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The links between exposure to work-related psychosocial risk factors and cardiovascular disease

Published by the European Agency for Safety and Health at Work (EU-OSHA), this discussion paper explores the links between psychosocial risk factors and increased risk of heart disease and stroke. It examines the direct effects that stress mechanisms can have on the cardiovascular system and how the impact work-related stress can have on unhealthy lifestyle habits can in turn impact on cardiovascular health. It also considers the contribution of a favourable work-related psychosocial work environment as a protective factor against cardiovascular disease.

It notes that, as the global burden of cardiovascular diseases (CVDs) remains large and is projected to continue to increase with population ageing, identifying modifiable risk factors is important. Raising awareness among employers about the health and cost benefits of a good psychosocial work environment and ensuring a decent work environment and level of job security by legislation may be beneficial for employee health, potentially including cardiovascular health.

The reviewed epidemiological research evidence suggests that compared to traditional risk factors, such as hypertension, high serum cholesterol, diabetes, smoking and obesity, work-related psychosocial stressors have a more modest role in cardiovascular aetiology among healthy individuals. However, work-related stressors might represent an important risk for vulnerable persons and those with pre-existing CVD. In addition, stress can result in unhealthy eating and alcohol and substance abuse.

The evidence reviewed in this paper suggests that work-related psychosocial stressors like job strain, effort-reward imbalance, long working hours, job insecurity, workplace bullying and violence at work should not be ignored. These stressors are linked to reduced wellbeing among employees and for this reason alone should be targeted.

A possible strategy for workplace CVD prevention and work-related stress reduction is a multicomponent approach with both individual-level stress management and health promotion, covering cardiovascular risk prevention (promotion of healthy lifestyle), ensuring a healthy physical work environment (prevention of prolonged static postures) and workplace-level stress prevention, including tackling psychosocial risk factors (excessive workload, poor team climate and poor leadership practices). This ‘holistic’ approach is consistent with the existing epidemiological research evidence, although interventional evidence on the effectiveness and cost-effectiveness of this approach is lacking.

EU-OSHA March 2023

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