Who is dying from job stress?

A paper published in the Lancet Diabetes and Endocrinology by lead author Professor Mika Kivimäki, from the University College London, reported on a study which included two types of work stress: job strain (having high work demands and low control over them) and effort–reward imbalance (putting in lots of effort but getting little reward in return).

Having a demanding job and little control over it is associated with an increased risk of premature death in men with cardiometabolic disease, according to a 14-year observational study of more than 100,000 people.

Cardiometabolic syndrome (CMS) is a combination of metabolic dysfunctions mainly characterized by insulin resistance, impaired glucose tolerance, hypertension, and central adiposity. CMS is now recognized as adisease entity by the World Health Organization

The researchers found that the same outcome cannot be said for women who are stressed at work, with no evidence to suggest it could shorten their lives — whether they have cardiometabolic disease or not.

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The authors found that among men with cardiometabolic disease, those experiencing job strain have a 68% greater risk of premature death than men with no job strain.

This finding was after they had considered socioeconomic status and several conventional and lifestyle risk factors — including smoking, hyperlipidaemia, obesity, hypertension, high alcohol consumption and physical inactivity.

It was also evident from the research that this increased risk is even present in men with cardiometabolic disease who have achieved their treatment goals, including those with a healthy lifestyle, and normal blood pressure and cholesterol levels.

Neither type of work stress is associated with increased mortality risk for women, with or without cardiometabolic disease.

The authors say that job stress may affect the body in numerous ways to cause this association, including hijacking natural responses to stress through heightened levels of the stress hormone cortisol, which increases glucose production and limits the effect of insulin, potentially leading to a worse prognosis in diabetes. 

In addition, increased inflammation and activation of the fight-or-flight response can elevate blood pressure and affect blood clotting, potentially increasing the risk of cardiac events in individuals who already have high levels of hardening of the arteries.

The findings suggest that controlling blood pressure and cholesterol levels alone are unlikely to eliminate the excess risk associated with job strain in men with cardiometabolic disease.

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