Medical Perspectives | Cardio-Metabolic

February 24, 2020

Jian Li et. al.

Stress in the workplace is a serious problem that can contribute towards heart disease. With most adults spending around half of their waking hours at work, the workplace is an important setting to promote health and well-being.

Increasingly, attentionbeing paid to the psychosocial work environment, with a major focus on work stress.

Six steps theoretical model by Jian Li

  • Step 1: Work Stress Increases the Risk of Incident Cardiovascular Disease  in Healthy Workers
    • Job-Control-Demand model (Karasek) and Effort-Reward Imbalance model (Siegrist), revealed that there is a 10%-40% comparison between excess CVD risks for those exposed to work stress than those workers without work stress.
  • Step 2: Work Stress Determines the Process of Return to Work after CVD Onset
    • Medical factors, demographic distribution and psychiatric conditions were determinants in the process of returning to work of people who had CVD onset. Psychosocial stress in the workplace was also given a highlight together with another major risk factor of no return to work which is, high-level of work stress and low level of job satisfaction.
  • Step 3: Patients with CVD Experience Higher Work Stress after Return to Work
    • Work stress level increased after the workers with CVD returned to work. This is mostly due to reduced health-related work performance, thus limiting their capacity to cope with their previous workload prior CVD onset. Their functional impairment leads to fewer opportunities of promotion and financial progress hence a reduced autonomy.
  • Step 4: Work Stress Increases the Risk of Recurrent CVD in Workers with CVD
    • There is still lack of information to further prove that there are bigger risks of having recurrent CVD after the 1st episode in patients or workers affected.
  • Step 5: Patients with CVD Who Suffer Full and Permanent Loss of Work Ability Transit to Disability Retirement
    • Severe CVD may result in complete loss of work ability thus forcing the affected person to retirement.
  • Step 6: Disability Retirees due to CVD are at Increased Risk of CVD Mortality
    • Psychosocial stress such as loss of status, feeling of worthlessness, worsening economic burden, and social isolation are considered to play an essential role in the increase in mortality in individuals with disability retirement.


Work stress affects the individual in more than one aspect, and how it is greatly linked with CVD. Most individuals spend one-third of their lives in the workplace, wherein work stress generally yields.  A wide range of strategies to reduce stress may be done to lessen risk of CVD among workers. Modification of workload and environment may improve quality of life of the affected individuals.


1) Pearlin LI, Skaff MM. Stress and the life course: a paradigmatic alliance. Gerontologist 1996; 36: 239-247.

2) Pearlin LI, Schieman S, Fazio EM, et al. Stress, health, and the life course: some conceptual perspectives. J Health SocBehav 2005; 46: 205-219.

3) Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int J Epidemiol 2002; 31: 285-293.

4) Amick BC 3rd, McDonough P, Chang H, et al. Relationship between all-cause mortality and cumulative working life course psychosocial and physical exposures in the United States labor market from 1968 to 1992. Psychosom Med 2002; 64: 370-381.

5) Sabbath EL, Mejía-Guevara I, Noelke C, et al. The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers. Soc Sci Med 2015; 146: 111-119.

6) Wahrendorf M, Blane D, Bartley M, et al. Working conditions in mid-life and mental health in older ages. Adv Life Course Res 2013; 18: 16-25.

7) Aboderin I, Kalache A, Ben Shlomo Y, et al. Life Course Perspectives on Coronary Heart Disease, Stroke and Diabetes: Key issues and implications for policy and research. Geneva: World Health Organisation. [Online]. 2002[cited 2015 Dec. 2]; Available from: URL: 665/67174/1/WHO_NMH_NPH_02.1.pdf

8) Kuh D, Ben-Shlomo Y, Lynch J, et al. Life course epidemiology. J Epidemiol Community Health 2003; 57: 778-783.

9) Kivimäki M, Kawachi I. Work Stress as a Risk Factor for Cardiovascular Disease. CurrCardiol Rep 2015; 17: 630.

10) Karasek RA. Job demands, job decision latitude, and mental strain: implications for job redesign. Admin Sci Q 1979; 24: 285-308.

11) Siegrist J. Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996; 1: 27-41.

12) Kivimäki M, Head J, Ferrie JE, et al. Why is evidence on job strain and coronary heart disease mixed? An illustration of218 J Occup Health, Vol. 58, 2016measurement challenges in the Whitehall II study. Psychosom Med 2006; 68: 398-401.

13) Landsbergis PA, Schnall PL, Pickering TG, et al. Life-course exposure to job strain and ambulatory blood pressure in men. Am J Epidemiol 2003; 157: 998-1006.

14) Chandola T, Siegrist J, Marmot M. Do changes in effortreward imbalance at work contribute to an explanation of the social gradient in angina? Occup Environ Med 2005; 62: 223230.

15) Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. BMJ 2006; 332: 521-525.

