Arbetsrelaterad stress kan dubbla risken för oregelbunden hjärtrytm
Efter semestern är många tillbaka på jobbet, något som inte alla mår bra av. Arbetsrelaterad stress har kopplats till en ökad risk för oregelbunden hjärtrytm.
- Nu rapporterar Hjärt-Lungfonden om en nyligen publicerad studie i Journal of the American Heart Association (JAHA) som visar att ansträngning och obalans mellan ansträngning och belöning på jobbet kan fördubbla risken för att utveckla förmaksflimmer.
- Vi vet sedan tidigare att det finns en tydlig koppling mellan arbetsmiljö och risk för hjärt-kärlsjukdom, framför allt när det gäller bristen på möjligheter att påverka sitt arbete. Den här studien bidrar med kunskap som skulle kunna leda till bättre sätt att förebygga och komma till rätta med riskfaktorer, säger Kristina Sparreljung, generalsekreterare för Hjärt-Lungfonden.
Nu lyfter Hjärt-Lungfonden forskning som nyligen publicerats i Journal of the American Heart Association som visar att arbetsrelaterad stress orsakad av hög arbetsbelastning och en obalans mellan ansträngningar och belöningar kan öka risken för att utveckla förmaksflimmer.
Forskarna undersökte arbetsstress hos cirka 6 000 personer på kontorsjobb i Kanada. Resultaten visar att de som upplever hög arbetsbelastning och där betydande ansträngningar möts med låga belöningar, såsom låg lön eller bekräftelse, kan ha en 97 procent ökad risk att utveckla oregelbunden hjärtrytm, jämfört med arbetare som inte utsätts för dessa arbetsrelaterade stressorer.
Att känna igen och hantera stressorerna på arbetsplatsen kan vara en effektiv strategi för att förebygga förmaksflimmer hos vuxna, enligt forskarna.
- Den här studien tyder på att arbetsrelaterad stress kan vara relevant att inkludera i förebyggande hälsoåtgärder. Att känna igen och hantera psykosocial stress på arbetsplatsen är viktigt för att främja hälsosamma arbetsmiljöer, säger John Pernow, ordförande för Hjärt-Lungfondens forskningsråd.
Minst 400 000 personer i Sverige lever med förmaksflimmer. Förmaksflimmer är den vanligaste formen av arytmi hos den vuxna befolkningen – en onormal hjärtrytm. Det kan leda till stroke, hjärtsvikt eller andra hjärt-kärlkomplikationer.
Fakta om forskningsstudien (Källa: Hjärt-Lungfonden)
Titel och länk: Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18‐Year Prospective Study
Forskare undersökte medicinska databaser på 5 926 vuxna (49 procent män, 51 procent kvinnor) på kontorsjobb i Kanada, med 18 års uppföljningsdata. Deras genomsnittliga ålder var 45 år i början av studien (1999-2001) och 65 år i slutet av uppföljningen (december 2018). Arbetsrelaterad stress bedömdes genom självrapporterade enkäter.
Fakta om förmaksflimmer (Källa: Hjärt-Lungfonden)
Förmaksflimmer, i dagligt tal ofta kallat hjärtflimmer, är den vanligaste hjärtrytmrubbningen hos vuxna.
Minst 400 000 personer i Sverige lever med förmaksflimmer. Men mörkertalet är stort och endast drygt två tredjedelar har fått diagnosen.
Varje år får flera tusen personer i Sverige stroke till följd av förmaksflimmer.
Om man misstänker förmaksflimmer undersöks hjärtats elektriska funktioner med hjälp av olika former av EKG.
Blodproppsförebyggande behandling den absolut viktigaste faktorn när det gäller att minska risken för förtidig död och lidande och en av hörnpelarna i vården av personer med förmaksflimmer.
