"It's true, hard work never killed anybody, but I figure, why take the chance?" former President Ronald Reagan quipped at the Gridiron Dinner in 1987.
Reagan may have been onto something. A new review of research, published today in the journal Lancet, shows that job strain can increase the risk of a heart attack and death.
The findings may be particularly relevant today. As the country struggles with an unemployment rate of 8.1 percent, many people are facing tremendous pressure to perform well on the job.
A team of researchers from across Europe examined a total of 13 previous studies conducted between 1986 and 2006 that looked at job strain as a risk factor for heart attack and death. In total, the researchers evaluated data from about 200,000 patients for an average of 7.5 years, more than two times the number of patients studied in a previous review.
The researchers found that people who have highly demanding jobs and little freedom to make decisions are 23 percent more likely to have a heart attack. This was true regardless of gender, age and socioeconomic status.
Additionally, if we assume that job strain causes heart attacks, the risk of having a heart attack from your job is 3.4 percent, relatively low compared to that of smoking (36 percent) and not exercising (12 percent). This study, though, cannot definitively demonstrate a cause-effect relationship.
Scientists think that the increase in job stress triggers your brain to go into a defensive "fight-or-flight" mode that can take its toll on the body, and your heart.
"The [theory] that work stress influences heart health is more than 30 years old," said lead study author Mika Kivimaki of University College London. "[But] the pooling of published and unpublished studies allowed us to investigate [this] with greater precision than has been previously possible."
Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University Medical Center, said the new research could leave many wondering what they can do in light of its findings.
"I think this is an area where changing the job situation may not be something that we have that much control over," said Williams, who was not involved with the study. "It may be in the long run that [we need] an alternative approach, rather than changing the work environment, that might focus on workers, try to train them in coping skills."
Williams said he has seen beneficial outcomes in highly stressed patients in his anger and stress management workshop LifeSkills, which provides training in coping skills and building supportive relationships.
He also stresses the importance of other psychosocial factors involved such as depression or stress at home that may play a role in risk of heart disease. Depression and anxiety are among the 10 most common diagnoses in primary care.
Moreover, many studies show that depression occurs more often in patients after a heart attack, creating a perpetual cycle of worsening severe heart disease and major depression.
Still, the American Heart Association considers stress a contributing risk factor to heart disease, but not a major risk factor. According to the AHA, healthy measures like quitting smoking, controlling cholesterol, exercising and maintaining a healthy weight are better ways of reducing your risk of coronary heart disease.
There are also major heart disease risk factors you cannot control, such as getting older, being male and your genes.
If there is one thing that is clear, it is that heart disease is a significant problem in the United States.
An American will have a coronary event about every 25 seconds, and someone will die of one about every minute, according to the updated 2012 AHA report on heart disease.
More than 16 million Americans have heart disease. It caused 1 of every 6 deaths in 2008, accounting for more than 400,000 deaths. Almost 800,000 Americans with have a new heart attack each year, and 470,000 will have a repeat attack.
Study author Kivimaki agreed that people experiencing job strain would do well to address other more significant contributors to heart disease.
"High strain is associated with an elevated risk of developing heart disease, but this excess risk is probably smaller than previously thought," Kivimaki says. "For those with job strain, adopting a healthy lifestyle seems particularly important."