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Work stress and heart disease: the mediators

Stress at work can influence employees behaviours, such as their level of physical activity and their diet. It can also have a biological impact on the body, raising the risk of heart diseaase.

Research carried out at University College London reveals the biological and behavioural factors linking work stress with heart disease.  Work stress is known to be an important determinant of heart disease among working age populations. What the researchers found was that work stress is mediated through indirect and direct pathways i.e. health behaviours and effects on stress pathways.

This longitudinal study had a total of 10,308 London based male and female civil servants participating.  Participants were studied in 1985-1988 (phase 1) and again at several intervals up to 2002-04 (phase 7).  When the study began the participants were aged 35-55.

Work stress was assessed twice: at phase 1 and again in 1991-93.  This gave the researchers measures on the duration of exposure to work stress.  They found that work stress was lowest in the highest civil service grade.

The researchers also measured Coronary Heart Disease (CHD) events, including fatal CHD, incident non fatal myocardial infraction (MI), with or without angina.  These measurements were taken between what the researchers say was phase 2 ? 7 (an average of 12 years of follow up)  The researchers also measure biological risk factors  for CHD included the metabolic syndrome and its components, such as waist circumference, morning rise in cortisol and low heart rate variability.   Behavioural risk factors were measured and these included alcohol consumption, smoking, activity and diet. 

The researchers found that Greater reports of work stress were associated with higher risk of heart disease.  This was true for both major Coronary Heart Disease events (fatal events and MI) and definite angina.   Among older participants (50-60) there was little association between work stress and CHD.    Greater reports of work stress were associated with poorer health behaviour such as eating less fruit and vegetables and less exercise.  Greater reports of work stress were associated with lower heart rate variability and also elevated morning rise in the stress hormone cortisol and overall metabolic syndrome.

This study found that around 32% of the effect of work stress on CHD can be explained by the effect of work stress on health behaviours (low physical activity and poor diet in particular) and the metabolic syndrome. The association was stronger among employees younger than 50 years old and those still in employment.  The researchers say that this study ?demonstrates that stress at work can lead to CHD through direct activation of the neuroendocrine stress pathways and indirectly through health behaviours?   To read  a BBC article on this research click here to access the article click here


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