In the year 1959, Henry I. Russek published his famous paper on the relationship between work related stress and heart disease. Russek concluded that emotional stress of occupational origin appeared far more significant than family history, high fat diet, obesity, smoking or lack of exercise.
Previously, Ray H Rosenman and Meyer Friedman had suggested that the increasing work related stress unique to industrialized society played a dominant role in the high incidence of clinical coronary heart disease. Since then, many studies have confirmed that work related stress is associated with an elevated risk of coronary artery disease (CAD). This association is present independent of gender, age, and socioeconomic status.
How can we deal with job related stress? For many of us, avoidance of stress at work is unrealistic, at least for those of us who want to keep our jobs. So, should we just accept and live with the cold fact that the stress we experience at work will increase our risk of having a heart attack. Is there really nothing we can do about it? Is there a way to reduce the damaging effects of job stress on our health?
A recent paper published in the Canadian Medical Association Journal addresses the question if and how we can reduce the damaging effect of work related stress on the risk of heart disease. The hypothesis was that healthy lifestyle characterized by physical activity, a healthy diet, a healthy weight, and avoidance of smoking and heavy drinking could off-set the the deleterious impact of work related stress on the risk of heart disease.
The investigators used pooled data from seven European cohort studies for meta-analysis. More than 100 thousand people were included in the analysis, their mean age was 44.3 years, 51.8 percent were women. Overall, 15.7 % reported job strain according to defined criteria. Mean follow-up was 7.3 years. Smoking, heavy drinking (men > 28 alcoholic drinks a week, women > 21 alcoholic drinks a week), physical inactivity and obesity (BMI >30) were used to define unhealthy lifestyle. Participants were grouped into three lifestyle categories: healthy lifestyle (no lifestyle risk factors), moderately unhealthy lifestyle (1 risk factor) and unhealthy lifestyle (2-4 lifestyle risk factors).
The 10 year incidence of CAD was 18.4 per 1.000 among participants with job strain and 14.7 per 1.000 among those without job strain. This difference is statistically significant, conforming previous findings that job strain is a risk factor for CAD.
The 10 year incidence of coronary artery disease was 30.6 per 1.000 among participants with unhealthy lifestyle, 17.8 per 1.0000 amonge those with a moderately unhealthy lifestyle and 12.0 per 1.000 among those with a healthy lifestyle. Thus, patients with an unhealthy lifestyle had 18.6 more events per 1.000 than those with a healthy lifestyle. This difference was statistically significant and confirms the negative effects of unhealthy lifestyle on the risk of heart disease.
Among participants who reported job strain, the 10 year incidence of CAD was 31.2 per 1.000 people for those with unhealthy lifestyle and 14.7 per 1.000 for those with a healthy lifestyle.
Bottom line: Work related stress increases the risk of coronary artery disease. Those with job strain and healthy lifestyle had about half the rate of coronary heart disease compared to those with job strain and unhealthy lifestyle.