Association between occupational stress responses and cardiovascular disease incidence in middle-aged Japanese: findings from the Aichi workers’ cohort study

Objectives: This study aimed to investigate the association between occupational stress responses indicated by fatigue and nonspecific physical complaints and the incidence of subsequent cardiovascular disease (CVD) in middle-aged Japanese workers. Methods: A cohort of 4,820 Japanese workers (3876 men and 944 women) aged 35–65 years was followed up from 2007 to March 2022 for CVD incidence. Fatigue and nonspecific physical complaints were evaluated using the 57-item Brief Job Stress Questionnaire, and each was categorized into two groups based on the presence or absence. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) for stress responses to CVD were estimated using a multivariable Cox proportional hazard model adjusted for age, sex, smoking status, alcohol consumption, regular exercise, sleep duration, working hours, body mass index, systolic blood pressure, total cholesterol, and histories of hypertension, hyperlipidemia, and diabetes, night shift and job type. Results: During the median follow-up of 13.7 years, 116 patients with CVD were identified. The presence of fatigue was independently associated with CVD incidence (HR: 2.28, 95% CI: 1.05–4.94). Similarly, the presence of nonspecific physical complaints was significantly associated with CVD incidence (HR: 2.54, 95% CI: 1.43–4.52). The sex-stratified analysis showed consistent results in men but not in women. Conclusions: These findings suggest that fatigue and nonspecific physical complaints may serve as early indicators of CVD risk among middle-aged Japanese male workers. Incorporating routine assessment of these stress responses into workplace health screening could facilitate targeted prevention strategies.