Stress and high efforts, low reward increase men’s heart disease risk

The double risk of job strain and effort-reward imbalance explained.


Heart disease is the No. 1 cause of death in the U.S. According to research, two psychological stressors—job strain and an effort-reward imbalance system at work—may raise the risk of heart disease. Few research, nevertheless, have looked at the combined effect.

Effort-reward imbalance (ERI) is a concept that identifies a stressful psychosocial work environment. It indicates an imbalance between the effort and received rewards.

A new study by the American Heart Association examines the separate and combined effect of job strain and ERI exposure on coronary heart disease (CHD) incidence in a prospective cohort of white-collar workers in Quebec, Canada.

Compared to males without those stresses, men who report having stressful jobs and believe they put in a lot of effort for little pay had a double risk of developing heart disease.

Lead study author Mathilde Lavigne-Robichaud, R.D., M.S., doctoral candidate, Population Health and Optimal Health Practices Research Unit, CHU de Quebec-University Laval Research Center in Quebec, Canada said, “Considering the significant amount of time people spend at work, understanding the relationship between work stressors and cardiovascular health is crucial for public health and workforce well-being. Our study highlights the pressing need to proactively address stressful conditions to create healthier work environments that benefit employees and employers.”

The study monitored roughly 6,500 white-collar professionals for 18 years, from 2000 to 2018, with an average age of around 45 and no history of heart disease. They examined data from health and employment surveys for 3,118 men and 3,347 women working in various jobs in Quebec. Employees in senior management, professionals, technical, and office roles participated in the surveys. There were people with no high school diploma and university degrees.

They gathered data on heart disease using well-established health databases and used results from validated questionnaires to quantify job stress and effort-reward imbalance.

The study found:

  • Compared to males who did not report these stresses, men who reported job stress or effort-reward imbalance had a 49% higher chance of developing heart disease.
  • Men who reported experiencing both job stress and an effort-reward imbalance had a twofold increased risk of developing heart disease compared to men who did not report experiencing both stressors simultaneously.
  • It is unclear how work-related psychosocial stress affects the heart health of women.
  • The combined effects of work stress and an effort-reward imbalance system on men were comparable to the size of the effect of obesity on the risk of coronary heart disease.

Lavigne-Robichaud said“Our results suggest that interventions aimed at reducing stressors from the work environment could be particularly effective for men and have positive implications for women, as these stress factors are associated with other prevalent health issues such as depression. The study’s inability to establish a direct link between psychosocial job stressors and coronary heart disease in women signals further investigation into the complex interplay of various stressors and women’s heart health.”

Journal Reference:

  1. Mathilde Lavigne-Robichaud, Xavier Trudel, Denis Talbot 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. DOI: 10.1161/CIRCOUTCOMES.122.009700
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