Women in Power, Beware Heart Problems

The combination of heavy work pressure and high authority may take a toll on some women's heart health, new research suggests.

The study of more than 3,000 adults ages 18 to 77 found that over 10 years, women in demanding jobs with high levels of autonomy or authority had an increased risk of developing heart disease.

The same was not true of men, the researchers found, and highly demanding work in and of itself was not related to heart disease risk in either women or men.

Instead, other features of work life -- including authority over decision-making for women, and occupational "prestige" for men -- did seem to make a difference in heart health.

A number of studies have suggested high job strain may increase the risk of heart disease, but much of this research has suffered from a lack of consistency, including in the way "job strain" is defined.

One standard definition of high job strain used for years in research is that workers deal with high demands but have little control over their work or leeway for creativity.

But in the current study, high job strain defined in this way was not related to the risk of heart disease or death in either men or women.

On the other hand -- and "contrary to expectations" -- heart disease risk was elevated among women deemed to be under "active" job strain, meaning their work demands were high, but they were in positions of authority, making decisions and controlling how they worked.

These women were nearly three times as likely to develop heart disease during the study period as women with high work demands and little autonomy, according to findings published in the American Journal of Epidemiology.

The study suggests that work strain, when defined as high demand/low authority, is not a risk factor for heart disease for either men or women, explained lead author Dr. Elaine D. Eaker of Eaker Epidemiology Enterprises in Chili, Wisconsin.

Yet, the findings show that some forms of job stress for women may well be risk factors.

For men in the study, higher income and higher job prestige were related to a lower risk of heart disease and death. Men who worked as laborers or operators had the highest rates of heart disease and death, while those in professional or managerial positions had the lowest.

But job strain -- whether in an occupation with high authority or one with little autonomy -- was not related to heart disease or death among men.

The various relationships between job characteristics and heart disease remained after Eaker's team accounted for factors such as age, smoking and high blood pressure.

Exactly why "active" job strain might be a heart risk for women is unclear, the authors say, but they speculate that societal factors are at work. This study, they point out, was begun in the 1980s, when U.S. women were first coming into high-power positions in significant numbers.

These women could be regarded as being on the "cutting edge of a social transition," according to Eaker and her colleagues.

"I do think that the shift in social roles is a very likely explanation of our findings," Eaker said.

The difficulty these women may have experienced in "breaking out of old roles and into roles with more authority," she noted, could have taken a toll on their health.

SOURCE: American Journal of Epidemiology, May 15, 2004.

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