Pressure of work and overtime shortens life

‘Term, holidays, term, holidays, till we leave school,

and then work, work, work, till we die.’

CS Lewis

The political plan is for men and women to work

longer and retire later. This will reduce pension costs

in the short term but will it also reduce long term

costs by precipitating earlier mortality, or is that just

the musing of a cynic? In the 27 member states of

the European Union, it is predicted that between

2010 and 2060 there will be a reduction of 24 million

men aged 64 years or less and an increase of 32

million men aged 65 or over, with 65 being the

widely accepted age at retirement(1). The size of the

problem and challenge is therefore self evident – the

fundamental question relates to whether this form of

reducing cost (lengthening working life) impairs

health.

Work stress has been linked to coronary heart

disease in a working-age population of British Civil

Servants and particularly those under 50 years of age

(2). Work stress was associated with reduced physical

activity, poor diet, the metabolic syndrome and

lower heart rate variability. Interestingly, after an

average of 12 years follow up the older, and therefore

more likely to be retired, were less susceptible to the

work induced psychosocial effect. This suggests that

early retirement might be good for health and

although the data are conflicting, fatigue and

depressive symptoms do improve but major chronic

diseases are not affected(3).

Stress was one of the nine major risk factors pre-

dicting acute coronary events in the INTERHEART

study with stress at work and at home (general

stress) being significantly associated(4). In a prospec-

tive cohort study of 812 healthy industrial employees

(545 men, 267 women), those with high job strain

after adjustment for age and gender had a 2.2-fold

cardiovascular mortality risk compared to colleagues

with low job strain (mean follow up 25.6 years)(5).

Job strain relates to a combination of high work

demands and low job control, whereas effort–reward

imbalance (low salary, low security, few career

opportunities) increased the cardiovascular risk 2.4-

fold. Both predicted increased cholesterol levels and

body mass index. It is also possible that working

long hours (over 11 a day regularly) may increase

risk of cardiovascular disease (6). This in turn rein-

forces the finding that consistently working overtime

(3–4 hours a day) significantly adversely influences

fatal and non-fatal coronary heart disease with an

increasing adverse effect as the overtime hours

increased(7).

Before we can independently attribute work stress

to coronary heart disease, associated well-recognised

risk factors need to be taken into account. However,

there is an increasing body of evidence that work

stress is associated with conventional risk factors

(hypertension, raised cholesterol) and cardiac events,

and as stress is an individualised perception it should

always be queried and taken into account in any

patient interview.

So we will in general all be working longer, but

the working world will need to take into account the

negative impact of work stress, overtime and long

working hours. The need to plan ahead and avoid a

pension crisis is imperative but quality of life should

not be sacrificed as a consequence. After all, nobody

on his or her deathbed wished they had spent more

time at the office.

Disclosure

None.

Graham JacksonEditor

Email: gjcardiol@talk21.com

EDITORIAL

ª 2011 Blackwell Publishing Ltd Int J Clin Pract, October 2011, 65, 10, 1019 1019

Consistently

working

overtime

adversely

influences fatal

and non-fatal

coronary

disease

References1 White A, DeSousa B, Clarke N et al. Men’s health

in Europe. J Men’s Health 2011; in press.

2 Chandola T, Britton A, Brunner E et al. Work

stress and coronary heart disease: what are the

mechanisms? Eur Heart J 2008; 29: 640–8.

3 Burdorf A. Is early retirement good for your health?

BMJ; 341: c6089.

4 Rosengren A, Hawken S, Ounpuu S et al. Associa-

tion of psychosocial risk factors with risk of acute

myocardial infarction in 11119 cases and 13648

controls from 52 countries (the INTERHEART

study): case-control study. Lancet 2004; 364: 953–

62.

5 Kivimaki M, Leino-Arjas P, Luukkonen R, Riihi-

maki H, Vahtera J, Kirjonen J. Work stress and risk

of cardiovascular mortality: prospective cohort

study of industrial employees. BMJ 2002; 325: 857.

6 McInnes GT. Overtime is bad for the heart. Eur

Heart J 2010; 31: 1672–3.

7 Virtanen M, Ferrie JE, Singh-Manoux A et al. Over-

time work and incident coronary heart disease: the

Whitehall II prospective cohort study. Eur Heart J

2010; 31: 1737–44.

doi: 10.1111/j.1742-1241.2011.02777.x