Association of work-related stressors, support, and satisfaction with cardiovascular disease incidence among Japanese civil servants: a prospective cohort study

Objectives: Work-related stress is associated with cardiovascular disease (CVD), yet the contributions of specific work-related stressors, support, and satisfaction to CVD incidence are not fully understood. Clarifying whether lifestyle behaviors and physiological factors mediate associations between stressors and CVD is essential for targeted prevention. Methods: In this prospective cohort study, a cohort of 4820 Japanese workers (3876 men and 944 women) aged 35-65 years was followed up for CVD incidence from 2007 to 2022. Work-related stressors (eg, quantitative job overload), support (eg, supervisor support), and satisfaction (eg, family life satisfaction) were assessed using the 57-item Brief Job Stress Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for CVD risk. Mediation analysis evaluated the role of lifestyle behaviors (eg, smoking, alcohol consumption) and physiological factors (eg, systolic blood pressure, obesity) in the association between stressors and CVD incidence. Results: Quantitative job overload, low supervisor support, and low family life satisfaction were independently associated with increased CVD incidence (HRs ranging from 1.69 to 2.33). A proportion (24.9%) of the association of quantitative job overload with CVD was significantly mediated by obesity (P = .007). Conclusions: Quantitative job overload, lack of supervisor support, and low family life satisfaction were significant predictors of CVD among Japanese civil servants. These findings suggest that both reducing excessive workload and strengthening support systems inside and outside the workplace may be important for CVD prevention among Japanese civil servants.