February 15, 2011
Women, work, stress, and heart disease: 5 ways to protect yourself
Harvard researchers have uncovered strong links between women’s job stress and cardiovascular disease. Findings from the Women’s Health Study (WHS) — a landmark inquiry into disease prevention involving more than 17,000 female health professionals — show that women whose work is highly stressful have a 40% increased risk of heart disease (including heart attacks and the need for coronary artery surgery) compared with their less-stressed colleagues. The results, which were presented at an American Heart Association meeting in 2010, also showed that women who worry about losing their jobs are more likely to have high blood pressure and unhealthy cholesterol levels and to be obese. These findings are especially distressing in the current economic climate.
The researchers used a definition of “job strain” that combines psychological demand and degree of control. Demand refers to the amount, pace, and difficulty of the work. Control means the ability to make work-related decisions or be creative at work.
The WHS wasn’t the only source of bad news about work stress and heart problems in women. A large 15-year study of nurses in Denmark concluded that the greater the work pressure, the higher the risk for heart disease among women ages 51 and under. And in a study of white-collar workers in Beijing, job strain was associated in women (but not in men) with increased thickness of the carotid artery wall, an early sign of cardiovascular disease.
The body is programmed to react to life-threatening stress (“The house is on fire!”) with a “fight-or-flight” response, in which the brain triggers a cascade of chemicals and hormones that speed the heart rate, quicken breathing, increase blood pressure, and boost the amount of energy (sugar) supplied to muscles. Unfortunately, the body does a poor job of discriminating between grave, imminent dangers and less momentous ongoing sources of stress, such as financial difficulties, job strain, and even worries about potential problems that haven’t yet arisen. When the fight-or-flight response is chronically in the “on” position, the body suffers.
It’s unclear how job strain causes cardiac problems. The stress may aggravate inflammation in coronary arteries, leading to blood clots that can trigger a heart attack. Stress also makes it harder to practice heart-healthy habits, such as exercise, a good diet, not smoking, and adequate sleep. It’s hard to tell what proportion of heart attack risk is due to psychological stress as opposed to, say, smoking or lack of exercise. And some women may be predisposed (genetically or from early life experience) to react less effectively than others to stressors. We’ll learn more about these matters as research into women’s unique risks for heart disease continues.
What can you do?
The stress induced by excessive demands and too little control is not unique to the workplace. Many women have multiple concurrent jobs — for example, caring for children, aging parents, or other relatives while running a household and working outside the home — often without the resources to manage them all. Situations like this may be unavoidable, and in a tight job market, you may feel there’s little you can do to make your work life less stressful. Nevertheless, there are steps you can take, including these:
- Foster mutually supportive relationships with friends, family, and co-workers.
- Get regular exercise. It’s good for the heart, reduces anxiety and depression, and improves sleep.
- Limit intrusions (such as work-related e-mails) on your life outside of work.
- Practice relaxation techniques, such as meditation, deep breathing, progressive relaxation, or visualization.
- If you’re feeling overwhelmed, seek help from a mental health professional.
Alcohol, hypertension, and heart attacks
Q. I am a 57-year-old man with a dilemma. I understand from your articles that moderate drinking may help me avoid a heart attack like the one that killed my brother. But I’ve just been diagnosed with hypertension, and I was told that alcohol can raise my blood pressure and stress my heart. So I need to know if drinking is likely to help my heart or harm my health.
A. Your question itself holds the solution to your quandary; it’s the word moderate. In moderate amounts, alcohol does appear to reduce the risk of heart attacks, particularly in men who are middle-aged and older. And while heavy drinking will raise blood pressure and cause many other health problems, moderate drinking does not lead to hypertension. In both cases, a moderate “dose” amounts to one to two drinks a day, counting 5 ounces of wine, 12 ounces of beer, or 1½ ounces of liquor as one drink.
A Harvard study makes the point. The subjects were 5,164 male physicians who had hypertension but no other cardiovascular diseases when the study began in 1982. The scientists tracked the men over the next 26 years. During that time, moderate drinking was associated with a reduced risk of heart attacks, even in these hypertensive men. As compared with their non-drinking peers, men who averaged five to seven drinks a week experienced a 22% lower risk of heart attacks, while men who averaged over eight drinks a week enjoyed a 43% lower risk. Because so few of the men averaged two or more drinks a day, the researchers were unable to evaluate the impact of heavier drinking.
In the bad old days, some tobacco companies used doctors (or actors posing as medics) to tout their terrible wares. Now, Harvard scientists report that drinking appears to protect hypertensive doctors from heart attacks. It may sound odd, but it represents enormous progress — as long as you include the word “moderate.”
— Harvey B. Simon, M.D.
Editor, Harvard Men’s Health Watch