Study: High Efforts, Low Recognition Doubles Heart Disease Risk in Men

A recent study suggests that a lack of recognition can take a particularly hard toll on people of all sexes, with men suffering the most from heart attacks.

Risk Is as Great as Obesity
At Greatest Risk, Those With High Effort and Low Rewards

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Job strain combined with high efforts and low reward doubles men’s heart disease risk, according to a study in Circulation: Cardiovascular Quality and Outcomes journal. It finds that “These psychosocial stressors are each associated with heart disease risk and the combination was especially dangerous to men.” The researchers did not have enough data to draw the same conclusion about women.

The impact is highest in top performers. “Men exposed to stressful working conditions who also felt that they put forth high effort but received low rewards had twice the risk of heart disease compared to men who were free of those psychosocial stressors.”

Risk Is as Great as Obesity

The study finds that “the impact of job strain and effort-reward imbalance combined was similar to the magnitude of the impact of obesity on the risk of coronary heart disease in the study of nearly 6,500 white-collar workers in Canada.”

Researchers studied nearly 6,500 white-collar workers, with an average age of about 45 years old without heart disease and followed them for 18 years from 2000 to 2018. They studied health and workplace survey information for 3,118 men and 3,347 women in a wide range of jobs in Quebec. The surveys included employees working in senior management, professional, technical and office workers roles. Education levels ranged from no high school diplomas to university degrees. Researchers measured job strain and effort-reward imbalance with results from proven questionnaires and retrieved heart disease information using established health databases.

Heart disease is the No. 1 cause of death in the US, according to American Heart Association statistics. In 2020, nearly 383,000 Americans died of heart disease. About 10,000 heart attacks occur on the job each year, according to the Occupational Safety & Health Administration.

“Considering the significant amount of time people spend at work, understanding the relationship between work stressors and cardiovascular health is crucial for public health and workforce well-being,” says lead study author Mathilde Lavigne-Robichaud, R.D., M.S., doctoral candidate, Population Health and Optimal Health Practices Research Unit, CHU de Quebec-University Laval Research Center in Quebec, Canada. “Our study highlights the pressing need to proactively address stressful working conditions, to create healthier work environments that benefit employees and employers.”

At Greatest Risk, Those With High Effort and Low Rewards

“Job strain refers to work environments where employees face a combination of high job demands and low control over their work. High demands can include a heavy workload, tight deadlines, and numerous responsibilities, while low control means the employee has little say in decision-making and how they perform their tasks,” Lavigne-Robichaud explained.

“Effort-reward imbalance occurs when employees invest high effort into their work, but they perceive the rewards they receive in return — such as salary, recognition, or job security — as insufficient or unequal to the effort. For instance, if you’re always going above and beyond, but you feel like you’re not getting the credit or rewards you deserve, that’s called effort-reward imbalance.”

The study finds:

Men who said they experienced either job strain or effort-reward imbalance had a 49% increase in risk of heart disease compared to men who didn’t report those stressors.
Men reporting both job strain and effort-reward imbalance were at twice the risk of heart disease compared with men who did not say they were experiencing the combined stressors.
The impact of psychosocial stress at work on women’s heart health was inconclusive.
In men, the impact of job strain and effort-reward imbalance combined was similar to the magnitude of the impact of obesity on the risk of coronary heart disease.

“The US workforce is among the most stressed in the world, and these workplace stressors can be as harmful to health as obesity and secondhand smoke,” says Eduardo J. Sanchez, M.D., M.P.H., FAHA, FAAFP, chief medical officer for prevention at the American Heart Association. “This study adds to the growing body of evidence that the workplace should be prioritized as a vehicle for advancing cardiovascular health for all. The American Heart Association remains committed to and engaged in providing employers with the resources and information they need to actively support the health of their employees and communities through science-backed changes to policy and culture.”

The researchers admit that one study limitation is that the researchers studied men and women in white-collar jobs primarily in Quebec, Canada, and the results might not fully represent the diversity of the American working population. However, the study findings may be relevant to white-collar workers in the US and other high-income countries with similar job structures, according to Lavigne-Robichaud.

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