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Job strain may increase mortality risk in men with cardiometabolic disease

By Nicole MacKee
A stressful job may add to the mortality risk of men with cardiometabolic disease, say researchers in The Lancet Diabetes & Endocrinology.

The researchers examined the association between work stress and mortality using data from seven European cohort studies comprising more than 100,000 participants with or without pre-existing coronary heart disease, stroke or diabetes. Two indicators of work stress were considered: job strain (high job demand with little control in the workplace) and effort-reward imbalance (where monetary and nonmonetary rewards did not match the effort invested in the job).

After controlling for socioeconomic status and conventional risk factors and their treatment, the researchers found that in men with cardiometabolic disease, those who reported job strain had an increased risk of premature death during follow up (mean 14.9 years) compared with those without job strain (multivariable-adjusted hazard ratio [HR], 1.68).

Effort-reward imbalance was not associated with an increased mortality risk in men with cardiometabolic disease, but there was a heightened risk in men without cardiometabolic disease (HR, 1.22).

Neither component of work stress was associated with increased mortality in women.

Professor David Hare, Professorial Fellow at the University of Melbourne and Senior Cardiologist at Austin Health, said it was possible that the ‘job strain’ investigated in the study was a function of other sociological demographics.

‘[The researchers] attempted to control for socioeconomic status, but mostly this was only rated high, intermediate or low on the basis of their occupational title,’ Professor Hare told Cardiology Today.

‘There have been many data over the years demonstrating that persons of lower socioeconomic status have higher mortality, this being driven by many factors including income, access to good health care, education and social isolation.’

Professor Hare said it was unclear why significance was found for job-strain in men, but not effort-reward imbalance, which had been suggested as an important component for work stress. He said interventional data would be needed to support any calls to address job strain in addition to the usual cardiometabolic risk factors.

‘Maybe tighter control of other risk factors such as LDL-cholesterol is all that is required,’ Professor Hare said.
Lancet Diabetes Endocrinol 2018;