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     Volume 4 Issue 16 | October 8 , 2004 |

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Stress and heart problems

Wendy Moore

Experts in medicine and stress have argued for decades over whether stress can cause problems with the heart and cardiovascular system, including strokes and raised blood pressure. The facts are still unclear but growing evidence does support a link between certain kinds of stress and problems with the heart.

Links between stress and heart problems
The Government's health white paper, Saving Lives, published in 1999, warns that people in stressful jobs - with either very high demands or little control over their work - are more likely to suffer heart disease. It cites a long-running study of civil servants, the Whitehall II study, which shows that women in high demand/low control jobs are more than 70% more likely to develop coronary heart disease than their counterparts in jobs with high levels of control. Men in low control jobs are more than 50% more likely to develop heart problems than men in high control jobs.

The British Heart Foundation believes that while the impact of stress on the heart disease is still uncertain, stress does seem to play a role in increasing risk. It points to research which shows that people under work strain, suffering depression or with an 'angry' personality, are more likely to develop heart problems. The charity warns that for people who already have heart disease, stress can bring on angina or even - very exceptionally - a heart attack.

The American Heart Association agrees. It says: 'More and more evidence suggests a relationship between the risk of cardiovascular disease and environmental and psychosocial factors.'

Heart attacks
Some studies have even found that stress can cause fatal heart attacks. One study, published in the British Medical Journal in 2000, reported that more men died of heart attacks on the day the Dutch football team was eliminated from the European football championship in 1996 than on an average day. Another study, published in the British Medical Journal in 1998, found that men working very long hours in Japan - more than 11 hours a day - are more prone to fatal heart attacks. However, it also found men working less than seven hours a day are more at risk than those working seven to nine hours a day.

A new book out this year, Stress and The Heart, brings together experts in the field to analyse all the research. This cites studies which show clear links between heart problems and certain kinds of work stress, depression, anxiety and hostility.

But not everybody is convinced. Graham MacGregor, professor in cardiovascular medicine at St George's Hospital, London, dismisses the research as flawed. He says: 'There is no evidence that stress leads to high blood pressure or to heart disease. Professor MacGregor, who chairs the Blood Pressure Association, accepts that stress may trigger a heart attack in people already suffering severe heart disease. But he does not believe research so far has conclusively proved a link between stress and developing heart problems.

Work strain and heart problems
The possibility of a link between a stressful job and heart problems was first suggested nearly 100 years ago. As heart disease became a growing problem in the west, it first increased among people in better-off social classes. This led to the idea of 'executive stress' causing heart attacks. But as heart disease began to decline in the 1970s it has fallen fastest among the better-off so that people in lower income groups are now more at risk. It is now believed that the stress involved in a job lower down the pecking order is more likely to cause heart problems.

Since the 1960s a number of studies have linked two types of work strain to increased heart disease. One group of studies has found that people in jobs with high demands and low control are more prone to heart problems. The other branch of research has found that people in jobs with high effort for little reward suffer more heart disease.

An analysis of several studies, reported in the book Stress and The Heart, has found that people in high effort/low reward jobs are between two and six times more likely to develop coronary heart disease. An overview of research on job control found links between high demands/low control and heart disease in 17 out of 25 studies. As well as the Whitehall II study of civil servants, which established the link, the phenomenon has been spotted in major studies in Germany, Sweden and Finland. The Whitehall II study found that both kinds of work stress were independently related to heart problems. People suffering both kinds of strain doubled their heart disease risk, compared to those under one type of stress, the research found.

'There is no doubt that people who occupy jobs which are repetitive, where they have little control over what they are doing, do have a higher risk of heart disease,' says Dr Eric Brunner, senior lecturer in epidemiology at University College London, who is one of the contributors to Stress and The Heart.

Source: www.heartdisease.about.com



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