Fakta om stress (Källa: Hjärt-Lungfonden)
Stress är en etablerad riskfaktor för hjärt-kärlsjukdom. Långvarig negativ stress skapar en obalans i kroppen som gör oss mer mottagliga för sjukdom. Vid stress sänder hjärnan signaler som får hjärtat att slå fortare, musklerna spänns, stresshormoner utsöndras i blodet för att frigöra nödvändig energi, smärttröskeln höjs och blodet blir mer trögflytande för att vi inte ska förblöda om vi skadas. När hotbilden är borta går kroppen tillbaka i normalläge, slappnar av och återhämtar sig.
Symtom: Tidiga signaler på att man är alltför stressad kan vara dålig sömn eller att man känner en stor trötthet som inte går att vila bort. En del blir lätt irriterade eller rastlösa och har svårt att koppla av. Olustkänslor, oro, rädsla och ångest liksom svårigheter att koncentrera sig kan också vara tecken på stress. Kroppen kan även reagera med hjärtklappning och det kan kännas svårt att andas. Vissa drabbas av orolig mage, smärtor eller förstoppning medan andra lider av andra typer av värk. Överkänslighet mot ljud, ljus eller vissa dofter kan också vara varningssignaler. På samma sätt kan utslag och eksem vara en larmklocka som signalerar att kroppen är i obalans.
Hantering: Många som lyssnar till varningssignalerna kan snabbt komma i balans igen. Ofta räcker det med en tids vila, ett miljöombyte eller en förändring av livssituationen för att återhämta sig. Oavsett symtom är det avgörande att man tar bort åtminstone några av orsakerna till att man känner sig stressad. En sund livshållning med god sömn, fysisk träning och avkoppling kan både förbygga stress och bryta skadliga mönster. Vissa kan även behöva hjälp av psykologisk eller psykiatrisk expertis. Läs mer om stress och om hur man kan hantera och förbygga stress här.
Om Hjärt-Lungfondens arbete:
Hjärt-Lungfonden samlar in pengar till vinnande hjärt-lungforskning och arbetar för ökad kunskap om forskningens betydelse, för att ge fler ett längre och friskare liv. Hjärt-Lungfonden bildades 1904 i kampen mot tuberkulos (tbc) och i dag är vår vision en värld fri från hjärt-lungsjukdom. Verksamheten är helt beroende av gåvor från privatpersoner och företag. Stöd forskningen på pg 90 91 92-7 eller swisha valfri gåva till 90 91 927. www.hjart-lungfonden.se
Från press release Hjärtlungfonden
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https://www.ahajournals.org/doi/10.1161/JAHA.123.032414
Psychosocial Stressors at Work and Atrial Fibrillation Incidence: An 18‐Year Prospective Study
Journal of the American Heart Association
https://doi.org/10.1161/JAHA.123.032414
Abstract
Background
Psychosocial stressors at work, defined by the job strain and effort–reward imbalance at work (ERI) models, were shown to increase coronary heart disease risk. No previous study has examined the adverse effect of psychosocial stressors at work from both models on atrial fibrillation (AF) incidence. The objective of this study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in a prospective cohort study.
Methods and Results
A total of 5926 white‐collar workers (3021 women and 2905 men) free of cardiovascular disease at baseline were followed for an average of 18 years. Job strain (high psychological demands combined with low decision latitude) and ERI were assessed using validated instruments. AF events were identified in medical databases with universal coverage. Hazard ratios (HRs) with 95% CIs were estimated using Cox regression models, controlling for socioeconomic characteristics and lifestyle‐related and clinical risk factors. A total of 186 AF incident events were identified over 18 years. Workers exposed to job strain (HR, 1.83 [95% CI, 1.14–2.92]) and ERI (HR, 1.44 [95% CI, 1.05–1.98]) had a higher risk of AF in fully adjusted models. Combined exposure to job strain and ERI was associated with a 2‐fold AF risk increase (HR, 1.97 [95% CI, 1.26–3.07]).
Conclusions
Psychosocial stressors at work from the job strain and ERI models are associated with an increased risk of AF, separately and in combination. Workplace prevention strategies targeting these psychosocial stressors at work may be effective to reduce the burden associated with AF.
Clinical Perspective
What Is New?