16) Trudel X, Brisson C, Milot A, et al. Adverse psychosocial work factors, blood pressure and hypertension incidence: repeated exposure in a 5-year prospective cohort study. J Epidemiol Community Health [published online ahead of print 2015 Nov 3]. (doi: 10.1136/jech-2014-204914).

17) Mital A, Desai A, Mital A. Return to work after a coronary event. J CardiopulmRehabil 2004; 24: 365-373.

18) Vooijs M, Leensen MC, Hoving JL, et al. Disease-generic factors of work participation of workers with a chronic disease: a systematic review. Int Arch Occup Environ Health 2015; 88: 1015-1029.

19) Jelinek MV, Thompson DR, Ski C, et al. 40 years of cardiac rehabilitation and secondary prevention in post-cardiac ischaemic patients. Are we still in the wilderness? Int J Cardiol 2015; 179: 153-159.

20) Fukuoka Y, Dracup K, Takeshima M, et al. Effect of job strain and depressive symptoms upon returning to work after acute coronary syndrome. Soc Sci Med 2009; 68: 1875-1881.

21) Du CL, Cheng Y, Hwang JJ, et al. Workplace justice and psychosocial work hazards in association with return to work in male workers with coronary heart diseases: a prospective study. Int J Cardiol 2013; 166: 745-747.

22) Fiabane E, Argentero P, Calsamiglia G, et al. Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery? Int Arch Occup Environ Health 2013; 86: 561-569.

23) Worcester MU, Elliott PC, Turner A, et al. Resumption of work after acute coronary syndrome or coronary artery bypass graft surgery. Heart Lung Circ 2014; 23: 444-453.

24) Pogosova N, Saner H, Pedersen SS, et al. Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology. Eur J PrevCardiol 2015; 22: 1290-1306.

25) Varekamp I, Verbeek JH, van Dijk FJ. How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective. Int Arch Occup Environ Health 2006; 80: 87-97.

26) Detaille SI, Heerkens YF, Engels JA, et al. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies. Scand J Work Environ Health 2009; 35: 261-281.

27) de Jong M, de Boer AG, Tamminga SJ, et al. Quality of working life issues of employees with a chronic physical disease: a systematic review. J OccupRehabil 2015; 25: 182-196.

28) Li J, Dollard MF, Loerbroks A, et al. Cardiovascular disease is associated with the perception of worsening psychosocial work characteristics. Int J Cardiol 2015; 186: 149-151.

29) Yonezawa R, Masuda T, Matsunaga A, et al. Effects of phase II cardiac rehabilitation on job stress and health-related quality of life after return to work in middle-aged patients with acute myocardial infarction. Int Heart J 2009; 50: 279-290.

30) Li J, Zhang M, Loerbroks A, et al. Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis. Int J Occup Med Environ Health 2015; 28: 8-19.

31) Biering K, Andersen JH, Lund T, et al. Psychosocial working environment and risk of adverse cardiac events in patients treated for coronary heart disease. J OccupRehabil 2015; 25: 770-775.

32) Augusto TTR, Costa Sá E, Rocha LE. Cardiovascular disease as cause for disability pensions. Occup Med Health Aff 2014; 2: 186.

33) Mäntyniemi A, Oksanen T, Salo P, et al. Job strain and the risk of disability pension due to musculoskeletal disorders, depression or coronary heart disease: a prospective cohort study of 69,842 employees. Occup Environ Med 2012; 69: 574-581.

34) Juvani A, Oksanen T, Salo P, et al. Effort-reward imbalance as a risk factor for disability pension: the Finnish Public Sector Study. Scand J Work Environ Health 2014; 40: 266-277.

35) Gjesdal S, Svedberg P, Hagberg J, et al. Mortality among disability pensioners in Norway and Sweden 1990-96: comparative prospective cohort study. Scand J Public Health 2009; 37: 168-175.

36) Björkenstam C, Alexanderson K, Björkenstam E, et al. Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality ― a cohort study of 4.9 million inhabitants in Sweden. BMC Public Health 2014; 14: 1247.

37) Kortum E, Leka S, Cox T. Psychosocial risks and workrelated stress in developing countries: health impact, priorities, barriers and solutions. Int J Occup Med Environ Health 2010; 23: 225-238.

38) World Health Organization. Cardiovascular disease. Geneva: World Health Organization. [Online]. 2015[cited 2015 Dec. 2]; Available from: URL: diseases/en/

39) Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-952.

40) O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112-123. 41) Tetrick LE, Winslow CJ. Workplace stress management interventions and health promotion. Annu Rev Organ Psychol Organ

Was this article helpful? Rate us!

Suggested For You

What You Need to Know about Cardiology Updates for the Primary Care Physician

Wilmark N. Gular, M.D.

6 min read

cardio-metabolic, others

Be The first to know