Heart Disease More Common in Men Facing Both Job Strain and Low Reward at Work

CATEGORY: STRESS & MIND-BODY

Picture months of pushing hard on a project while decisions get made over your head and the credit lands somewhere else. Men living with both halves of that, heavy demands paired with little control plus effort that goes unrewarded, were about twice as likely to develop coronary heart disease as men facing neither, among 6,465 white-collar workers followed for 18 years. Either stressor on its own tracked with a 49% higher risk.¹ Coronary heart disease is the narrowing of the heart’s arteries that leads to heart attacks and chest pain. The study watched workers rather than changing their jobs, which leaves an association rather than proof that work stress damages the heart.

Two Kinds of Strain, Measured Separately

Job strain is the classic one: high demands, little control. Heavy workloads and tight deadlines, with almost no say over how the work gets done. Effort-reward imbalance is the second, sustained effort poured into a job that gives too little back in pay, recognition or security. Each has been studied on its own for decades. This study asked what happens when they stack.

571 Coronary Events Among the Men, 265 Among the Women

The workers were in Quebec, Canada: 3,118 men and 3,347 women, all free of cardiovascular disease when the study opened in 2000. Validated questionnaires measured job demands, control, effort and rewards. Over the next 18 years, through 2018, researchers tracked who developed coronary heart disease using medical records, counting 571 events among men and 265 among women. Men exposed to one stressor carried a 49% higher risk than men exposed to neither, and men exposed to both carried roughly double. The authors noted that the combined effect was similar in size to the risk associated with obesity. Results in women were inconclusive, the statistical ranges too wide to show an effect in either direction, which the authors read as a call for more research rather than evidence that women are unaffected.¹

One Province, One Kind of Job

White-collar workers in a single Canadian province may not stand in for every workforce, and a questionnaire captures a job at certain moments, not a whole career. The long follow-up and the clear stacking pattern still make this one of the better looks at how the psychological climate of work relates to heart health. Larger pooled research agrees on direction while landing lower. Eleven European studies covering 90,164 workers found either stressor alone linked to a 16% higher risk of coronary heart disease over about 10 years, both together to 41%.² A separate pooling of 197,473 workers linked job strain alone to a 23% higher risk.³ The Quebec numbers sit above both.

Key Takeaways

• Men facing high job strain and effort-reward imbalance together had about twice the coronary heart disease risk of men facing neither, across 18 years of follow-up; one stressor alone tracked with 49% higher risk.
• The authors put the size of that combined effect on a par with the risk associated with obesity.
• Findings in women were inconclusive, too uncertain to point either way, and the design shows association rather than proven cause.

References

1. Lavigne-Robichaud M, Trudel X, Talbot D, et al. Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures. Circulation: Cardiovascular Quality and Outcomes. 2023;16(10):e009700. link
2. Dragano N, Siegrist J, Nyberg ST, et al. Effort-reward imbalance at work and incident coronary heart disease: a multicohort study of 90,164 individuals. Epidemiology. 2017;28(4):619–626. link.
3. Kivimäki M, Nyberg ST, Batty GD, et al. Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data. The Lancet. 2012;380(9852):1491–1497. link.