In this prospective cohort study, workers exposed to psychosocial stressors at work from the job strain and effort–reward imbalance models had an increased risk of atrial fibrillation.
What Are the Clinical Implications?
- Reducing psychosocial stressors at work may be an effective strategy to improve the prevention of atrial fibrillation.
- Clinical awareness on these work stressors and their adverse effect on cardiovascular health is needed.
trial fibrillation (AF) is the most common form of arrythmia, affecting about 1 in 4 men and women aged >40 years in their lifetime.1AF increases the risk of strokes, heart failure, and other cardiovascular complications.2Individuals with AF have higher morbidity, as measured with disability‐adjusted life years.3With the worldwide aging of the population, it is estimated that from 2010 to 2060, the number of adults aged ≥55 years with AF will more than double.4To address the increasing public health and economic burden associated with AF, primary prevention is critical.5Modifiable lifestyle‐related risk factors including alcohol intake and cigarette smoking have been identified as AF risk factors.6, 7
Psychosocial stressors at work are modifiable risk factors from the work environment that were shown to increase coronary heart disease (CHD) risk.8Two main models have been used to assess the adverse effect of psychosocial stressors at work. The demand–control model (ie, job strain) suggests that workers simultaneously experiencing high psychological demands and low decision latitude are more likely to develop stress‐related health problems.9Siegrist's effort–reward imbalance model (ERI) suggests that efforts should be rewarded in various ways: income, respect and esteem, and occupational status control. Workers are in a state of harmful imbalance when high efforts come with low reward and thus more susceptible to health problems.10Psychosocial stressors at work from the job strain and ERI models are complementary both theoretically and empirically.11Theoretically, job strain refers to the quantity and characteristics of work tasks. It acts as a threat to our need for autonomy, triggering an adverse stress response mechanism. The ERI model relies on the concept of social reciprocity, a central concept of the employment contract in which social actors expect to receive rewards in exchange for efforts invested at work.12, 13Empirically, previous studies have documented the effect of psychosocial stressors at work from both models on the risk of CHDs.8
However, few prospective studies have assessed the effect of psychosocial stressors at work on AF incidence. Available evidence suggests that psychosocial stressors at work from the job strain model is associated with an increased risk of AF.14, 15, 16There is no evidence about the effect of ERI, and the effect of combined exposure remains unknown. The aim of the present study was to examine the separate and combined effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in an 18‐year prospective study of men and women without cardiovascular disease (CVD) at entry.
DISCUSSION
The aim of the present study was to examine the effect of psychosocial stressors at work from the job strain and ERI models on AF incidence in an 18‐year prospective study. Psychosocial stressors at work from both models were associated with the AF risk, separately and in combination. Associations were robust to adjustment for sex, education, alcohol consumption, smoking, physical activity, body mass index, family history of CVD, diabetes, hypertension, and hypercholesterolemia.
In the present study, workers exposed to job strain had a higher risk of AF (HR, 1.83). Three prospective studies conducted in Sweden had previously examined this association and were summarized in a meta‐analysis (pooled HR, 1.37).14, 15, 16Methodological considerations including a lower participation at baseline (≤65%),16alternative job strain assessment based on job titles14and the use of a shorter follow‐up period16may partly explain this slightly lower risk estimate. The present study examined the adverse effect of ERI on AF for the first time. Our results showed that workers exposed to an ERI at work had a 44% AF risk increase when compared with unexposed workers. These findings suggest that psychosocial stressors at work from both models should be considered to fully capture the adverse effect of workplace stressors on AF.
In the present study, combined exposure to job strain and ERI was associated with AF risk. Our results are coherent with previous studies, suggesting a deleterious effect of combined exposure on CHD risk.37In a previous study conducted by our research team, men exposed to both psychosocial stressors at work had more than double the risk of incident CHD compared with those unexposed. A study conducted among Danish workers reported that combined exposure to job strain and ERI was associated with higher CHD risk among men (15%) and women (11%).38A previous multicohort study reported increased CHD risk ranging from 16% for either exposure to 41% for exposure to both work stressors.8In the present study, the point estimate of AF risk increase associated with combined exposure was higher than that observed for job strain or ERI considered separately. However, given overlaps in CIs, this finding should be confirmed in future studies.
