Skip to main content
Log in

Effort—reward imbalance, heart rate, and heart rate variability: the cardiovascular risk in young finns study

  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background: Work stress indicated by effort—reward imbalance is hypothesized to cause autonomic arousal, which, if prolonged or frequent, could contribute to cardiovascular pathology. However, only limited empirical evidence on this mechanism is available. Purpose: This study examined associations between effort-reward imbalance, heart rate (HR), and heart rate variability (HRV). Method: The participants were 457 women and 406 men (mean age 32.3 years) derived from the population-based Young Finns Study. Effort—reward imbalance was defined as the ratio between effort and reward, higher efforts compared to rewards indicating greater imbalance. Results: In age-adjusted regression models, higher effort-reward imbalance was associated with lower HRV, and lower reward was associated with higher HR among women. These associations were not attenuated after additional adjustments for demographic characteristics and coronary risk factors. No significant associations of effort—reward imbalance or its components with HR and HRV were found in men. Conclusion: Our finding of lower HRV and higher HR in young healthy women with high effort—reward imbalance and low rewards provides evidence of a potential mechanism that may link effort-reward imbalance to the development of coronary heart disease (CHD) in women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Åkerblom, H. K., Uhari, M., Pesonen, E., Dahl, M., Kaprio, E. A., Nuutinen, E. M., et al. (1991). Cardiovascular risk in young Finns.Annals of Medicine, 23, 35–39.

    Article  PubMed  Google Scholar 

  • Allen, M. T., Stoney, C. M., Owens, J. F., & Matthews, K. A. (1993). Hemodynamic adjustments to laboratory stress: The influence of gender and personality.Psychosomatic Medicine, 55, 505- 517.

    PubMed  Google Scholar 

  • Antelmi, I., de Paula, R. S., Shinzato, A. R., Peres, C. A., Mansur, A. J., & Grupi, C. J. (2004). Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease.American Journal of Cardiology, 93, 381–385.

    Article  PubMed  Google Scholar 

  • Berntson, G. G., Bigger, J. T. J., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., et al. (1997). Heart rate variability: Origins, methods, and interpretive caveats.Psychophysiology, 34, 623–648.

    Article  PubMed  Google Scholar 

  • Berntson, G. G., Cacioppo, J. T., Binkley, P. F., Uchino, B. N., Quigley, K. S., & Fieldstone, A. (1994). Autonomic cardiac control. III. Psychological stress and cardiac response in autonomic space as revealed by pharmacological blockades.Psychophysiology, 31, 599–608.

    Article  PubMed  Google Scholar 

  • Bigger, J. T., Jr., Fleiss, J. L., Rolnitzky, L. M., & Steinman, R. C. (1993). Mycardial infarction: The ability of several short-term measures of RR variability to predict mortality after myocardial infarction.Circulation, 88, 927–934.

    PubMed  Google Scholar 

  • Blumenthal, J. A., Burg, M. M., Barefoot, J., Williams, R. B., Haney, T., & Zimet, G. (1987). Social support, type A behavior, and coronary artery disease.Psychosomatic Medicine, 49, 331–340.

    PubMed  Google Scholar 

  • Chandola, T., Siegrist, J., & Marmot, M. (2005). Do changes in effort-reward imbalance at work contribute to an explanation of the social gradient in angina?Occupational and Environmental Medicine, 62, 223–230.

    Article  PubMed  Google Scholar 

  • Collins, A., & Frankenhaeuser, M. (1978). Stress responses in male and female engineering students.Journal of Human Stress, 4, 43–48.

    PubMed  Google Scholar 

  • Dekker, J. M., Crow, R. S., Folsom, A. R., Hannan, P. J., Liao, D., Swenne, C. A., et al. (2000). Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: The ARIC Study.Circulation, 102, 1239–1244.

    PubMed  Google Scholar 

  • Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability.Perceptual and Motor Skills, 91, 515–524.

    Article  PubMed  Google Scholar 

  • Dishman, R. K., Nakamura, Y., Garcia, M. E., Thompson, R. W., Dunn, A. L., & Blair, S. N. (2000). Heart rate variability, trait anxiety, and perceived stress among physically fit men and women.International Journal of Psychophysiology, 37, 121–133.

