Work-Related Stress Linked to Increased Risk of Peripheral Artery Disease

April 28, 2020
Patrick Campbell

New research from investigators in Europe is shedding light on the impact of mental stress on risk of peripheral artery disease

New research published in a special spotlight issue of the Journal of the American Heart Association, is adding new data to the discussion around the impact of work-related stress on a patient’s cardiovascular health.

The analysis, which evaluated data from 11 studies that included more than 135,000 individuals, indicates patients with work-related stress were 1.4 times as likely to have a record of peripheral artery disease (PAD), even after adjustment for age, sex, and lifestyle variables.

“Our findings suggest that work-related stress may be a risk factor for peripheral artery disease in a similar way as it is for heart disease and stroke,” said lead investigator Katriina Heikkilä, PhD, senior researcher at the Karolinska Institute, Stockholm, in a statement.

With more and more data detailing the link between mental stress and cardiovascular diseases, investigators of the current study sought to evaluate mental stress impacted PAD risk. In an effort to investigate potential associations between job strain and PAD, Heikkilä and team of colleagues conducted an analysis of 11 prospective cohort studies examining populations from Finland, Sweden, Denmark, and the United Kingdom. From these studies, investigators were able to identify a cohort that included 139,132 participants with more than 1.7 million person-years of data.

Briefly, studies included in the analysis were Copenhagen Psychosocial Questionnaire versions I and II, the Danish Work Environment Cohort Study, the Finnish Public Sector) study, the Health and Social Support study, the Helsinki Health Study, the Intervention Project on Absence and Well-Being, the Swedish Longitudinal Occupational Survey of Health, the Still Working study, Whitehall II, and Work, Lipids and Fibrinogen Stockholm. Of note, all studies were identified through the Individual-Participant Data Meta-Analysis in Working Populations (IPD-Work) Consortium.

The main exposure of the study was job strain, which was assessed through answers to baseline questionnaires from each study. Outcomes of interest in the study included PAD outcomes—identified through study records—and deaths from any cause.

In addition to age and sex, the analyses were adjusted for multiple lifestyle factors including socioeconomic position, BMI, alcohol consumption, leisure-time physical activity, baseline diabetes mellitus, and smoking status. Of note, investigators used τ2, I2, and subgroup analyses to examine heterogeneity.

Of the 139,132 patients included in the analysis, 36.4% were men, 23.4% of participants reported job strain at baseline, and 667 individuals had a hospital record of PAD during 1,718,132 person-years at risk examined in the study. The overall incidence of PAD reserved in the study was 3.88 per 10,000 person-years of follow-up.

Results of the investigators’ analysis indicated presence of job strain was associated with a 1.41-fold increase in the risk of hospitalization for PAD (95% CI, 1.11—1.80)—investigators highlighted these results were consistent in both sexes after adjustment for socioeconomic and smoking status. Additionally, investigators noted study-specific estimates were moderately heterogeneous (τ2=.0427, I2=26.9%).

Investigators also pointed out results indicated an increased risk among men, those with high socioeconomic position, and smokers, but noted subgroup analyses were limited by a relatively low number of patients.

Multiple limitations were noted in the current study. Limitations included only including PAD hospitalization data and not having data related to cholesterol levels and blood pressure available.

This study, “Job Strain as a Risk Factor for Peripheral Artery Disease: A Multi-Cohort Study,” is published in the Journal of the American Heart Association.