Excluding AF cases occurring in the first 5 years of follow‐up yielded similar results. Indeed, estimates were slightly attenuated for job strain and combined exposure. This is consistent with results from a previous study on job strain and AF, which have reported similar associations before and after excluding any AF events occurring within the first 5 years.14However, estimates remained the same for ERI. Of the 186 AF cases observed over the follow‐up, 51 occurred before retirement. In sensitivity analyses censoring at retirement, the association between psychosocial stressors at work and AF incidence was also observed, with slightly higher point estimates. This suggests that the effect could be of higher magnitude when restricting to the period in which participants are still in the workforce. However, results must be interpreted with caution given reduced statistical power and wider CIs. Importantly, our sensitivity analyses also showed that the effect of psychosocial stressors at work on AF is not explained by the precipitating effect of other CVDs, including CHD and heart failure. Primary prevention in workplaces aiming to reduce psychosocial stressors at work may therefore contribute to prevent AF cases among workers without preexisting CVD.
The precise mechanisms by which psychosocial stressors at work increase AF risk are not well understood. However, some pathophysiological mechanisms may directly or indirectly predispose or trigger AF. Exposure to psychosocial stressors is known to activate the autonomic nervous system as well as the hypothalamic–pituitary–adrenal axis and the renin–angiotensin–aldosterone system.39, 40, 41Exposure to psychosocial stressors at work has been shown to predispose to the development of common clinical conditions associated with AF: hypertension, diabetes, and arterial stiffness.42, 43, 44Furthermore, the autonomic nervous system may play a more direct role in the initiation and maintenance of AF since surges of both sympathetic and parasympathetic activity have been associated with the onset of AF.45, 46
The present study has limitations. First, job strain and ERI were assessed only once, leading to potential misclassification of exposure over time. This misclassification would likely result in an underestimation of the true association between psychosocial stressors at work and AF risk.47, 48Second, individuals with missing data on exposure or covariates were excluded. However, a post hoc analysis showed that these excluded participants had similar AF incidence rate when compared with included participants (P=0.56). Selection bias is therefore unlikely. Third, the sensitivity of the algorithm used to identify AF events in medico‐administrative databases was 70.8%, according to a previous validation study using medical records as the gold standard.29Therefore, a proportion of AF events found in medical records could have been missed. It is reasonable to assume that this potential misclassification is nondifferential regarding the exposure, which could have led to an underestimation of the true effect. Finally, the study population was composed of white‐collar workers. Therefore, generalization may be limited to workers sharing similar occupations. A majority of workers in Canada hold white‐collar occupations,49favoring generalization to a large segment of the workforce. The adverse effect of psychosocial stressors at work on AF risk among blue‐collar workers should be examined in future studies. Previous evidence suggests that blue‐collar workers have a higher prevalence of exposure to job strain and that the adverse effect of job strain on cardiovascular outcomes is of higher magnitude in this particular population.50, 51
This study also has important strengths. This is the first study to examine the adverse effect of psychosocial stressors at work from both job strain and ERI models on AF risk, in a prospective cohort of men and women followed for 18 years. Participation was high, minimizing the possibility for selection bias. Validated instruments were used for job strain and ERI assessment. Prevalent cases of CVDs were excluded, and the potential effect of main cardiovascular risk factors was accounted for.52, 53
CONCLUSIONS
In the present study, job strain and effort reward imbalance at work were associated with an increased risk of AF incidence over 18 years. Our findings also suggest that work‐stress–related AF could manifest without preexisting CVD events. Prevention strategies targeting psychosocial stressors at work could provide benefits to reduce the public health and economic burden associated with AF. A workplace intervention aiming to reduce job strain and ERI exposures was shown to be effective to reduce BP means and hypertension prevalence among workers.54Therefore, such interventions may be effective to reduce the burden associated with AF at the population level.
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https://www.ahajournals.org/doi/10.1161/JAHA.123.032414
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