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When Work Stress Combines With Social Stress, Women Face Higher Risk of Heart Disease

Woman stressed out at work.

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Key Takeaways

  • A decades-long study found that stress in both the workplace and social life may put older women more at risk for coronary heart disease.
  • Work and social stress, especially when prolonged, lead to high blood pressure and inflammation, which can lead to heart disease.
  • Everything from work-life balance to policy changes can help.

It's no secret that stress can exacerbate your risk of developing coronary heart disease (CHD), but according to a new study, for postmenopausal women, social and job-related stressors can work together to increase that risk.

From 1993 to 2015, researchers from Drexel University in Pennsylvania evaluated job strain, social strain, and stressful life events in almost 94,000 postmenopausal women. They found that life events (e.g. the death of a spouse, lost job) and social strain like isolation each heightened the risk of CHD, whereas job strain was not independently linked to heart disease. However, when the women experienced high job and social strain, CHD risk was highest. The study was published in late February in the Journal of the American Heart Association.

"We were able to look at not only the independent effects of different types of psychosocial stressors but also the interaction," Yvonne Michael, ScD, SM, professor of epidemiology and biostatistics at Drexel and study author, tells Verywell. "And that's important because we know that these stressors don't exist in a vacuum. They don't exist just one at a time."

Chicago-based cardiologist Melissa Tracy, MD, who published a commentary on the study along with Annabelle Santos Volgman, MD, FACC, FAHA, tells Verywell that the study speaks volumes now more than ever before, with events like the pandemic worsening stress for some.

"The pandemic, the social isolation, and the political climate have just added so much more stress to all of us," Tracy says. But she's noticed that her female patients, in particular, often prioritize taking care of others before themselves, which can add more stress. "So I'm trying to get patients to put themselves up here because they are not elevated themselves. They can't help all those other people that they so beautifully want to help."

What This Means For You

In order to lower your risk of developing CHD, reducing stress in your life may be a good idea. Developing positive social relationships, meditating, and setting boundaries with work can all be good places to start.

Combined Stressors Increase Risk

Researchers followed postmenopausal women aged between 50 and 79, each one for an average of 14.7 years, from 40 geographically diverse clinical centers throughout the U.S.

The majority of respondents were White (85.4%) and continued their education past high school (79.8%). This skew in demographics, Tracy and Volgman wrote, as well as the time period, which is very different from today, should be considered, with future studies reflecting more diverse and modern samples.

For the study, job-related experiences were divided into four categories:

  • Active work (high demand and high control)
  • High strain (high demand and low control)
  • Low strain (low demand and high control)
  • Passive work (low demand and low control)

Social strain was evaluated by asking respondents about the number of people who get on their nerves, ask too much of them, exclude them, or try to coerce them. And life events were separated into 11 categories like the death of a spouse, major problems with finances, and serious illness. Women were asked to indicate the extent to which the event upset them.

At the close of the study, women with the following were most likely to develop CHD:

  • High stressful life events score (12% increased risk)
  • High social strain (9% increased risk)
  • High social strain and passive job strain (21% increased risk)

Although the combination of social and job strain produced the greatest risk, there was no significant association found between job strain alone and CHD.

Researchers also considered other demographic factors, finding that in general, women with lower educational attainment and family income were also most likely to develop CHD. Other predictive factors included smoking, hypertension, Type 2 diabetes (also known as diabetes mellitus), and high cholesterol.

How Can Social and Job Stress Heighten Risk?

"The prolonged effects of stress are directly related to endothelial damage," the study authors wrote, referring to the tissue which forms the cells that line the blood vessels and heart.

When people experience stressful situations, especially without respite, over time, it can lead to increased blood pressure and inflammation, which is known to cause that endothelial damage, accelerating processes such as clogged arteries. The authors add that stress can interfere with a person's ability to function in daily life, "leading to difficulties in learning new things and being active in social relationships."

However, healthy and rewarding social relationships can work as protective factors to stress, and may make women "more confident in their ability to control their environment, which may help them reduce the perception of threats and act as an important resource in handling adverse situations," such as at work, "and therefore relieve the potential negative health impact of stress."

If this potential protective factor of personal relationships isn't there, however, other life stresses can compound. "Social connections are very important, but we also know that sometimes, those relationships may also be a burden," Michael says. "So relationships have both the positive as well as the potential negative effect." This may explain why women who experience both job and social strain are the most likely to develop CHD.

How to Lower Your Risk

Experts say changes in the workplace and in your personal life can all help decrease your risk of developing CHD.

Learning From the Pandemic

Michael suggests we can use the pandemic to witness how social and job strain interact.

"The pandemic has really illustrated in a very clear way the dual role that many women play where they're both working as well as taking primary caregiving roles with the loved ones in their life," she says. "Those barriers that used to exist between your work life and your home life—the absence of them have created their own difficulties in terms of managing it all."

If the pandemic is a microcosm for these risk factors, then, Michael says we can use the moment to inspire changes in the workplace. That could include making spaces available for exercise, meditation, and yoga, for example, "providing more control to employees about how they manage their work and their time," she says.

At the same time, yoga rooms alone aren't going to cut it. Policies allowing for paid leave or affordable childcare, for example, are of utmost importance, too. "Looking at policy, I think, is really important because we don't want to put the burden back on women," Michael adds. "Companies can say, 'Take care of yourself in your busy day to go exercise.' Where is that going to happen? That just creates additional strain, or says, 'This is your fault because you're not eating healthy.'"

Tracy and Volgman, in their work with patients during the past year, also have a few recommendations. "What the pandemic has shown us is that we can do things in a different way," Tracy says, hoping that employers see the benefits to flexibility in hours, working from home, and reduced commuting time, for example. "What I hope we learn from this is that there are ways in which we can all adjust our work-life balance to complete our work, but in a fashion that doesn't take away from the balance of life. Life is so much more than going to work."

Prioritizing Care

Volgman, who is a professor of medicine and senior attending physician at Rush Medical College and Rush University Medical Center, tells Verywell that after patients have a heart attack, they are expected to go to cardiac rehab in the hospital to aid recovery. "A lot of women don't want to go because they don't want to take the time. They're too busy taking care of other people," she says. "We just have to redirect their perspective and make sure that they're well enough."

She adds that women are under-referred by their doctors to seek out heart health and prevention services, which makes a study like the current one all the more important. One change you can instantly make, she says, is incorporating meditation for 20 to 40 minutes in your day, or even just practicing deep breathing when you can.

While meditation might not seem accessible to everybody, Volgman says, it's life-changing for so many of her patients, and helps them develop a sense of calm that wasn't there before. "Twenty minutes of meditation equals two hours of sleep," she says. "I just talked to one of my patients, who I referred [to transcendental mediation], and she says 'I'm a totally different person.'"

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Wang C, Lê‐Scherban F, Taylor J, et al. Associations of job strain, stressful life events, and social strain with coronary heart disease in the women’s health initiative observational studyJ Am Heart Assoc. 2021 Feb;10(5):e017780

  2. Tracy M, Volgman AS. Pearls and purple: The dawn of a modern age. J Am Heart Assoc. 2021 Feb;10(5), e020903. doi:10.1161/JAHA.121.020903