Fit for duty: How reducing workplace stress could help prevent heart attacks

When the leader of a major organisation suffers a heart attack, it tends to make the headlines.

That was the case in 2017, when the American Heart Association’s volunteer president, cardiologist John Warner, M.D., went into cardiac arrest. That was the case in 2009, when 42-year-old Ranjan Das, CEO of SAP India, suffered a heart attack and died — after a workout, no less. And that was the case in 2015, when United Airlines CEO Oscar Munoz, an athlete and vegan, suffered a heart attack, an incident that is still often called upon to underline the link between stress, well-being and heart trouble among business leaders.^{1, 2, 3}

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Cardiovascular disease is the leading cause of death around the world, representing 31 percent of all global deaths. Yet we are still surprised when it affects people like Warner, Das and Munoz. That’s perhaps because we forget the role of stress, an underappreciated risk factor in cardiovascular disease - and one that may disproportionately affect expatriate employees.⁴

While individuals can’t control factors like age and genetics, they can drastically reduce their heart-disease risk by avoiding smoking, maintaining a healthy weight, being physically active and following a healthy diet. Research has shown that those four actions alone reduce the risk of coronary artery disease and sudden cardiac death by 80 percent. (Imagine a drug maker announcing a therapy with an 80-percent efficacy and virtually no negative side effects!)⁵

But tackling those four risk factors isn’t enough if stress isn’t addressed.  Consider what one source told The Times of India about Das: “Ranjan was a health freak. He ate right, jogged and worked out daily. He had no bad habits like drinking or smoking. He was always very ambitious, and always believed that four hours of sleep were enough for him to be fit and fresh.”⁶

A small study at Harvard Medical School has drawn a connection between activity in the amygdala, the part of the brain that handles intense emotions, and the build-up of plaque in arteries. The researchers scanned the brains of 293 people with no history of heart disease, then followed up to see who had experienced cardiovascular events. ‘What we found was that amygdala activity very nicely predicted the development of cardiovascular disease events over the five years of follow-up’, says lead researcher Ahmed A. Tawakol, M.D.^{7, 8, 9}

The knock-on effect of stress

There are other links as well. 'People under stress may try to "manage" their stress by smoking, drinking to excess or stress-eating', says Dr Stella George, Senior Medical Director, Aetna International. 'What’s more, if the stress relates to overwhelming work responsibilities, they may end up getting less sleep and less physical activity than they need, which can also increase their likelihood of having heart trouble.'

In some cases, stress can even lead directly to a heart condition known as takotsubo cardiomyopathy. Sometimes called broken-heart syndrome, this condition causes chest pain, breathlessness and collapse and can lead to hospitalisation.^{10, 11}

Some employers recognise that they bear some responsibility for helping workers avoid or deal with workplace stress. For example, when American Express revamped its Healthy Living global well-being programme in 2014, it focused on three pillars: Stress less, Eat Well and Move More.¹²

"Of course, you as an employer can’t completely eliminate stress from the workplace any more than you can eliminate deadlines or performance appraisals," says Dr Lori Stetz, Senior Medical Director, Aetna International. "But you can recognise and try to mitigate unhealthy stressors."

Stresses faced by expats

The American Psychological Association’s 2017 Work and Well-Being Survey offers some insight into the causes of stress. According to the survey, the top five stress factors among the workers surveyed were low salaries, lack of opportunity for growth or advancement, too heavy of a workload, uncertain or undefined job expectations and unrealistic job expectations. While low salaries may not be a problem for well-paid international workers, expats face many of the same challenges as their colleagues back home — and other challenges besides, which can exacerbate stress. 'Finding accommodation, integrating into a new culture, raising children without family close at hand — these unique issues can become major stressors for expats and globally mobile workers', says Dr Mitesh Patel, Medical Director, Aetna International.¹³

Dr Patel adds, 'In a recent survey of 2000 working-age expats, we found that 41 percent of respondents took up to six months to feel part of a local community. And 68 percent said that finding accommodation was a challenge. Of these, 39 percent said it had impacted their well-being. Employers have the opportunity to put the right workplace support around expats to help alleviate these settling-in stresses which can weigh heavily on employees mental and physical health.'

