Job Stress Is Factor in Heart Disease, Experts Say

“This job’s going to be the death of me yet.”

Maybe you’ve heard those words coming from your own lips during some crisis at your place of employment. The fact is, most of us who work for a living probably voice similar sentiments at times. Often we say it jokingly, but for many American wage-earners, this oft-repeated statement may be dangerously close to the truth.

While work-related stress is as old as civilization itself, the highly structured, highly technical, increasingly complex and often depersonalized workplace of the 1980s may be an especially stressful environment for many who deal with it every day. Now a growing body of medical evidence suggests that some jobs exact a potentially deadly toll.

Contributing Factor

The American Heart Assn. classifies stress as a contributing factor in the development of heart disease. While its impact isn’t as significant as that of smoking, high blood pressure and high blood cholesterol, stress shouldn’t be ignored.

There is still much to be learned about job stress and its effects on the cardiovascular system, but a number of recent independent studies have turned up some surprising findings.

* In their day-to-day jobs, police officers and firefighters face one crisis after another, as well as the ever-present threat of physical injury and even violent death. Consequently, it has often been assumed that police officers and firefighters are at greater risk of heart attack than almost any other type of worker. And yet two studies at the Veterans Administration Outpatient Clinic in Boston show that officers and firefighters actually have no greater incidence of coronary heart disease than the general public.

* Bus drivers, on the other hand, are not so fortunate. Dr. S. Leonard Syme, an epidemiologist at UC Berkeley, along with David Ragland Ph.D., and Marilyn Winkelby Ph.D., studied 1,500 bus drivers in San Francisco. The researchers found that, compared to other groups of the same age, race and socioeconomic level, the bus drivers were 50% more likely to suffer from high blood pressure. They also discovered that newly hired bus drivers with normal blood pressure were likely to develop high blood pressure within 3 to 5 years. Similar studies of transit drivers in widely separated areas of the world confirmed the group’s findings.

* People with highly monitored indoor jobs may also face an increased incidence of heart problems. A study conducted at the University of North Carolina by investigator Suzanne G. Haynes (Haynes is now at the National Cancer Institute in Bethesda, Md.), revealed that women telephone company workers using video display terminals reported a surprisingly high incidence of anginal chest pain, a symptom of coronary heart disease. Among VDT users, 15.2% reported angina, compared with 7.7% of the non-users.

Strict Rules Cited

The highest rates of chest pain were found in women who, like the bus drivers, had jobs with high demand and low control. Their jobs involved dealing with complaint calls from telephone company customers and answering directory assistance calls. And the workers had strict rules about how to handle the calls. They were constantly monitored and were penalized if they didn’t stick to the rules.

* The hearts of women workers in general, however, seem less affected by job-related stress than those of their male co-workers. In the Framingham, Mass., Heart Study, Haynes found that women in the labor force have no greater incidence of heart disease than housewives, and that employed women still enjoy a significant survival advantage over employed men. In fact, women employed for the longest period of time seemed to have the lowest incidence of heart disease.

* Two other unrelated studies yielded apparently conflicting results. Harvard Medical School researchers found that white-collar workers may be 30% less likely to die of a heart attack than blue-collar workers. But another report showed that administrative employees with management responsibilities are more likely to be disabled by heart disease than either blue-collar workers or such other professionals as lawyers, educators and entertainers. This research was done at the National Institute for Occupational Safety and Health in Cincinnati.

Stress as a risk factor is such a complicated issue that no one study can be expected to give us the answer. However, various studies are closing in on the problem of stress. Most authorities would agree that you are better off if you feel you have a “say” in how your job is carried out.

The level of job stress is frequently higher for people in positions with high psychological strain and low control, says Dr. Peter Schnall of Cornell University Medical College. Schnall heads a team of researchers who screened 2,556 male workers in New York City, then picked 191 of the most “job-strained”--all of whom had elevated blood pressures--to study closely.

