Stress at work has been linked with coronary heart disease in retrospective and prospective studies.1 2 The biological mechanisms remain unclear.3 Plausible pathophysiological mechanisms involve direct neuroendocrine effects and indirect effects mediated by adverse health behaviours.4–6
The metabolic syndrome is a cluster of risk factors that increases the risk of heart disease and type 2 diabetes.7 Characteristics of the metabolic syndrome are abdominal obesity, atherogenic dyslipidaemia (raised triglycerides, small low density lipoprotein particles, and low concentrations of high density lipoprotein cholesterol), high blood pressure, insulin resistance (with or without glucose intolerance), and prothrombotic and proinflammatory states (table 1). Previous studies found a social gradient in work stress and the metabolic syndrome,8 9 suggesting that the social gradient in the metabolic syndrome and heart disease could in part be explained by greater exposure to work stress among less advantaged social groups. Cross sectional studies have linked work stress with components of the syndrome,10 11 but this association is not consistent.4 12