A bad day at work may be worse than you think, according to a World Neurosurgery article written by Barrow doctors to draw attention to research linking high job strain and stroke risk.

The February 2016 article focused on a meta-analysis of six prospective cohort studies evaluating job strain and stroke risk, which was published in Neurosurgery in November 2015. The authors of the meta-analysis concluded that high-strain jobs were significantly associated with ischemic stroke risk when compared to low-strain jobs, especially in women.

“Barrow Neurosurgeon Dr. Felipe Albuquerque was the section editor of the World Neurosurgery News Section, and after we saw the article published we felt it was particularly relevant to the World Neurosurgery audience for two reasons: an ongoing, burgeoning interest of neurosurgeons in ischemic stroke and its potential personal relevance to the audience,” said Dr. Bradley Gross, an endovascular surgical neuroradiology fellow at Barrow.

While the Barrow doctors wrote the article for a neurosurgical audience, the results of the meta-analysis are relevant to anyone who has a high-strain job in any field. This was defined as a job with high demand and low control, whereas a low-strain job was defined as a position with low demand and high control. Demand encompassed time pressure, mental load, and coordination responsibilities. Control represented skill discretion and decision authority.

One of the six studies was from the United States, one was from Asia, and the other four were from Europe. Sample sizes ranged from 6,070 to 48,361 people, with a total of 138,782 participants. Mean follow-up periods ranged from 3.4 to 16.7 years. Across these studies, the percentage of people with high-strain jobs ranged from 11 to 27 percent.

Awareness of the problem should prompt meticulous attention to cardiovascular risk reduction among people with high-strain jobs.

-Dr. Bradley Gross, Endovascular Surgical Neuroradiology Fellow

There were limitations, such as three studies evaluating only women and one study evaluating only men. All but one study adjusted for age, but most did not account for race, history of cerebrovascular disease, or risk factors such as hypertension, diabetes, and physical activity index.

However, the Barrow doctors called the results “provocative” and said the findings encourage attention to cardiovascular risk reduction among people with high-strain jobs.

“It’s not surprising,” Dr. Gross said. “Work stress has been associated with elevated inflammatory responses, elevated cortisol, destabilization of atherosclerotic plaques, and accelerated cellular aging. There are many studies that have shown high job strain to be associated with ischemic heart disease, a similar pathophysiology to cerebral ischemic disease.”

Dr. Gross said the exact pathophysiologic mechanism behind job strain and ischemic stroke is not entirely clear, and neither is the association between job strain and hemorrhagic stroke. He said the duration of time that a person holds a high-strain job is another variable that requires further study.

So, what is the big takeaway?

“First and foremost is awareness,” Dr. Gross said. “Awareness of the problem should prompt meticulous attention to cardiovascular risk reduction among people with high-strain jobs. A general part of the history and physical of any patient includes their occupation, which may potentially be used in the future as a way to stratify risk for cardiovascular and even cerebrovascular ischemic disease.”