Workload, perceived stress, and modifiable cardiovascular risk burden in a German prevention survey

Background Long working hours and psychosocial stress are recognized as relevant and modifiable determinants of cardiovascular health. The World Health Organization and the International Labour Organization have highlighted long working hours as an important occupational risk factor for cardiovascular morbidity and mortality. However, it remains unclear whether workload and stress exhibit additive or interactive associations with an overall modifiable risk factor burden in community-based prevention samples. Purpose To examine the joint association of workload (weekly working hours) and perceived stress with modifiable cardiovascular risk burden in a German prevention survey. Methods In a cross-sectional German prevention survey (58-item questionnaire), weekly working hours were dichotomized as <40 vs ≥40 h/week and perceived stress as lower vs. higher stress. The primary outcome was a modifiable risk burden score excluding stress (range 0–5), summing obesity, smoking, alcohol, low physical activity, and impaired sleep (≥4/5 domains required). Associations were assessed using multivariable linear regression with robust standard errors including workload, stress, and their interaction, adjusted for age, sex, education, household income, and cardiovascular disease (CVD) status. Predictive margins were plotted across the 2×2 exposure groups. Results The adjusted analysis included 470 participants with complete exposure, outcome, and covariate data. The four workload–stress groups differed in age, sex distribution, education, and income (Table 1). Mean (SD) risk burden increased across groups from 0.65 (0.74) in low workload/low stress to 1.27 (0.99) in high workload/high stress (Table). In fully adjusted models, ≥40 h/week was associated with a higher risk burden (β 0.20, 95% CI 0.01–0.38; p=0.035) and higher stress with a higher risk burden (β 0.47, 95% CI 0.19–0.75; p=0.001), with no evidence of interaction (p=0.497), suggesting largely additive effects. Predictive margins showed a stepwise increase in adjusted mean risk burden across workload–stress groups (Figure): 0.67 (95% CI 0.55–0.79), 0.87 (0.74–0.99), 1.14 (0.87–1.40), and 1.20 (0.98–1.43). Conclusion In this German prevention survey, higher workload and higher perceived stress were independently associated with greater modifiable cardiovascular risk burden (excluding stress). The absence of statistical interaction supports largely additive, not synergistic, relationships, highlighting workload and stress as complementary prevention targets.