NEW YORK (Reuters Health) - For men at risk of heart disease, the combination of a very stressful job and a failing marriage can increase their chances of death, according to a new report.

While many would expect that severe stress brought on by natural disasters or war can have heart attack-inducing consequences, few may associate long-term chronic stress with heart health and overall longevity.

Now, the findings from a 9-year study indicate that men with an "above average risk" of heart disease who reported high levels of job-associated stress and a marriage that ended in divorce increased their risk of death by as much as 69% compared with men in low-stress jobs who remained married.

Lead author Dr. Karen A. Matthews of the University of Pittsburgh School of Medicine in Pennsylvania and co-author Dr. Brooks B. Gump of State University of New York in Oswego published their findings in the February 11th issue of the Archives of Internal Medicine.

In the study, the researchers looked at nearly 11,000 married men aged 35 to 57 who answered questions about work stress and marital status each year for 9 years. The men were initially healthy, but were considered to be at high risk of heart disease because they had high blood pressure, elevated cholesterol or were smokers.

"Increasing number of different work stressors and divorce during the trial were associated with total and cardiovascular mortality during the 9-year follow-up period," the authors write.

Those men that reported three or more different work stressors such as a demotion, "personal troubles" with one or more co-workers, getting fired or laid-off, or difficulty finding a new job had a 26% higher risk of death compared with men reporting no stress from their jobs.

And the study revealed that men who had three or more job stressors and got divorced had a 37% increased risk of overall mortality compared with men who remained married.

However, the greatest risk of death was seen in men who divorced and reported many work stressors during the study period--the combined factors were associated with a 69% increased risk of death due to all causes, the report indicates.

"Thus, a synergistic adverse effect may occur when different domains of stressors co-occur in individuals lives," the authors write, "...suggesting that remaining married in midlife has protective effects in the face of adverse experiences at work."

Possible explanations for the findings may be due to the fact that stress increases the release of stress hormones and raises blood pressure, both of which can negatively impact heart health, according to Matthews and Gump.

The researchers suggest that men seek counseling to help alleviate various stressors that they may be experiencing at work and in their marriages.

SOURCE: Archives of Internal Medicine 2002;162:309-315.

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