Work and Ischemic Heart Disease

Recent studies provide convincing evidence that work-related stress contributes significantly to the pathogenesis and onset of ischemic heart disease. Work-related stress is one of the most widely studied chronic life stresses related to ischemic heart disease. Many factors in the work environment have been studied in relation to the development of ischemic heart disease. One model proposed based on studies of tension at work is the “job strain” model, defined by Karasek as jobs with high demand but low decision latitude. Hyperresponsivity of the sympathetic nervous system is manifested by an exaggerated heart rate and blood pressure responses to work-related stress. Like other psychosocial factors, chronic work-related stress appears to have direct pathophysiological effects, including stimulation of the hemodynamic system and neurohumoral arousal. However, the data have indicated the existence of individual differences in responsivity of the sympathetic nervous system. Acute stress triggers myocardial ischemia, promotes arrhythmogenesis, and stimulates platelet function, and in the presence of underlying atherosclerosis, it causes coronary vasoconstriction. Because multiple coronary risk factors, including previously established factors such as hypertension, hypercholesterolemia, and smoking, as well as work-related stress, contribute to the development of ischemic heart disease, worker-specific targeted interventions