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As the leading cause of death worldwide, cardiovascular disease has been the source of much research. These studies have found that stress is a top psychological factor in developing heart diseases. For example, according to Kristina Orth-Comer et al., in “Marital Stress Worsens Prognosis in Women with Coronary Heart Disease,” the authors state that marital stress, but not work stress, causes increased risk for cardiovascular disease. But this study only begins to scratch the surface of the multitude of lifestyle issues that deteriorate people’s health and cause cardiovascular disease. This paper will investigate the findings of five studies before comparing the similarities and differences in findings. The paper will help establish a consolidated look at the various factors affecting cardiovascular disease, and provide a clear framework for people to see ways they can avoid developing a form of the disease. With life being the source of so many stressors, it is important to understand the health implications of lifestyle decisions, and develop ways that people can prevent cardiovascular disease. But in studying the relationship between stressors and cardiovascular disease, individual personality type also needs to be factored in.

With stress being the top psychological factor contributing to cardiovascular disease, it is important to identify the various sources of these stressors that are common in our everyday lives. Two such sources are presented in Orth-Comer et al’s., “Marital Stress.” In the paper, the authors investigate the impact that marriage and work have on stress levels, and its relation with coronary heart disease. The authors studied women between 30 and 65 years old who lived in Stockholm, Sweden, and who were hospitalized for suffering from an acute coronary event between 1991 and 1994. In total, 335 women were included in the study. The researchers found that women married or living with a male partner were nearly three times more likely than those who were not, to have recurring cardiovascular issues. However, women who were working did not have a significant recurrent coronary event, (Orth-Gomer et al., 2000). The study factored in adjustments for age, education, diagnoses, diabetes, systolic blood pressure, estrogen status, smoking, high-density lipoprotein cholesterol level, triglyceride level, and left ventricular dysfunction.

It is interesting to note that the authors’ findings are different from the findings associated with men, and the authors surmise that difference indicates the need to have preventative measures that are specific for the needs of women with CHD. However, the authors admitted that the causes are not well understood. In the studies related to men, the large stressors are associated with psychosocial influences, and these relate closely with the onset of cardiovascular health issues. It is interesting to note that the occurrence of CHD in men is more associated with work stressors. However, the psychosocial stress related to women is poorly understood because there is a lack of studies on women. “Whereas marital stress has been shown to affect women’s mental health, to our knowledge, no studies have evaluated whether marital stress has adverse effects on CDH among men” (Orth-Gomer et. al., 2000).

In a study conducted by Hans Bosma et al., “Two Alternative Job Stress Models and the Risk of Coronary Heart Disease,” the authors discuss the evidence that there is a deep-seeded link between psychosocial hazards at work and workers’ health. Typically, the stress is associated with job strain that stems from the high demands of workers and the lack of control that workers have. Further, the authors state that work stress is also perpetuated by the lack of reward that is given to workers for the amount of effort that they put in. The rewards that are taken into account in the model include money, esteem and control of status – that includes job security and promotions. “In a prospective study among German blue-collar men, poor promotion prospects and job insecurity (low rewards) in men having a high workload and a high need for control (high efforts) predicted new cardiovascular events” (Bosma et al., 1998). In another study, the researchers examined the causes of stress, including work characteristics and social support. The study was conducted between 1985 and 1988 on both male and female civil servants aged between 35 and 55 years old. The research was based in London, where the subjects were given a screening examination for cardiovascular diseases. Over 10,300 civil servants were included in the examination, with about 33% female. Those same workers were examined again between 1989 and 1990, and again between 1991 and 1993, and it was discovered that women reported a high effort and low reward conditions at work than did men. In the lower-level jobs, both men and women reported less reward for their work than did those in the higher-level jobs. About 17% of women and 15% of men reported high job strain. “Job strain was not consistently related to new coronary heart disease reports; only the association between self-reported job strain and any coronary heart disease outcome in men was statistically significant” (Bosma et al., 1998). The researchers stated that the relationship between job demands and job control did not have a significant impact on the number of reported cases of cardiovascular disease. Furthermore, low work support did not affect CHD rates.

In a study conducted by Mika Kivimaki et al., “Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees,” the researchers examined the association between stress at work, and the risk of dying from cardiovascular disease. The work stress model was based on the effort-reward imbalance and job strain, which are the same parameters that were applied to the “Two Alternative Job Stress Models.” This study is older than the previous study cited in this paper, as its initial examination was conducted in 1973 of behavioural and biological risks, stressful characteristics of work and cardiovascular disease. However, a follow-up was conducted in 2001. This study had a longer timeline than the previously referenced study, as it extended 10 years, rather than 8. This study also completed a follow-up after 25 years. There were longer intervals between examinations of subjects. This study examined 812 employees, with about 33% females, similar to the previous study.

