal metrics.

In particular, participants with work-related stress had lower odds of having the ideal physical activity (OR, 0.70; 95% CI, 0.56-0.86). Although a similar association was observed for the other ideal metrics, the CIs included the null.

The researchers acknowledged their limitations, including social desirability and recall bias. Both may have affected the accuracy of a self-administered diet, physical activity, and smoking questionnaires. Also, because of its cross-sectional design, the study cannot establish a definitive causal link between work-related stress and CVH due to the possibility of reverse causation. However, the researchers expressed confidence in their findings and suggested areas for further research.

“Our findings support the importance of workplace wellness programs designed to manage stress, promote CVH, and reduce the risk of CVD events,” the authors concluded. “Additional research that uses a prospective study design may be needed to establish a definitive causal link between work-related stress and unfavorable CVH.”

References

1. Ogunmoroti O, Osibogun O, Allen NB, et al. Work-related stress is associated with unfavorable cardiovascular health: the multi-ethnic study of atherosclerosis. J Am Heart Assoc. Published online November 6, 2024. doi:10.1161/JAHA.124.035824

2. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123

3. Bild DE, Bluemke DA, Burke GL, et al. Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol. 2002;156(9):871-881. doi:10.1093/aje/kwf1134.

4. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010;121(4):586-613. doi:10.1161/CIRCULATIONAHA.109.192703