Job strain may raise risk of premature mortality in men with cardiometabolic disease
Job strain may increase the risk of premature mortality among men with cardiometabolic disease, an effect not seen in women regardless of cardiometabolic status, as demonstrated by an observational study from Europe.
“[O]ur 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 first author Professor Mika Kivimäki from the Helsinki Institute of Life Science, University of Helsinki, Finland.
“The mortality difference between groups with and without job strain was ... independent of socioeconomic status and several conventional and lifestyle risk factors,” said Kivimäki and co-authors.
Researchers used data from seven cohort studies in the IPD-Work* consortium to identify the link between work stress, defined as job strain or an effort-reward imbalance, and mortality in 102,663 individuals (mean age 43.9 years, 43.4 percent male), of whom 3,441 had cardiometabolic disease (ie, coronary heart disease, stroke, or diabetes) at baseline. Job strain was assessed using the Job Content Questionnaire and Demand-Control Questionnaire, while effort-reward imbalance was measured using the Effort-Reward Imbalance at Work questionnaire.
After a mean follow-up period of 13.9 years during which there were 3,841 deaths, men with cardiometabolic disease who experienced job strain had a 68 percent higher risk of premature mortality than those without job strain (149.8 vs 97.7 per 10,000 person-years, adjusted hazard ratio [HR], 1.68, 95 percent confidence interval [CI], 1.19–2.35; p=0.024). [Lancet Diabetes Endocrinol 2018;doi:10.1016/S2213-8587(18)30140-2]
This elevated risk was evident even among men with job strain who had reached their treatment targets such as those with normal blood pressure levels and no dyslipidaemia (HR, 6.17, 95 percent CI, 1.74–21.9; p=0.0049), those highly adherent to pharmacotherapy (HR, 2.38, 95 percent CI, 1.34–4.20; p=0.0029), and those with no lifestyle risk factors (ie, current smoking, obesity, high alcohol consumption, and physical inactivity; HR, 2.01, 95 percent CI, 1.18–3.43; p=0.010).
Furthermore, the mortality risk difference between men with cardiometabolic disease with vs without job strain (difference, 52.1 per 10,000) was less than that observed in men with cardiometabolic disease who were current smokers (difference, 78.1 per 10,000 vs former smokers) but higher than that of men with risk factors such as hypertension, obesity, lack of physical activity, and high total cholesterol levels or alcohol consumption (5.9–44.0 per 10,000 vs lower-risk individuals).
Conversely, there was no apparent increased risk of premature mortality due to work stress in women regardless of baseline cardiometabolic status or in men without cardiometabolic disease, although a slight elevation was demonstrated among men without cardiometabolic disease who experienced effort-reward imbalance (HR, 1.22, 95 percent CI, 1.06–1.41; p=0.048).
“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,” said Kivimäki, who called for further studies to identify ideal interventions.
According to Dr Yulong Lian from Nantong University in Jiangsu, China, mental health status may have a role to play in the work stress-mortality association.
“The prevalence of poor mental health, 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. These psychological distresses are likely to increase the mortality risk of patients with cardiovascular disease or diabetes. Other life and work stressors, such as social isolation, loneliness, workplace bullying, and job insecurity, might also contribute to the progression of cardiometabolic disease,” he said in an editorial. [Lancet Diabetes Endocrinol 2018;doi:10.1016/S2213-8587(18)30172-4]
Despite limitations including potential over- or underestimation of the link between cardiometabolic disease and mortality, the findings call attention to the importance in reducing work stress in patients with cardiometabolic disease, he said.