Work Stress Leads to Heart Disease and Diabetes

People with high job stress over a protracted period of time have double the risk of developing the metabolic syndrome.

British investigators report. This relationship may help explain the reported link between stressors of everyday life and heart disease.

Dr. Tarani Chandola and colleagues at University College London evaluated data from the prospective Whitehall II study, which recruited 10,308 participants ages 35 to 55 from 20 civil service departments between 1985 and 1988.

Surveys regarding job demands, job control, lack of social support at work, and health behaviors were completed at baseline and in 1989, 1991-1993, and 1997-1999. There were 7034 subjects remaining at the final evaluation.

Subjects underwent clinical examinations to determine the prevalence of metabolic syndrome, defined by the presence of three or more risk factors (abdominal obesity, hypertriglyceridemia, low high density lipoprotein cholesterol, hypertension, and hyperglycemia).

As reported , work stress was defined as being in the lowest third of work social support, with high job demands and low job control.

Compared with subjects who never reported work stress, those who reported work stress three or more times over the 14-year study period had double the risk of metabolic syndrome.

The authors observed a dose-response relationship. After adjusting for age, employment grade, health behaviors and excluding patients who were obese at baseline, the odds ratio for those reporting high work stress only one time was 1.11, rising to 1.47 for those reporting high job stress at two time points. The odds ratio was 2.29 for those with high job stress three or more times (p = 0.01 for trend).

Dr. Chandola’s group also observed a social gradient, in which those in the lowest employment grades had more than double the risk of developing metabolic syndrome than those in the highest grades. After adjusting for work stress and health behaviors, the social gradient was no longer significant.

The mechanism underlying the relationship between work stress and metabolic syndrome remains unknown. The authors posit that the effects of stress on the autonomic nervous system, neuroendocrine activity, biological resilience, and adrenocortical function may be involved.

BMJ Online First 2006.

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