    Article  PubMed  Google Scholar 

  • Du, X. J., Riemersma, R. A., & Dart, A. M. (1995). Cardiovascular protection by oestrogen is partly mediated through modulation of autonomic nervous function.Cardiovascular Research, 30, 161–165.

    PubMed  Google Scholar 

  • Elo, A.-L. (1994). Assessment of mental stress factors at work. In C. Zenz, O. B. Dickerson, & E. P. Horvath (Eds.),Occupational Medicine (3rd ed., pp. 945–959). Baltimore: Mosby.

    Google Scholar 

  • Elo, A.-L., Leppanen, A., Lindström, K., & Ropponen, T. (1990).Miten käytät työstressikyselyä (työterveyshuolto 17). Helsinki:Työterveyslaitos.

    Google Scholar 

  • Elo, A.-L., Leppänen, A., Lindström, K., & Ropponen, T. (1992).Occupational Stress Questionnaire: User’s instruction (Reviews 19). Helsinki: Finnish Institute of Occupational Health.

    Google Scholar 

  • Elovainio, M., Leino-Arjas, P., Vahtera, J., & Kivimäki, M. (2006). Justice at work and cardiovascular mortality: A prospective cohort study.Journal of Psychosomatic Research, 61, 271–274.

    Article  PubMed  Google Scholar 

  • Fahlen, G., Peter, R., & Knutsson, A. (2004). The Effort-Reward Imbalance model of psychosocial stress at the workplace: A comparison of ERI exposure assessment using two estimation methods.Work and Stress, 18, 81–88.

    Article  Google Scholar 

  • Gianaros, P. J., Salomon, K., Zhou, F., Owens, J. F., Edmundowicz, D., Kuller, L. H., et al. (2005). A greater reduction in high- frequency heart rate variability to a psychological stressor is associated with subclinical coronary and aortic calcification in postmenopausal women.Psychosomatic Medicine, 67, 553–560.

    Article  PubMed  Google Scholar 

  • Girdler, S. S., Turner, J. R., Sherwood, A., & Light, K. C. (1990). Gender differences in blood pressure control during a variety of behavioral stressors.Psychosomatic Medicine, 52, 571–591.

    PubMed  Google Scholar 

  • Habib, G. (1997). Reappraisal of the importance of heart rate as a risk factor for cardiovascular morbidity and mortality.Clinical Therapeutics, 19, 39–52.

    Article  PubMed  Google Scholar 

  • Hanson, E. K. S., Godaert, G. L. R., Maas, C.J. M., & Meijman, T. F. (2001). Vagal cardiac control throughout the day: The relative importance of effort-reward imbalance and within-day measurements of mood, demand and satisfaction.Biological Psychology, 56, 23–44.

    Article  PubMed  Google Scholar 

  • Harris, K. F., & Matthews, K. A. (2004). Interactions between autonomic nervous system activity and endothelial function: A model for the development of cardiovascular disease.Psychosomatic Medicine, 66, 153–164.

    Article  PubMed  Google Scholar 

  • Huikuri, H. V., Jokinen, V., Syvanne, M., Nieminen, M. S., Airaksi-nen, K. E., Ikaheimo, M. J., et al. (1999). Heart rate variability and progression of coronary atherosclerosis.Arteriosclerosis, Thrombosis, and Vascular Biology, 19, 1979–1985.

    PubMed  Google Scholar 

  • Jain, D., Joska, T., Lee, F. A., Burg, M., Lampert, R., & Zaret, B.L. (2001). Day-to-day reproducibility of mental stress-induced abnormal left ventricular function response in patients with coronary artery disease and its relationship to autonomic activation.Journal of Nuclear Cardiology, 8, 347–355.

    Article  PubMed  Google Scholar 

  • Janszky, I., Ericson, M., Mittleman, M. A., Wamala, S., Al-Khalili, F., Schenck-Gustafsson, K., et al. (2004). Heart rate variability in long-term risk assessment in middle-aged women with coronary heart disease: The Stockholm Female Coronary Risk Study.Journal of Internal Medicine, 255, 13–21.

    Article  PubMed  Google Scholar 

  • Jennings, J. R. (2000). Heart rate. In G. Fink, T. Cox, N. J. Rothwell, E. R. de Kloet, R. T. Rubin, B. S. McEwen, et al. (Eds.),Encyclopedia of Stress (Vol. 1, pp. 333–337). San Diego: Academic Press.

    Google Scholar 

  • Jokinen, V., Ukkola, O., Airaksinen, K. E. J., Koistinen, J. M., Ikäheimo, M. J., Kesäniemi, Y. A., et al. (2003). Temporal changes in cardiovascular autonomic regulation in type II diabetic patients: association with coronary risk variables and progression of coronary artery disease.Annals of Medicine, 35, 216–223.

    Article  PubMed  Google Scholar 

  • Juonala, M., Viikari, J. S. A., Hutri-Kähönen, N., Pietikäinen, M., Jokinen, E., Taittonen, L., et al. (2004). The 21-year follow- up of The Cardiovascular Risk in Young Finns Study: Risk factor levels, secular trends and east-west difference.Journal of Internal Medicine, 255,457–468.

    Article  PubMed  Google Scholar 

  • Kivimäki, M., Ferrie, J. E., Brunner, E., Head, J., Shipley, M. J., Vahtera, J., et al. (2005). Justice at work and reduced risk of coronary heart disease among employees: The Whitehall II Study.Archives of Internal Medicine, 165, 2245–2251.

    Article  PubMed  Google Scholar 

  • Kivimäki, M., Leino-Arjas, P., Luukkonen, R., Riihimäki, H., Vahtera, J., & Kirjonen, J. (2002). Work stress and risk of cardiovascular mortality: Prospective cohort study of industrial employees.British Medical Journal, 325, 857–860.

    Article  PubMed  Google Scholar 

  • Komesaroff, P. A., Esler, M. D., & Sudhir, K. (1999). Estrogen supplementation attenuates glucocorticoid and catecholamine responses to mental stress in perimenopausal women.Journal of Clinical Endocrinology and Metabolism, 84, 606–610.

    Article  PubMed  Google Scholar 

  • Kudielka, B. M., Buske-Kirschbaum, A., Hellhammer, D. H., & Kirschbaum, C. (2004). Differential heart rate reactivity and recovery after psychosocial stress (TSST) in healthy children, younger adults, and elderly adults: The impact of age and gender.International Journal of Behavioral Medicine, 11, 116- 121.

    Article  PubMed  Google Scholar 

  • Kuper, H., Singh-Manoux, A., Siegrist, J., & Marmot, M. (2002). When reciprocity fails: Effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II study.Occupational and Environmental Medicine, 59,777–784.

    Article  PubMed  Google Scholar 

  • Matthews, K. A., Gump, B. B., & Owens, J. F. (2001). Chronic stress influences cardiovascular and neuroendocrine responses during acute stress and recovery, especially in men.Health Psychology, 20,403–410.

    Article  PubMed  Google Scholar 

  • Myrtek, M., Weber, D., Brugner, G., & Müller,W. (1996). Occupational stress and strain of female students: Results of physiological, behavioral, and psychological monitoring.Biological Psychology, 42, 379–391.

    Article  PubMed  Google Scholar 

  • Palatini, P., & Julius, S. (2004). Elevated heart rate: A major risk factor for cardiovascular disease.Clinical and Experimental Hypertension, 26, 637–644.

    Article  PubMed  Google Scholar 

  • Peter, R., & Siegrist, J. (1999). Chronic psychosocial stress at work and cardiovascular disease: The role of effort-reward imbalance.International Journal of Law and Psychiatry, 22, 441- 449.

    Article  PubMed  Google Scholar 

  • Peter, R., & Siegrist, J. (2000). Psychosocial work environment and the risk of coronary heart disease.International Archives of Occupational and Environmental Health, 73, s41-s45.

    Article  PubMed  Google Scholar 

  • Porges, S. W (1995). Cardiac vagal tone: A physiological index of stress.Neuroscience and Biobehavioral Reviews, 19, 225–233.

    Article  PubMed  Google Scholar 

  • Riese, H., Van Doornen, L. J. P., Houtman, I. L. D., & De Geus, E. J. C. (2004). Job strain in relation to ambulatory blood pressure, heart rate, and heart rate variability among female nurses.Scandinavian Journal of Work, Environment & Health, 30, 477–485.