List of Occupations

Assembly-line workers, service workers, short-order cooks, waiters, clerical workers and teachers are among the occupational groups in which job strain is frequently found, Schnall says. All fit the high demand-low control pattern that produces stress and high blood pressure.

On the other hand, people may be able to perform highly demanding--even dangerous--jobs with no apparent ill effects. This may explain why officers, firefighters and such high-tension specialists as air traffic controllers have no higher incidence of cardiovascular problems than the average American.

“Professional jobs that are high in demand but also high in control don’t produce the same kind of strain that many workers in high demand-low control jobs encounter,” Schnall says. “Our research suggests that (certain) jobs are stressful regardless of the personality of the individual who is in it.”

“As a worker, you need to have a way of participating in what you’re doing and have some discretion in dealing with the demands of your job,” says Syme, whose study of San Francisco bus drivers revealed that many drivers feel trapped and hopeless.

The drivers are forced to work under the demands of a time schedule that is often impossible to meet, Syme explains. Yet many drivers attempt to stay on schedule by forfeiting lunch hours and rest breaks, knowing that supervisors will take note when drivers are late. Since most drivers have few other work skills and earn high salaries that would be hard to duplicate somewhere else, they try to protect their jobs at all costs.

‘Stopping the Pain’

“Expecting a worker to adjust to circumstances like these is asking a lot,” Syme says. “Sometimes it’s the system itself and the working environment it produces that needs to be changed. The Japanese system of worker input in the auto industry has proved its beneficial impact to the point that American companies are now beginning to adopt it. It’s a case of stopping the pain at the source rather than just trying to help people adjust to the pain.”

Responsibility over fellow workers also appears to heighten the risk of job-related stress and resulting heart problems, according to Robert Brackbill, Ph.D., an epidemiologist at the NIOSH.

Brackbill and other scientists studied 446,000 persons approved for Social Security disability payments from 1969 to 1976 and concluded that managers as an occupational group have the highest odds of being disabled by heart disease.

“We found the common element to be some type of supervisory function and management responsibilities, whether the person is a factory foreman, a store manager or an office administrator,” Brackbill notes. It may be no coincidence that this managerial class of employees includes many of the aggressive, hard-driving executives who typify so-called “Type A” behavior and who may be prime candidates for developing heart disease.

In a 2-year experiment with monkeys, Jay Kaplan, Ph.D., and his colleagues at Bowman Gray School of Medicine in Winston-Salem, N.C., found that social turmoil produced a higher level of atherosclerosis, one type of “hardening of the arteries,” in aggressive, dominant animals than in more submissive ones.

Groups of Five

Monkeys normally live in groups of five, Kaplan says, with one monkey dominant in each group. The others form a “pecking order” based on strength and aggressiveness, with the weakest, least assertive monkey at the bottom. In the experiment, the groups were realigned monthly, and dominant monkeys were repeatedly thrown into conflict with other dominant monkeys.

“Human behavior is certainly much more complex than that of monkeys,” Kaplan says, “but I think there’s an analogy between an aggressive monkey in a new social group and the type of aggressive mid-level executive who jumps from job to job in quest of more money, recognition and other rewards. Our conclusion is that there’s potential for personality to interact with job situations in a way that could be dangerous. Job stress is only half the equation. The other half is the person’s reaction to it.”

Few of us can afford to give up the jobs we have, of course--no matter how stressful they may be. But we can adopt certain defenses against job strain and the health problems it can cause. Some of these include:

* Valuing and enjoying one’s work, and giving job satisfaction equal priority with such factors as salary and position.

* Refusing to be ruled by unrealistic deadlines and demands.

* Taking adequate time off for rest and relaxation.

* Avoiding confrontational, competitive situations whenever possible.

* Staying on amiable terms with fellow employees, regardless of whether they are superiors or subordinates.

“We need to raise the consciousness of everybody, across the board, about the problem of job stress,” Syme concludes. “One way to start reducing stress is to try to help the people who work with you. Another is to work with supervisors to encourage worker input and advice about work conditions.”