How working – and not working – affects heart disease risk

by Carolyn Thomas  ♥  @HeartSisters

I find myself in an uneasy position since I survived a heart attack. After a rewarding 35+ year high-profile career in the public relations field, I am no longer able to go to work because of ongoing debilitating symptoms of coronary microvascular disease.

I was in deep denial about this turn of events in the early months, desperate to return to the work I loved and to those I loved working with.

I felt even crazily hopeful that I might be somehow able to feel “normal” again if only I could just get back to my office. 

So after three months, I tried a return-to-work trial, half days only to start. But it very quickly became apparent to me (and, unfortunately, to my colleagues) that I was just no longer able to function while juggling multiple deadlines, all due yesterday – the normal hair-on-fire pace in the world of non-profit PR.

My doctor ordered me off work on extended medical leave.

Ironically, I later learned that having a job may be better for our health than not working. 

So report the authors of a study published in the Journal of Health and Social Behavior. Their study found:

“Employed people are generally better off, and being employed is both important and positive for most people, while those out of the workforce, the unemployed, and disability retirees have poorer health”.

Oh, great. . .

So not only are those of us no longer able to work for health reasons feeling really bad because of what’s making it impossible for us to work in the first place, but now we feel even worse because not working may be bad for our health.

Of course, it’s not all a happy, healthy bed of roses out there in the workplace, either. We know that certain working conditions can actually hurt our health.

We’ve been told for decades, for example, that high job strain (the demoralizing combination of high job stress but limited decision-making ability at work) can be a  source of depression, exhaustion, job dissatisfaction and even increased rates of heart disease.

But in 2004, Johns Hopkins research(1) using data from the Framingham Offspring Study failed to support the widely held notion that high job strain was a significant risk factor for the development of either coronary heart disease or total mortality over a 10-year period in either men or women.

And, even more surprising, women in this study were almost three times more likely to develop coronary heart disease when their workplace environment included both high job demands and high decision-making latitude. 

In other words, women whose stressful careers provided higher levels of decision authority or skill discretion are at far greater risk for having a cardiac event than those women experiencing high stress and low-decision-making latitude. This was true even after adjustment for the standard risk factors associated with coronary heart disease.

Harvard research(2) published this month studied over 22,000 female health care workers about the pace, amount of work, demands, required skills, control over decision-making, and job security.  Researchers found that 70% of the relationship between job strain and cardiovascular events “cannot be explained by traditional risk factors for cardiovascular disease or anxiety/depression.”

They also found that job-related stressors are known to be associated with heart disease risk, but most prior studies have been conducted in men.  Information about the cardiovascular effects of job-related stressors in women is important, researchers noted, given the dramatic increase in female participation in the work force over the past decades, and the fact that psychosocial stressors affect women and men differently.

Researchers  recommend that to help cope with stress, women should ensure they get plenty of exercise, carve out time for relaxation activities, and not allow jobs to interfere with private time.

“Because we live in the electronic age, we also spend a lot of time on our electronic devices ‘off the clock,’ and we should try to avoid this. A social support network is very important, too.”

In an interesting study published in Occupational and Environmental Medicine, female nurses who felt they were under “too much pressure” at work also had a significantly increased risk of developing angina or having a heart attack, once again independent of traditional coronary risk factors – particularly among nurses younger than age 51 years.

Most nurses also have to contend with something that many of the rest of us don’t: shift work. This in itself is linked to increased cardiac risk factors.

When I attended the Canadian Cardiovascular Congress in Vancouver last fall, I interviewed Queen’s University researcher Dr. Joan Tranmer – a former nurse herself with 15 years of experience working rotating shifts. Dr. Tranmer’s research has looked at not only nurses, but a variety of female hospital staff (mean age 46) who have to work shift rotations (admin, lab, technologists). She told her conference audience:

“Women hospital staff working night shifts may be compromising their own health as they try to improve the health of patients.

“We found that women who had both a long history of working shifts and were still doing shifts today were most at risk for developing  cardiovascular disease.