Researchers found a 2.2 times increase in job strain. This is different from the previous study, which didn’t find a significant difference in the number of CHD cases. However, it should be noted that this study focused on deaths associated with the connection between high work stress and cardiovascular diseases. Furthermore, the length of time between examinations is much greater than in the previous study, and this indicates that a high amount of work stress is indeed connected with cardiovascular disease, but it takes much longer to culminate than what was indicated in the study conducted by Bosma et. al. This information indicates that the study of the relationship between cardiovascular disease and stressors needs a long timeline.
In another study, conducted by Johan Denollet et al., “Usefulness of Type D personality in Predicting Five-Year Cardiac Events Above and Beyond Concurrent Symptoms of Stress in Patients With Coronary Heart Disease,” the authors investigated the effects of psychological stress and type D personalities on CHD. It should be noted, that people with type D personalities are more prone to worrying, gloominess, irritability, social inhibition, and lack of self-assurance. While type D personalities have been connected in various studies with psychological stress, there had not been much emphasis on the study of type D personalities on CHD. The researchers studied 337 patients who had CHD, and who were followed for 5 years. In the end, the researchers found that those with type D personalities had a greater chance of developing a CHD. “Type D patients had an increased risk of death/infarction … compared with non-type D patients, independent of disease severity” (Denollet et al., 2006). A major cardiac event was connected in this study to stress.

In a study conducted by Fredric Schiffer et. al., “The quiz electrocardiogram: A new diagnostic and research technique for evaluating the relation between emotional stress and ischemic heart disease,” the researchers set out to examine blood pressure as 43 subjects listed to a 12-minute tape-recorded stress quiz. The examination concluded that there was significantly higher heart rate in executives with angina than those who did not have angina. The researchers concluded that there is a connection between stress and angina. “The quiz electrocardiogram is presented as a new research technique and diagnostic test for evaluating the relation of emotional stress to ischemic heart disease” (Schiffer et. al., 1975). This study may appear to divert from the previous four, but it further establishes that stress is connected with cardiovascular disease. And that solidifies the argument of Denollet, which proves that people who are more prone to stress due to personality type have an increased risk for cardiovascular disease than those who are not as stressed.

In closing, various aspects of these studies line up with each other, while others do not. In comparing the study of Orth-Comer et al., there wasn’t a reported higher proportion of people having CHD due to stressors at work, and that research lines up with what is reported in Bosma et al., which also did not see a significant jump in the number of reported CHD-related cases due to job stressors. Denollet et al’s study was slightly different than the others, because it focused on a personality type, rather than on a life situation, such as marriage or work. Given the high rate of people with type D personality developing CHD, further research is needed in studies that deal primarily with life situations to evaluate the personality types of those in those situations. For example, Orth-Comer et al., studied marriage and work, but they didn’t factor in whether those who are married, or those who work in the types of jobs that were subject of the study, had a type D personality. After all, people with type D personalities might be more attracted to marriage, for example. Because of the significant breakthrough in Denollet et al.’s research, personality type should be taken as a factor in all studies that connect the frequency of stress in a particular lifestyle.

Works Cited
Bosma, H. et al. (1998, Janurary). Two Alternative Job Stress Models and the Risk of Coronary 
Heart DiseaseAmerican Journal of Public Health.

Denollet, J. et. al. (2006, Feb. 14). Usefulness of Type D Personality in Predicting Five=Year Cardiac
Events Above and Beyond Concurrent Symptoms of Stress in Patients with Coronary Heart Disease. American Journal of Cardiology. 

Kivimaki, M., et. al. (2002, Oct. 19). Work stress and risk of cardiovascular mortality: prospective 
cohort study of industrial employeesUs National Library of Medicine National Institutes of Health. 

Orth-Gomer, K. (2000, Dec. 20). Marital Stress Worsens Prognosis in Women With 
Coronary Heart DiseaseThe Journal of the American Medical Association.

Schiffer, F. et. al. (1975, June 11). The quiz electrocardiogram: A new diagnostic and research
technique for evaluating the relation between emotional stress and ischemic heart disease. Department of Medicine, Harvard Medical School and Beth Israel Hospital. 

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By Hanna Robinson

Hanna has won numerous writing awards. She specializes in academic writing, copywriting, business plans and resumes. After graduating from the Comosun College's journalism program, she went on to work at community newspapers throughout Atlantic Canada, before embarking on her freelancing journey.

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