"Work, stress & health" are perhaps nowhere as
inextricably linked, as for the cardiovascular (CV) system. This
is embodied by "econeurocardiology", the biological
paradigm by which social factors, such as work stressors, are
processed by the CNS, leading to pathophysiologic changes that
increase CV risk. The store of elucidating econeurocardiologic
mechanisms is rich. Theoretical advances allow us to model the
work environment with ever-greater cogency. Thanks to practical
applications of these models, a large body of empirical evidence
has accumulated, implicating work stressors in the etiology of
CVD. This is of great public health importance: CVD is the major
cause of morbidity & mortality in the industrialized world
and rising worldwide. Conservative estimates attribute over 25%
of CVD risk to work-related factors.
The clinician is often called upon to judge the CV work fitness
of patients. Given the rising prevalence of working conditions
potentially harmful to the CV system, this type of judgment will
be ever more frequently sought, and ever more difficult to render.
Jobs where public safety could be compromised by acute cardiac
events are often those in which exposure to cardio-deleterious
factors is the greatest. Yet, except for physical activity, there
is a lack of evidence-based guidelines to help clinicians make
informed recommendations concerning exposure to occupational factors
& CVD patients. Unlike other sub-specialties, e.g. pulmonary
medicine, in which knowledge about occupational factors is integrated
into clinical practice, cardiology has yet to systematically consider
the workplace with respect to CVD.
The discipline of Occupational Cardiology can be an inter-face
between 1 cardiology & occupational-preventive medicine.
Needed for its further development are:
" Refining & disseminating knowledge of workplace stressors
in the etiology of CVD,
" Acumen in taking & interpreting an occupational history
relevant to the CV system,
" Guidelines for diagnosis & management of work-related
CVD, informed by clinical trials in which the effectiveness of
workplace modifications is tested for CVD patients.
" Educational programs for cardiology & occupational-preventive
medicine,
" Physician empowerment to formulate & implement "heart
healthy" workplace changes,
" Cooperation with other key participants: occupational health
psychologists (OHP), other occupational & public health specialists,
epidemiologists, labor & management
" Legislative and policy support for these goals.
We hope to promote exchange on how Occupational Cardiology can
tie the "Work, stress & health" paradigm to prevention-oriented
clinical practice.
CORRESPONDING AUTHOR: Dr. Karen Belkic, IPR, USC School of
Medicine, 1000 South Fremont, Unit 8, Alhambra, California 91803
USA, kbelkic@hsc.usc.edu