Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the multiple risk factor intervention trial

Background: Acute life stressors can trigger premature death, but the role of more enduring, chronic stressors is less clear. We evaluated men's mortality risk associated with number of different work stressors and marital dissolution during the Multiple Risk Factor Intervention Trial (MRFIT). Methods: Men without definite evidence of coronary heart disease (CHD) at study entry but with above-average risk for CHD mortality based on blood pressure, serum cholesterol levels, and/or cigarette smoking were recruited into MRFIT. Survivors at the end of the trial were followed up for mortality for an additional 9 years. All 12336 survivors who completed the work-event checklist at the annual evaluations during the trial were included in the analyses of work stressors, whereas the 10904 who were married at the start of the trial were included in the analyses of marital dissolution. Results: Increasing number of different work stressors and divorce during the trial were associated with total and cardiovascular mortality during the 9-year follow-up period (Ps≤.01 for linear trend), with a relative risk of 1.26 (95% confidence interval, 1.07-1.48) for those reporting 3 or more different work stressors compared with those reporting none, and relative risk of 1.37 (95% confidence interval, 1.09-1.72) for those who divorced compared with those who remained married for total mortality. Analyses were adjusted for age, intervention group, educational attainment, occurrence of a nonfatal cardiovascular event during the trial, smoking, diastolic blood pressure, alcohol consumption, and serum cholesterol level (the last 4 adjustments were trial averages). Conclusion: Work and marital stressors increase risk for mortality in men.