High effort, low reward, and cardiovascular risk factors in employed Swedish men and women: baseline results from the WOLF Study.
OBJECTIVE
To examine associations between measures of work stress (that is, the combination of high effort and low reward) and cardiovascular risk factors.


METHODS
Cross sectional first screening of a prospective cohort study.


METHODS
The study was conducted among 5720 healthy employed men and women living in the greater Stockholm area aged 19-70 years. All analyses were restricted to subjects with complete data (n = 4958). The investigation of associations between indicators of effort-reward imbalance and cardiovascular risk factors was restricted to the age group 30-55 years (n = 3427).


RESULTS
Subjects reporting high effort and low reward at work had a higher prevalence of well known risk factors for coronary heart disease. After adjustment for relevant confounders, associations between a measure of extrinsic effort and reward (the effort-reward ratio) and hypertension (multivariate prevalence odds ratio (POR) 1.62-1.68), increased total cholesterol (upper tertile 220 mg/dl)(POR = 1.24) and the total cholesterol/high density lipoprotein(HDL)-cholesterol ratio (upper tertile 4.61)(POR 1.26-1.30) were found among men. Among women a measure of high intrinsic effort (immersion) was related to increased low density lipoprotein (LDL)-cholesterol (upper tertile 130 mg/dl)(POR 1.37-1.39). Analyses of variance showed increasing mean values of LDL cholesterol with an increasing degree of the effort-reward ratio among men and increased LDL-cholesterol among women with high levels of intrinsic effort (upper tertile of immersion).


CONCLUSIONS
Findings lend support to the hypothesis that effort-reward imbalance represents a specific constellation of stressful experience at work related to cardiovascular risk. The relation was not explained by relevant confounders (for example, lack of physical exercise, body weight, cigarette smoking).
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D008078:Cholesterol, LDL / Q000097:blood; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012201:Reward; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology