Recent studies have controversial results about the correlation between job strain and stroke so in this study we aimed to find out if there is any correlation or not. We could not find any significant relationship between job types, job strain and stroke types. Stroke was more commonly seen in housewives, employees, farmers and self-employments. Probably about employees and housewives, inactivity and about farmers and self-employment, high stress levels may be involved but this study does not have enough evidences to prove this hypothesis.
The pathogenesis of coronary heart disease and ischemic stroke is somewhat overlapped and atherosclerosis is the most common cause for them (Fisher and Folland, 2008). Job strain is often associated with some risk factors of cardiovascular disease (CVD) such as metabolic syndrome, high body mass index, glucose metabolic dysfunction, dyslipidemia and etc. which are also known as stroke risk factors (Chandola et al., 2008). There are several studies about how job strain can affect the cardiovascular system, for example by activating neuroendocrine feedback to stressors, hypothalamic-pituitary-adrenal axis dysfunction, metabolic syndrome, indirect effect of unhealthy behaviors such as smoking and lack of exercise and etc. (Vrijkotte et al., 2000; Brunner et al., 2002; Kunz-Ebrecht et al., 2004; Hemingway et al., 2005; Chandola et al., 2008).
A meta-analysis study by Fransson et al. (2015) for the purpose of investigating the association between job strain and different subtypes of stroke performed on 196380 working males and females from 14 European cohort studies, showed that job strain can cause an approximately 20% increased risk of acute ischemic stroke. There was no association between job strain and the overall stroke or hemorrhagic stroke. This correlation between job strain and ischemic stroke, is similar to the results of a meta-analysis study by Kivimaki et al. (2012) performed on 197473 participants from 13 European cohort studies, which noted an association between job strain and coronary heart disease.
A prospective study by Tsutsumi et al. (2009) examined the association between occupational stress and stroke risk performed on 6553 Japanese male and female workers showed a more than 2-fold increase in total stroke risk among male patients with high job strains compared to male patients with low job strains. In female patients, there was no statistically significant differences for any stroke incidence among the high strain and low strain jobs.
A meta-analysis study by Nyberg et al. (2013) was conducted on 47045 participants from eight studies to investigate the association between job strain and cardiovascular risk factors. This study showed that a patient with job strain has a higher prevalence of diabetes, smoking and physical inactivity. In this study no significant clinical difference was found in blood lipids, blood pressure, pulse pressure or prevalence of hypertension between patients with or without job strain.
A study by Torén et al. (2014) was performed to investigated the association between job strain, coronary heart disease (CHD) and stroke. They comprised 6070 men who were free from any previous history of CHD and stroke at baseline. It was concluded that exposure to job strain, increases the risk of CHD especially in smokers and blue-collar workers but no increase in stroke risk was seen.
Limitations: In this study, we only discussed the relationship between job strain and stroke rates without adjusting other possible variables so the effects of other variable may have an influence on the result. As this study was done for the first time in our region so we didn’t perform it in the format of cohort, for confirmation any relation, we need the higher number of patients in a longer period of time.