Women and Heart Disease

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Here is the latest Get Fit email from Dr. Jacobs.

Women, work, stress, and heart disease: 5 ways to protect yourself

Harvard researchers have uncovered strong links between women’s job stress and cardiovascular disease. Findings from the Women’s Health Study (WHS) — a landmark inquiry into disease prevention involving more than 17,000 female health professionals — show that women whose work is highly stressful have a 40% increased risk of heart disease (including heart attacks and the need for coronary artery surgery) compared with their less-stressed colleagues. The results, which were presented at an American Heart Association meeting in 2010, also showed that women who worry about losing their jobs are more likely to have high blood pressure and unhealthy cholesterol levels and to be obese. These findings are especially distressing in the current economic climate.

The researchers used a definition of “job strain” that combines psychological demand and degree of control. Demand refers to the amount, pace, and difficulty of the work. Control means the ability to make work-related decisions or be creative at work.

More evidence
The WHS wasn’t the only source of bad news about work stress and heart problems in women. A large 15-year study of nurses in Denmark concluded that the greater the work pressure, the higher the risk for heart disease among women ages 51 and under. And in a study of white-collar workers in Beijing, job strain was associated in women (but not in men) with increased thickness of the carotid artery wall, an early sign of cardiovascular disease.

Possible mechanisms
The body is programmed to react to life-threatening stress (“The house is on fire!”) with a “fight-or-flight” response, in which the brain triggers a cascade of chemicals and hormones that speed the heart rate, quicken breathing, increase blood pressure, and boost the amount of energy (sugar) supplied to muscles. Unfortunately, the body does a poor job of discriminating between grave, imminent dangers and less momentous ongoing sources of stress, such as financial difficulties, job strain, and even worries about potential problems that haven’t yet arisen. When the fight-or-flight response is chronically in the “on” position, the body suffers.

It’s unclear how job strain causes cardiac problems. The stress may aggravate inflammation in coronary arteries, leading to blood clots that can trigger a heart attack. Stress also makes it harder to practice heart-healthy habits, such as exercise, a good diet, not smoking, and adequate sleep. It’s hard to tell what proportion of heart attack risk is due to psychological stress as opposed to, say, smoking or lack of exercise. And some women may be predisposed (genetically or from early life experience) to react less effectively than others to stressors. We’ll learn more about these matters as research into women’s unique risks for heart disease continues.

What can you do?
The stress induced by excessive demands and too little control is not unique to the workplace. Many women have multiple concurrent jobs — for example, caring for children, aging parents, or other relatives while running a household and working outside the home — often without the resources to manage them all. Situations like this may be unavoidable, and in a tight job market, you may feel there’s little you can do to make your work life less stressful. Nevertheless, there are steps you can take, including these:
1. Foster mutually supportive relationships with friends, family, and co-workers.
2. Get regular exercise. It’s good for the heart, reduces anxiety and depression, and improves sleep.
3. Limit intrusions (such as work-related e-mails) on your life outside of work.
4. Practice relaxation techniques, such as meditation, deep breathing, progressive relaxation, or visualization.
5. If you’re feeling overwhelmed, seek help from a mental health professional.