Coping with change

How bad is workplace stress? The American Stress Institute reports that 80 percent of workers feel stress on the job and that nearly half say they need help to manage it. The group also emphasises that stress is not inherent in any particular occupation. 'Although the Institute is often asked to construct lists of the "most" and "least" stressful occupations, such rankings have little importance for several reasons', it says. 'It is not the job but the person-environment fit that matters'.¹⁴

Workplace stress has a clear negative impact on workers. According to a survey by Mental Health America, 63 percent of respondents said workplace stress had caused 'a significant impact on their mental and behavioural health'; the same percentage said stress had led them to engage in unhealthy behaviours like drinking or crying regularly.¹⁵

Workplace stress has a significant impact on organisations as well. A frequently quoted statistic says stress costs U.S. companies $300 billion a year in health care costs and lost productivity. 'Both employers and employees are paying high costs for stress’, says Dr Mitesh Patel. 'And those are causes that can and should be avoided'.¹⁶

Smart employers use all sorts of strategies to keep their workers healthy, safe and productive – from providing ergonomic chairs to opening on-site gyms to offering performance coaching. Acknowledging the risks associated with stress and helping workers get a handle on it is the next logical step in improving health and well-being.

While you can’t definitively protect yourself from heart disease, taking a healthy, balanced approach to nutrition, exercise, sleep, avoiding smoking that includes stress management can make a powerful difference.

So, with a balanced approach in mind, here are six actions an organisation can take to help employees improve their health and wellness and minimise the risk of developing a cardiac condition:

1.      Offer benefits that promote mental health: Many organisations offer employee assistance programs (EAPs), which allow workers to connect with trained mental health professionals for free, confidential short-term counselling and referrals to longer-term care. Some companies do even more. For example, accounting firm EY’s ‘r u ok?’ program encourages workers to engage their colleagues in dialogue about mental health. As EY’s vice-chair of talent, Carolyn Slaski, notes, ‘We have a unique responsibility to promote a culture of caring through one-on-one actions with our teams. I believe that r u ok? allows us to pay such attention to our people’s individual well-being by starting the dialogue in a safe, non-confrontational way’.¹⁷

2.      Encourage on-site relaxation and meditation: PricewaterhouseCoopers included 'nap pods' when it built a new office in Switzerland. The building’s designer, Stefan Camenzind, CEO of Evolution Design, says, 'Most people are told that the harder you work, the longer you work, the better it is. That’s not sustainable, and that’s probably also not true. It’s about smart working, and that means you need to recharge. In this context, nap rooms become more and more important.'¹⁸ Not every organisation can afford the luxury of a sleep pod in its offices. Why not consider setting aside a meeting room for an hour every day to enable employees to meditate, relax and recharge in peace and quiet?

3.      Don’t keep secrets: As UK-based consulting firm Shaw Gibbs notes, 'Open communication is critical in leadership – keeping employees up to date regarding changes, expectations and their own performance not only keeps them on track but also reduces feelings of stress and anxiety — after all, there is nothing worse than being kept in the dark'. And there’s the potential for even bigger disconnects when workers are an ocean away from the organisation’s headquarters.¹⁹

4.      Consider unique stressors for international workers: Expats face unique challenges that can lead to stress. Many of these can be minimised through careful pre-assignment planning and education — and even pre-assignment trips to the host country. 'It's important to set employees off on the right foot', says Dr Lori Stetz.

5.      Follow up with international workers: While it’s important to work closely with expats before they start an overseas assignment, the support shouldn’t stop there. 'We suggest employers check in after two to three months and again after eight to nine months', says Dr Lori Stetz. In addition, some employers implement support networks in and/or out of the workplace to reduce stress, as well as proactively tackle issues before they threaten assignment success. Pairing new international workers with a 'buddy' who’s been in the country longer is another simple strategy. It gives the individual someone to talk to, helps them get to know their host country and meet other expats. If done well and the assignee has a positive early experience, they are more likely to feel at home, in control and confident more quickly, helping to ensure they’re productive more quickly and potentially stay with the organisation longer.

6.      Promote and support healthy behaviours: Many employers seek out health and wellness benefits partners that take a holistic view of their employees' health, taking into consideration where they live, their family and medical history, medication, nutrition, and exercise, smoking and drinking habits to help them on their path to better health. Offering employees check-ups and encouraging people to know their numbers by having their blood checked for cholesterol levels and blood pressure are important steps. By bringing support that encourages well-being directly to employees via wellness or condition management coaching, for example, organisations can help ensure that employees don’t have to go out of their way to opt-in, making uptake more likely.²⁰ Read 6 ways to improve heart health for employee guidance on making small lifestyle changes to help strengthen their hearts.

Find out what else you can do to prevent heart attacks by listening to our Fit for Duty podcast episode below.