Stressful Jobs Linked to Repeat Heart Attacks

Recently had a heart attack? If so, getting back behind the desk at your high-stress job could be a killer.

For those who have already suffered a heart attack, too much stress at work may increase the chances of experiencing a second or third such episode, Canadian researchers found.

Men and women who survive one heart attack and return to their stressful jobs, are more than two times as likely to have a second attack, heart-disease-related death or severe chest pains.

Past research has shown that chronic stress can increase the risk of having a first heart attack, but this study, published in the current issue of the Journal of the American Medical Association, is the first to show that it can also increase the risk of a second attack.

"By showing that when they assessed job strain two years after the heart attack and found that patients with chronic elevations of job strain had higher mortality and recurrent events, they have made a strong case that job strain is a factor that affects prognosis following heart attack," says Dr. Redford Williams, head of psychiatry and behavioral sciences at Duke University.

By definition, a stressful job is one with high demands and low decision-making ability. A demanding pace at work, little authority and few opportunities to develop personal skills are all characteristics of such occupations.

Dr. Kristina Orth-Gomér of the Karolinska Institute in Sweden, writes in an accompanying editorial that "demands may be healthy as long as one can say yes or no to them. If authority over decisions, and opportunities for skills development are insufficient, chronic adaptation to a job strain situation may lead to illness."

And corporate America is the prime place for recurring heart attacks to strike.

"In the U.S., we work longer and harder than anyone," says Dr. Shukri David, chief of cardiology at Providence Hospital and medical director of the Providence Heart Institute. "We really overdo it here. The work environment should be more conducive to the American people's needs."

Taking Your Job to Heart

For two years, researchers in Quebec followed about 1,000 patients who returned to work after a heart attack. They found that chronic job strain was the major predictor of recurring heart problems.

"If you put yourself in a stressful situation, you don't exercise regularly, and you don't eat well because you don't have time," David says, "you pay little attention to the environment around you, and you don't get enough sleep."

David goes on to explain that in a high-stress situation, the heart beats faster and the "fight-or-flight" hormones, such as adrenaline, are released, which tend to decrease good cholesterol and increase bad cholesterol.

"This can cause a spasm in the artery, making a plaque rupture and triggering a heart attack," David says.

Authors of the article agree. In the study, they explain that job strain activates the sympathetic nervous system, which mediates the fight-or-flight response, causing an accentuated inflammation of the arterial wall, and the formation of a blood clot.

Researchers considered more than 20 other factors that might increase one's risk for a second heart attack. They took into account uncontrollable factors, such as sex, age and education.

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