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Women with high job strain have 40 percent increased risk of heart disease

FROM THE AMERICAN HEART ASSOCIATION:

Women with high job strain have 40 percent increased risk of heart disease

Women who report having high job strain have a 40 percent increased risk of cardiovascular disease, including heart attacks and the need for procedures to open blocked arteries, compared to those with low job strain, according to research presented at the American Heart Association’s Scientific Sessions 2010.

In addition, job insecurity – fear of losing one’s job – was associated with risk factors for cardiovascular disease such as high blood pressure, increased cholesterol and excess body weight. However, it’snot directly associated with heart attacks, stroke, invasive heart procedures or cardiovascular death, researchers said.

Job strain, a form of psychological stress, is defined as having a demanding job, but little to no decision-making authority or opportunities to use one’s creative or individual skills.

“Our study indicates that there are both immediate and long-term clinically documented cardiovascular health effects of job strain in women,” said Michelle A. Albert, M.D., M.P.H., the study’s senior author and associate physician at Brigham and Women’s Hospital, Boston, Mass.

“Your job can positively and negatively affect health, making it important to pay attention to the stresses of your job as part of your total health package.”

Researchers analyzed job strain in 17,415 healthy women who participated in the landmark Women’s Health Study. The women were primarily Caucasian health professionals, average age 57 who provided information about heart disease risk factors, job strain and job insecurity. They were followed for more than 10 years to track the development of cardiovascular disease. Researchers used a standard questionnaire to evaluate job strain and job insecurity with statements such as: “My job requires working very fast.” “My job requires working very hard.” “I am free from competing demands that others make.”

The 40 percent higher risks for women who reported high job strain included heart attacks, ischemic strokes, coronary artery bypass surgery or balloon angioplasty and death. The increased risk of heart attack was about 88 percent, while the risk of bypass surgery or invasive procedure was about 43 percent.

“Women in jobs characterized by high demands and low control, as well as jobs with high demands but a high sense of control are at higher risk for heart disease long term,” said Natalie Slopen, Sc.D., lead researcher and a postdoctoral research fellow at Harvard University Center on the Developing Child in Boston.

Previous research on the effects of job strain has focused on men and had a more restricted set of cardiovascular conditions. “From a public health perspective, it’s crucial for employers, potential patients, as well as government and hospitals entities to monitor perceived employee job strain and initiate programs to alleviate job strain and perhaps positively impact prevention of heart disease,” Albert said.

Co-authors are Robert G. Glynn, Ph.D., and Julie Buring, Sc.D. Author disclosures are on the abstract.

The National Institutes of Health funded the Women’s Health Study.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

* Stay up to date on the latest news from American Heart Association scientific meetings, including Scientific Sessions 2010, by following us at www.twitter.com/heartnews. We will be tweeting from the conference using #AHA10News.

Death of spouse, child may cause higher heart rate, other dangers

The death of a spouse or child can cause elevated heart rate and other potentially harmful heart rhythm changes among the recently bereaved, according to research presented at the American Heart Association’s Scientific Sessions 2010.

These changes in how the heart functions – which could increase the risk of heart attack and sudden cardiac death – tend to revert back to normal ranges within six months, researchers said.

“While the focus at the time of bereavement is naturally directed toward the deceased person, the health and welfare of bereaved survivors should also be of concern to medical professionals, as well as family and friends,” said Thomas Buckley, Ph.D., the study’s lead researcher, acting director of postgraduate studies at the University of Sydney Nursing School in Sydney, Australia.

“Some bereaved, especially those already at increased cardiovascular risk, might benefit from medical review, and they should seek medical assistance for any possible cardiac symptoms.”

Although heart attacks and sudden cardiac death have been shown in some studies to be more common among recently bereaved people, researchers have not been able to explain the cause for this phenomenon, or why the risk appears to dissipate with time.

Researchers studied 78 bereaved spouses and parents within two weeks of the death of a spouse or child and after six months. They then compared them to a group of volunteers who had not lost a loved one. The bereaved participants consisted of 55 women and 23 men who were between 33 and 91 years old.

Using 24-hour heart monitors and other tests, the researchers documented increases in heart rate (the number of times a heart beats per minute), reduced heart rate variability (a measure of the heart’s rhythmic regularity) and increases in clinical depression and anxiety.

“Increased heart rate and reduced heart rate variability in the early months of bereavement are possible mechanisms of increased cardiovascular risk during this often very stressful period,” he said.

Among the researchers’ findings:

* Bereaved patients had almost twice the number of episodes of rapid heartbeats, or supraventricular tachycardia (SVT), than non-bereaved participants in the first weeks after their loved one’s death (2.23 vs. 1.23 episodes of SVT). However, after six months their numbers were lower than in the control group (0.58 vs. 0.66).

