Unemployed at Higher Risk for Heart Attack?

Multiple job losses are as harmful as smoking and chronic disease, study finds

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Monday, November 19, 2012

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MONDAY, Nov. 19 (HealthDay News) -- More bad news for the jobless: Heart attack risk rises with unemployment, particularly in the first year, new research suggests.
What's more, heart risks associated with repeated joblessness may be on a par with that posed by major cardiovascular risk factors such as smoking or having diabetes or high blood pressure (hypertension).
Investigators, who interviewed almost 13,500 older adults over nearly two decades, said the findings appear to apply equally to men and women of all major racial and ethnic groups.
"Our study investigated how different dimensions of job instability were associated with increased risk for a heart attack," said study lead author Matthew Dupre, from the department of community and family medicine at Duke University in Durham, N.C.
"What we found is that risks for heart attack were significantly higher among the unemployed, and that risks increased incrementally with each additional job loss," he added. Voluntary retirement was not associated with a boost in heart health problems.
The strain of multiple job losses packs as great a punch to the heart as chronic disease or longtime negative behaviors, he said.
"For example, although current smoking status is a known risk factor for cardiovascular events, long-term patterns of tobacco use are more powerful predictors of risk," Dupre noted. "Similarly, it is not the onset of hypertension or type 2 diabetes mellitus that increases the risk of heart attack, but instead the strain that these illnesses exact on the cardiovascular system over time. Our findings for employment history largely mirror these protracted and cumulative associations."
For the study, published online Nov. 19 in Archives of Internal Medicine, the authors sifted through bi-yearly responses about employment status provided between 1992 and 2010 by participants in the U.S. Health and Retirement Study who were 51 to 75 years old. Their responses were correlated with heart attack incidence over the same time frame.
Fourteen percent were unemployed at the study's launch. And nearly seven in 10 experienced at least one job loss during the study period, which overlapped with the start of the recession in 2008, when U.S. unemployment approached a 30-year high.
Nearly 8 percent had a heart attack during the study period, and they were more likely to be older, male and white, and also more likely to live in the South.
Low income, low educational attainment, lack of health insurance, being overweight or obese, having high blood pressure or diabetes, a disability, depression, and a sedentary lifestyle also increased the risk of heart attack.
That said, the authors found that independent of all other risk factors, the odds for experiencing a heart attack went up with each additional job loss (up to the level of four or more job losses), when compared with those who never lost a job.
Also, while the first year of unemployment was associated with a boost in heart attack risk, unemployment longer than a year did not seem to further elevate risk.
The data did not include the reasons for job loss or the exact nature of the jobs, and the authors cautioned that both factors could play a role in heart attack risk. Dupre also said further research is needed before a direct cause-and-effect link can be established.
In an editorial accompanying the study, William Gallo of the City University of New York said future investigations should focus on the how's and why's of the association, including whether your stage of life at the time of job loss affects heart risk. The study participants were at or near the end of their careers.
Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said studies have shown that unemployment results in substantial physiologic stress. "This stress has been associated with excess risk for cardiovascular events," he said. "And stress itself leads to a variety of pro-inflammatory responses that can be a causal pathway to increased cardiovascular events."
Some theories abound that people who lose their jobs pay less overall attention to their health, Fonarow added. "Less access to health care among the jobless may also play a role, as could a related excess in drinking, a return to smoking, exercising less, or eating less healthfully," he said. "So the more insight we can get into this the better, because it's obviously a complex situation with many contributing factors."

SOURCES: Matthew E. Dupre, Ph.D., Duke Clinical Research Institute and department of community and family medicine, Duke University, Durham, N.C.; Gregg C. Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Nov. 19, 2012, Archives of Internal Medicine, online

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