Job-Stressed Women Face Higher MI Risk


CHICAGO — Women who report high psychological job strain have a 40% increased risk of cardiovascular disease, according to a large, 10-year prospective study.

High job strain is defined by a demanding job, often involving time pressure and conflict, coupled with little decision-making authority or opportunity for personal growth.

But women with high job strain weren't the only group at increased risk for acute MI and other cardiovascular events in this analysis of more than 17,000 working women participating in the Women's Health Study. Those with active job strain defined as high-demand work featuring a high sense of control, based on Robert Karasek's 14-item job strain model used in this study, had a 60% increase in total cardiovascular events compared with those reporting low job strain, Natalie Slopen, Sc.D., reported at the meeting.

This last point regarding the cardiovascular risks associated with active job strain should be near and dear to the hearts of female physicians. Many, perhaps most, physicians fit within the Karasek active job strain category, noted Dr. Slopen, a postdoctoral research fellow in the department of society, human development, and health at Harvard School of Public Health, Boston.

The Women's Health Study involves 17,415 female, mostly white, health professionals in good health at an average age of 57 years at enrollment in what was initially a randomized, placebo-controlled clinical trial of vitamin E and aspirin for primary prevention of cancer and cardiovascular disease. The study is now in the observational phase with 10 years of follow-up, during which 517 clinically verified nonfatal MIs, strokes, coronary revascularization procedures, and cardiovascular deaths have occurred.

In a Cox proportional hazards model adjusted for age, race, socioeconomic status, and study drug assignment, the 3,529 women who reported high job strain at baseline had a 90% increased risk of MI, a 40% increase in coronary revascularization, and a 40% increase in total cardiovascular events, compared with the 4,161 female health professionals with low job strain.

The 3,736 women who reported active job strain had a 60% increase in total cardiovascular events compared with the low job strain group.

The investigators also inquired about job insecurity. At baseline, 19% of Women's Health Study participants indicated they were concerned about future job loss. Contrary to the study hypothesis, however, no independent association was found between job insecurity and subsequent development of cardiovascular disease.

An important clinical implication of this study is that it may be useful for physicians to ask about job stress as part of their total health assessment of women employed outside the home. Women with high job strain or active job strain can be counseled that there are data to support several beneficial interventions. These include maintaining a physically active lifestyle to help burn off psychological stress, engaging in social support networks to aid in coping with work strain, and reserving time every day – as little as 10-15 minutes – for some form of relaxation. It's also important to limit the intrusion of work activities outside the workplace; e-mail is a big offender in this regard, according to Dr. Slopen.

The Women's Health Study is funded by the National Institutes of Health. Dr. Slopen declared having no relevant financial disclosures.

Women who reported high job strain at baseline had a 90% increased risk of myocardial infarction.


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