* The average heart rate for bereaved participants was 75.1 beats per minute (bpm) compared to 70.7 bpm in the non-bereaved in the early stages. But the rate for bereaved participants fell to 70.7 bpm after six months. Average minimum heart rates were 50.1 bpm initially for bereaved spouses and parents vs. 48.0 bpm in the others, and fell to 48.8 bpm after six months, almost identical to the non-bereaved volunteers.

* The average depression score in the bereaved was 26.3 compared to just 6.1 in the control group, using the Centre for Epidemiological Studies – Depression and Spielberger State Anxiety scales. This difference declined after six months, yet remained almost three times higher than among the controls.

* The average anxiety score was 46.7 in the bereaved and 28.8 in the control group. After six months, the rate increased to 29.1 in volunteers who had not experienced a loss and dropped to 37.2 among the bereaved participants.

“While our findings do not establish causality, they are consistent with evidence for psychosocial triggering of cardiovascular events,” Buckley said. “They suggest the need for further investigation of the link between bereavement and cardiovascular risk, including the potential for preventive measures.”

In the study, the bereaved had lost family members who were being treated in critical care areas of hospitals; so these results can’t necessarily be generalized to the broader community, because deaths that occur in hospices or at home may elicit a different response to grief. Furthermore, there weren’t enough bereaved parents in the study to assess their risk separately.

Co-authors are: Roger Bartrop, M.D.; Sharon McKinley, Ph.D.; Christopher Ward, Ph.D.; Anastasia Susie Mihailidou, Ph.D.; Marie-Christine Morel-Kopp, Ph.D.; Monica Spinaze, Dip. N.; and Geoffrey Tofler, M.D. Author disclosures are on the abstract.
The National Heart Foundation of Australia and the North Shore Heart Research Foundation in Sydney, Australia funded the study.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at http://www.heart.org/corporatefunding.

Less salt in teenagers’ diet may improve heart health in adulthood

Eating smaller amounts of salt each day as a teenager could reduce high blood pressure, heart disease and stroke in adulthood, according to research presented at the American Heart Association’s Scientific Sessions 2010.

Conducting a sophisticated computer modeling analysis, researchers projected the nationwide health effects of a 3-gram reduction in dietary salt from processed foods consumed by adolescent boys and girls.

Teenagers eat more salt each day – more than 9 grams (3,800 milligrams of sodium) – than any other age group, researchers said. The American Heart Association recommends no more than 1,500 milligrams of sodium per day for most Americans.

By reducing the salt teenagers eat each day by 3 grams, researchers projected through modeling a 44 percent to 63 percent (380,000 to 550,000) decrease in the number of hypertensive teenagers and young adults. They estimated a 30 percent to 43 percent decrease (2.7 to 3.9 million) in the number of hypertensives at ages 35 to 50.

“Reducing the amount of salt that is already added to the food that we eat could mean that teenagers live many more years free of hypertension,” said Kirsten Bibbins-Domingo, Ph.D., M.D., lead author of the study and associate professor of medicine and epidemiology at the University of California, San Francisco.

“The additional benefit of lowering salt consumption early is that we can hopefully change the expectations of how food should taste, ideally to something slightly less salty.”

A one-gram-per-day reduction in salt consumption results in a small drop of systolic blood pressure of 0.8 mm Hg, she said. “Reducing the salt in the teenage diet from an average of 9 grams to 6 grams would get teenage boys and girls to appropriate levels of salt intake.”
Measurable health benefits over time as teenagers reach age 50 would include:

* 7 percent to 12 percent reduction in coronary heart disease (120,000 to 210,000)
* 8 percent to14 percent reduction in heart attacks (36,000 to 64,000)
* 5 percent to 8 percent reduction in stroke (16,000 to 28,000)
* 5 percent to 9 percent reduction in death from any cause (69,000 to 120,000)

About 80 percent of salt comes from processed or prepared foods – 35 percent of that in cereals, breads and pastries.

“The hidden places of salt in our diet are in breads and cereals, canned foods and condiments, and of course fast foods,” said Bibbins-Domingo, also co-director of the UCSF Center for Vulnerable Populations. “Most of the salt that we eat is not from our salt shaker, but salt that is already added in food that we eat.”

Pizza is the biggest culprit of salt for teens according to data from the National Center for Health Statistics.

Manufacturers should continue to reduce salt in their foods in cooperation with local, state, and federal regulatory agencies, she said. Many major companies have already joined the National Sodium Reduction initiative and have voluntarily agreed to work to lower the salt content that is already added to processed and prepared foods.

Co-authors are: Pamela Coxson, Ph.D.; Tekeshe Mekonnen, M.S.; David Guzman, M.S.; and Lee Goldman, M.D., M.P.H. Author disclosures are on the abstract.
The American Heart Association funded the study.

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