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

CATEGORY: STRESS & MIND-BODY

Men who faced both high job strain and a mismatch between effort and reward at work were about twice as likely to develop coronary heart disease—the narrowing of the heart’s arteries that leads to heart attacks and chest pain—as men free of both stressors, according to a study that followed 6,465 white-collar workers for 18 years. Facing either stressor alone was linked to a 49% higher risk. Because the study observed workers rather than changing their jobs, it shows an association, not proof that work stress directly damages the heart.¹

Job Strain and Effort-Reward Imbalance Defined

The researchers measured two well-studied forms of workplace strain. Job strain describes a job with high demands but little control—heavy workloads and tight deadlines combined with little say over how the work gets done. Effort-reward imbalance describes putting sustained effort into a job that gives too little back in pay, recognition, or job security. Picture pushing hard on a project for months while decisions are made over your head and the credit lands elsewhere—each stressor alone wears on the body, and this study asked what happens when they stack.

3,118 Men and 3,347 Women in Quebec

The study followed white-collar workers in Quebec, Canada—3,118 men and 3,347 women, all free of cardiovascular disease at the start—from 2000 to 2018. Work stress was measured with validated questionnaires covering job demands, control, effort, and rewards. Over the 18 years, researchers tracked who developed coronary heart disease through medical records, counting 571 events among men and 265 among women.

Combined Effect Similar in Size to Obesity Risk

Men exposed to either job strain or effort-reward imbalance had a 49% higher risk of coronary heart disease than men exposed to neither. Men exposed to both had roughly double the risk. The authors noted that the size of that combined effect was similar to the risk associated with obesity. In women, the results were inconclusive—the statistical ranges were too wide to show an effect in either direction, which the authors say points to a need for more research rather than evidence that women are unaffected.¹

White-Collar Workers in One Canadian Province

As an observational study of white-collar workers in one Canadian province, the findings may not extend to every workforce, and questionnaires capture a job as it is at certain points in time, not a whole career. Even so, the long follow-up and the clear stacking pattern—two stressors linked to more risk than one—make this one of the stronger looks at how the psychological climate of work relates to heart health.

90,164 European Workers, 41% Higher With Both

A much larger pooling of 11 European studies put the same question to 90,164 workers and found the same stacking pattern with smaller numbers: over about 10 years, either stressor alone was linked to a 16% higher risk of coronary heart disease, both together to a 41% higher risk.² A separate pooling of 197,473 workers linked job strain alone to a 23% higher risk.³ The direction is consistent across both; the Quebec numbers sit higher.

Key Takeaways

• In an 18-year study of 6,465 white-collar workers, men facing both high job strain and effort-reward imbalance had about twice the risk of coronary heart disease; either stressor alone was linked to a 49% higher risk.
• The combined effect was similar in size to the risk associated with obesity, according to the study authors.
• Results in women were inconclusive—too uncertain to show an effect either way—and the study shows association, not 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.