Men who worked in stressful jobs that they felt required high effort but provided low reward had twice the risk of heart disease as men who were free of such stressors, a study has found.

The combined effect of job strain and effort-reward imbalance was similar to the magnitude of the effect obesity has on the risk of coronary heart disease, according to the study, which was published Tuesday in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes.

Results on how job stress affects women’s heart health were inconclusive in the study, which looked at data from nearly 6,500 white-collar workers in Canada.

“Our study highlights the pressing need to proactively address stressful working conditions, to create healthier work environments that benefit employees and employers,” said lead study author Mathilde Lavigne-Robichaud in a news release. She is a doctoral candidate in the Population Health and Optimal Health Practices Research Unit at CHU de Quebec-University Laval Research Center in Quebec, Canada.

Research has shown that both job strain and effort-reward imbalance at work may increase heart disease risk, but few studies have examined the combined effect.

So researchers examined health and workplace survey information for 3,118 men and 3,347 women in Quebec. Among them were employees working in senior management, professional, technical and office worker roles. Some had no high school diploma; some had earned a university degree.

Participants’ average age was about 45. At the time the study began, they had no known heart disease. They were followed for 18 years, from 2000 to 2018.

Researchers retrieved heart disease information using established health databases. Job strain and effort-reward imbalance were measured with questionnaires.

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

“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,” she said.

The study found that 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 either.

Men reporting both job strain and effort-reward imbalance were at twice the risk of heart disease compared with men who did not say so. For such men, the combined effect of job strain and effort-reward imbalance combined was similar to the effect of obesity on the risk of coronary heart disease.

The study’s inability to establish a direct link between psychosocial job stressors and coronary heart disease in women signals the need for further research, Lavigne-Robichaud said.

But overall, she said, “our results suggest that interventions aimed at reducing stressors from the work environment could be particularly effective for men and could also have positive implications for women, as these stress factors are associated with other prevalent health issues such as depression.”

Such interventions might include providing support resources, promoting work-life balance, enhancing communication and empowering employees to have more control over their work, she said.

The study was limited in that it studied people in white-collar jobs primarily in Quebec, so the results might not fully represent the diversity of the American working population. However, Lavigne-Robichaud said, the study’s findings may be relevant to white-collar workers in the United States and other high-income countries with similar job structures.

“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,” she said.