Her research results show that one in five women who do shift work have at least three of the five known risk indicators for heart disease (abdominal obesity or the so-called “apple-shaped” torso; high blood pressure; elevated blood glucose or pre-diabetes; elevated triglycerides  – a kind of blood fat tracked along with cholesterol; and low levels of HDL or “good” cholesterol).

A Finnish study published in the European Heart Journal in May 2010 suggested that people who worked three or more hours of overtime per day had a significantly increased risk of coronary death, non-fatal heart attacks, and angina.  After adjusting for sociodemographic factors, the study authors found that working three to four hours of overtime per day was associated with a 60% higher rate of coronary heart events, compared with working a standard seven-hour day.

Why the apparent link between increased cardiac risk factors and both working overtime hours and night shifts? One theory is the association in both to Type A behaviour traits (competitive, tense, time-conscious) or to factors such as anxiety, depression, lack of time for healthy eating/physical activity and doctor visits, lack of sleep, or high-blood pressure associated with work stress.

The Japanese even have a word for this condition: “karoshi” means death from overwork.

NOTE FROM CAROLYN: I wrote more about working when you’re a heart patient in my book ,A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press).

Q: How has working – or not working – affected your health?

See also:

Thoughts on Returning to Work if You’re a Heart Patient

Why Female Shift Workers May Be At Risk for Heart Disease

How Runaway Stress Hurts your Heart – and Your Brain

“Stress Creep”: Are you Like the Frog in the Pot of Boiling Water?

The New Country Called Heart Disease


1.  “Does Job Strain Increase the Risk for Coronary Heart Disease or Death in Men and Women?” American Journal of Epidemiology. 2004 Johns Hopkins Bloomberg School of Public Health Vol. 159, No. 10
2. “Job strain, job insecurity, and incident cardiovascular disease in the Women’s Health Study: Results from a 10-year prospective study”. Glopen N et al.  PLoS One 2012.


6 thoughts on “How working – and not working – affects heart disease risk

  1. Hello Carolyn – once again you have produced another gem. (How do you do it?) Very thought-provoking. The secret as Dr. Stohrer says here is to somehow learn how to balance the stress of a busy job with our health requirements. It ain’t easy!

    Liked by 1 person

    1. If it were easy, we’d all be doing it. I’ve been learning that “NO” is a complete sentence and so I try to use it lavishly when deciding if I should do things that I don’t really want to do/could be done by others. It works amazingly well.


  2. So you have hit on the crux of the puzzle within the conundrum – I am strong and capable and talented and reliable and . . .


    I am now not strong, not reliable, not working . . .have I helped myself? Well there are those who say I’d be dead had I not stopped working; on the other hand, what is THIS life of pills, angina, and incapable ness???

    A question for the existentialists among us


    Liked by 1 person

    1. JetGirl, you are exactly describing my own scenario, too. I now divide my life into ‘BHA’ (before heart attack) and ‘AHA’. Like two separate people in terms of competence and physical ability (and energy). It’s hard to get one’s brain wrapped around this profound transformation some days; I have tried to learn to enjoy the new s-l-o-w-e-r – p-a-c-e these days compared to my old crazy-nutso worklife before, but some days I’m better at it than others.


  3. I am certain that my work as an OB-GYN, which includes high stress, irregular hours and interrupted sleep, has contributed to my coronary artery disease. The question, of course, is how to limit these issues and create an environment of health for myself. Ideas?

    Liked by 1 person

    1. I hear ya, Dr. S! Common issue among busy overachievers who somehow believe the world will stop spinning on its axis if we slow down to a semi-normal pace.

      In the year leading up to my heart attack, for example, I went into work every Sunday to work on writing/launching a complex new website and other major projects. EVERY SUNDAY, a full (unpaid) day at the office. I even stopped thinking that working on Sundays was not a good thing. In fact, I rationalized the practice by telling myself and others: “I get SO much more work done on Sundays, with no meetings or interruptions to slow me down!” It’s that normalization of truly crazy-nuts behaviour we have to stop and question.

      And how much of what we believe we MUST do really must get done (and MUST be done by us) – often by willingly sacrificing healthy eating/exercise/lifestyle habits because we’re just so exhausted by running around with our hair on fire?


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