Effort-reward imbalance at work and total cardiovascular risk in German industrial workers

Introduction
Much evidence shows that psychosocial stress at work could cause cardiovascular disease via adverse changes in cardiovascular risk factors. However, few studies focus on the total risk for an individual of developing cardiovascular disease. Our study was to examine the impact of work stress on ‘total cardiovascular risk’ in a cohort of industrial workers in Germany.

Methods
The baseline study was conducted in 2009-2010 among 2609 employees working in a big airplane manufacturing company who were free of cardiovascular disease. Work stress was measured by a validated short questionnaire of Effort-Reward Imbalance, and the total cardiovascular risk was a composite measure based on the Systematic Coronary Risk Evaluation (SCORE-Germany) assessing the risk of developing cardiovascular mortality within the next 10 years.

Results
Using multivariate logistic regression to adjust for relevant confounding factors, it was found that low reward, high effort/reward ratio, and high overcommitment were all associated with high total cardiovascular risk (ORs were 1.68 (95% CI 1.36-2.08), 1.46 (95% CI 1.18-1.82), and 1.33 (95% CI 1.06-1.67), respectively).

Discussion
Our findings indicate that work stress, in terms of Effort-Reward imbalance, is strongly associated with the total cardiovascular risk estimate in healthy workers, and the ongoing follow-up study will be helpful to confirm the causal relations.