    Google Scholar 

  • Roos, E., Lahelma, E., Virtanen, M., Prättälä, R., & Pietinen, P. (1998). Gender, socioeconomic status and family status as determinants of food behavior.Social Science and Medicine, 46, 1519–1529.

    Article  PubMed  Google Scholar 

  • Rozanski, A., & Kubzansky, L. D. (2005). Psychologic functioning and physical health: A paradigm of flexibility.Psychosomatic Medicine, 67, s47-s53.

    Article  PubMed  Google Scholar 

  • Siegrist, J. (1996). Adverse health effects of high-effort/low-reward conditions.Journal of Occupational Health Psychology, 1,27- 41.

    Article  PubMed  Google Scholar 

  • Siegrist, J., Klein, D., & Voigt, K.-H. (1997). Linking sociological with physiological data: The model of effort-reward imbalance at work.Acta Physiologica Scandinavica, 161, 112–116.

    Google Scholar 

  • Siegrist, J., & Peter, R. (1994). Job stressors and coping characteristics in work-related disease: Issues of validity.Work and Stress, 8, 130–140.

    Article  Google Scholar 

  • Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., et al. (2004). The measurement of effort- reward imbalance at work: European comparisons.Social Science and Medicine, 58, 1483–1499.

    Article  PubMed  Google Scholar 

  • Sihvonen, A.-P., Kunst, A. E., Lahelma, E., Valkonen, T., & Mackenbach, J. P. (1998). Socioeconomic inequalities in health expectancy in Finland and Norway in the late 1980s.Social Science and Medicine, 47, 303–315.

    Article  PubMed  Google Scholar 

  • Stolarz, K., Staessen, J. A., Kuznetsova, T., Tikhonoff, V., State, D., Babeanu, S., et al. (2003). Host and environmental determinants of heart rate and heart rate variability in four European populations.Journal of Hypertension, 21, 525- 535.

    Article  PubMed  Google Scholar 

  • Task Force. (1996). Heart rate variability: Standards of measurement, physiological interpretation, and clinical use.Circulation, 93, 1043–1065.

    Google Scholar 

  • Telama, R., Yang, X., Laakso, L., & Viikari, J. (1997). Physical activity in childhood and adolescence as predictor of physical activity in young adulthood.American Journal of Preventive Medicine, 13, 317–323.

    PubMed  Google Scholar 

  • Tracey, K. J. (2002). The inflammatory reflex.Nature, 420, 853- 859.

    Article  PubMed  Google Scholar 

  • Tsuji, H., Larson, M. G., Venditti, F. J., Jr., Manders, E. S., Evans, J. C., Feldman, C. L., et al. (1996). Electrophysiology/pacing: Impact of reduced heart rate variability on risk for cardiac events: The Framingham Heart Study.Circulation, 94, 2850- 2855.

    PubMed  Google Scholar 

  • van Vegchel, N., de Jonge, J., Bosma, H., & Schaufeli, W. (2005). Reviewing the effort-reward imbalance model: Drawing up the balance of 45 empirical studies.Social Science and Medicine, 60, 1117–1131.

    Article  PubMed  Google Scholar 

  • Vrijkotte, T. G. M., van Doornen, L. J. P., & de Geus, E. J. C. (2000). Effects of work stress on ambulatory blood pressure, heart rate, and heart rate variability.Hypertension, 35, 880- 886.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liisa Keltikangas-Järvinen.

Additional information

This studywas supported by Academy of Finland (grants 111056 [L. K.-J.], 209514 [L. K.-J.], 209518 [L. K.-J.], and 53392 [O. T.R.]), Psykonet Graduate School of Psychology (M. H.), Otto A. Malm’s Donation Fund (M. H.), and Oskar Ö flund’s Foundation (M. H.).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hintsanen, M., Elovainio, M., Puttonen, S. et al. Effort—reward imbalance, heart rate, and heart rate variability: the cardiovascular risk in young finns study. Int. J. Behav. Med. 14, 202–212 (2007). https://doi.org/10.1007/BF03002994

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03002994

Key words

Navigation