Work-related stress linked to increased risk for peripheral artery disease

April 28, 2020

Science Daily/American Heart Association

People who reported work-related stress were more likely to be hospitalized for peripheral artery disease compared to those who did not report work-related stress, according to new research published today in the Journal of the American Heart Association, an open access journal of the American Heart Association. The article appears in a special spotlight issue exploring different aspects of the complex relationships between psychosocial factors and cardiovascular health.

Peripheral artery disease, or PAD, is a cardiovascular disease that occurs when cholesterol or other fatty substances in the blood build up in the blood vessels away from the heart, usually the legs, impeding blood flow. Symptoms often include leg pain while walking. Left untreated, peripheral artery disease increases the likelihood of heart disease and stroke. Worldwide, peripheral artery disease affects more than 200 million people, including more than 8.5 million in the United States. Despite the considerable burden of peripheral artery disease, the evidence on specific risk factors, including potential primary preventive targets, for this disease is scarce, according to researchers.

Work-related stress, or job strain, refers to psychological and social stress at work, often from high expectations combined with lower levels of personal control. Previous studies have linked work-related stress to other forms of atherosclerotic disease; however, few have specifically analyzed its effects on peripheral artery disease. This study focused on the relationship between work-related stress and hospital treatment for peripheral artery disease.

The researchers evaluated the records of 139,000 men and women (36.4% men; average age of study participants range 39-49) participating in 11 separate studies from 1985-2008 in Finland, Sweden, Denmark and the United Kingdom. Participants included in the analysis had no previous history of peripheral artery disease when the respective studies began. Individual information for each participant included age, sex, BMI, smoker or nonsmoker, alcohol consumption, physical activity level, diabetes status, socioeconomic position, data on hospitalizations and the questionnaire on work-related stress.

During an average 12.8 years of follow up, 667 people (0.2 to 1.8% of participants) were hospitalized for peripheral artery disease. Researchers found that people with work-related stress were 1.4 times as likely as those without work-related stress to have a record of peripheral artery disease in the hospitalization register, after adjusting for age, sex and lifestyle variables.

"Our findings suggest that work-related stress may be a risk factor for peripheral artery disease in a similar way as it is for heart disease and stroke," said lead study author Katriina Heikkilä, Ph.D., senior researcher at the Karolinska Institute, Stockholm.

Stress is associated with increased inflammation and higher blood glucose levels. So, although there is limited evidence linking work-related stress to heart disease, stress could be contributing to complications and exacerbations of peripheral artery disease.

The investigators measured work-related stress based on participants' ratings of statements to describe psychosocial aspects of their job. This information was compared to records on peripheral artery disease hospitalizations across nearly 13 years of hospital records.

Overall, nearly one-fourth of participants with no previous hospitalization for peripheral artery disease reported work-related stress at the beginning of the 11 studies.

Researchers noted increased risk among men, those with high socioeconomic position and smokers, but noted such subgroup analysis was limited by the small number of people with peripheral artery disease.

https://www.sciencedaily.com/releases/2020/04/200428093515.htm

Stressed at work and trouble sleeping? It's more serious than you think

April 28, 2019

Science Daily/European Society of Cardiology

Work stress and impaired sleep are linked to a threefold higher risk of cardiovascular death in employees with hypertension. That's the finding of research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

Study author Professor Karl-Heinz Ladwig, of the German Research Centre for Environmental Health and the Medical Faculty, Technical University of Munich, said: "Sleep should be a time for recreation, unwinding, and restoring energy levels. If you have stress at work, sleep helps you recover. Unfortunately poor sleep and job stress often go hand in hand, and when combined with hypertension the effect is even more toxic."

One-third of the working population has hypertension (high blood pressure). Previous research has shown that psychosocial factors have a stronger detrimental effect on individuals with pre-existing cardiovascular risks than on healthy people. This was the first study to examine the combined effects of work stress and impaired sleep on death from cardiovascular disease in hypertensive workers.

The study included 1,959 hypertensive workers aged 25-65, without cardiovascular disease or diabetes. Compared to those with no work stress and good sleep, people with both risk factors had a three times greater likelihood of death from cardiovascular disease. People with work stress alone had a 1.6-fold higher risk while those with only poor sleep had a 1.8-times higher risk.

During an average follow-up of nearly 18 years, the absolute risk of cardiovascular death in hypertensive staff increased in a stepwise fashion with each additional condition. Employees with both work stress and impaired sleep had an absolute risk of 7.13 per 1,000 person-years compared to 3.05 per 1,000-person years in those with no stress and healthy sleep. Absolute risks for only work stress or only poor sleep were 4.99 and 5.95 per 1,000 person-years, respectively.

In the study, work stress was defined as jobs with high demand and low control -- for example when an employer wants results but denies authority to make decisions. "If you have high demands but also high control, in other words you can make decisions, this may even be positive for health," said Professor Ladwig. "But being entrapped in a pressured situation that you have no power to change is harmful."

Impaired sleep was defined as difficulties falling asleep and/or maintaining sleep. "Maintaining sleep is the most common problem in people with stressful jobs," said Professor Ladwig. "They wake up at 4 o'clock in the morning to go to the toilet and come back to bed ruminating about how to deal with work issues."

"These are insidious problems," noted Professor Ladwig. "The risk is not having one tough day and no sleep. It is suffering from a stressful job and poor sleep over many years, which fade energy resources and may lead to an early grave."

The findings are a red flag for doctors to ask patients with high blood pressure about sleep and job strain, said Professor Ladwig. "Each condition is a risk factor on its own and there is cross-talk among them, meaning each one increases risk of the other. Physical activity, eating healthily and relaxation strategies are important, as well as blood pressure lowering medication if appropriate."

Employers should provide stress management and sleep treatment in the workplace, he added, especially for staff with chronic conditions like hypertension.

Components of group stress management sessions:

·      Start with 5 to 10 minutes of relaxation.

·      Education about healthy lifestyle.

·      Help with smoking cessation, physical exercise, weight loss.

·      Techniques to cope with stress and anxiety at home and work.

·      How to monitor progress with stress management.

·      Improving social relationships and social support.

Sleep treatment can include:

·      Stimulus control therapy: training to associate the bed/bedroom with sleep and set a consistent sleep-wake schedule.

·      Relaxation training: progressive muscle relaxation, and reducing intrusive thoughts at bedtime that interfere with sleep.

·      Sleep restriction therapy: curtailing the period in bed to the time spent asleep, thereby inducing mild sleep deprivation, then lengthening sleep time.

·      Paradoxical intention therapy: remaining passively awake and avoiding any effort (i.e. intention) to fall asleep, thereby eliminating anxiety.

https://www.sciencedaily.com/releases/2019/04/190428143520.htm