Introduction Stress can no longer be recognized as a problem of an individual only. Due to its versatile presence in every human’s life, often resulting in health complications, stress has become a social problem and the role of work-related stress in this puzzle should not be underestimated. Coronary heart disease (CHD) is on the list of stress-related health problems. 1997 2000 1991 2001 2001 2002 2003 2005 1999 1995 1998 1998 1998 2002 2005 2005 1997 2001 2002 2005 The current study aimed to fill this gap and to assess the relationship between work-related stress and preclinical atherosclerotic changes in healthy employees. We considered carotid artery intima-media thickening and/or plaque presence as a surrogate of coronary atherosclerosis. To detect these changes “gold-standard” methodology, i.e., B-mode carotid ultrasound examination, was applied. Because of the complex nature of the pathogenesis of CHD, other contributing factors have not been disregarded. Methods Organization of the study First, all participants took part in a psychological study in which the level of stress and coping were evaluated with relevant questionnaires (see below). Then, the participants consecutively presented themselves for a clinical visit in which a medical examination took place and a blood sample was taken. Tests for biochemical parameters (see below) were performed on the same day as the blood sample was taken, according to routine laboratory procedures. Sera for immunological parameters (see below) were collected and stored according to international laboratory standards, then tested in runs (up to 40 sera per day) to minimize day-to-day variations. Participants 1 Table 1 Characteristics of studied groups  n n (n Number 50 (50%) 25 (50%) 75 (50%)  Females  Males 50 (50%) 25 (50%) 75 (50%) Age 47.2 ± 6.8 50.16 ± 6.46 48.68 ± 6.63  Mean (years)   Minimum 34 35 34.5  Maximum 65 64 64.5 Individual risk factors 26 (26%) 23 (46%) 49 (32%)   Hypertension   Obesity 19 (19%) 17 (34%) 36 (24%)  Diabetes 1 (1%) 1 (2%) 2 (1.3%) Alcohol use     Every day 3 (3%) 0 3 (2%)   2–3×a week 23 (23%) 2 (4%) 25 (16.7%)   Less 69 (69%) 47 (94%) 116 (77.3%)   Never 5 (5%) 1 (2%) 6 (4%)  Smoking cigarettes 49 (49%) 30 (60%) 79 (52.7%)  Hormone replacement therapy 8 (8%) 4 (8%) 12 (8%) Physical activity      2–3×a week 26 (26%) 12 (24%) 38 (25%)   1×in 7–10 days 32 (32%) 14 (28%) 46 (30.7%)   Less 42 (42%) 24 (48%) 66 (44%) Family risk factors 41 (41%) 31 (62%) 72 (48%)  Hypertension  Obesity 45 (45%) 23 (46%) 68 (45.3%)  Diabetes 31 (31%) 12 (24%) 43 (28.7%)  Heart attack 36 (36%) 21 (42%) 57 (38%)  Stroke 30 (30%) 17 (34%) 47 (31.3%) Instruments Work-related stress 2001 α α α α α α α α α 2001 Coping α Prior to the study, appropriate approval from the Local Ethics Committee was obtained. Participants were provided with detailed written information on the study’s objectives and the methods that were going to be used; subsequently they signed their informed consent. 2 Anticardiolipin antibodies 1990 x  Anti- β 2  glycoprotein 2  GP 2 Anti-HSP antibody 1989 x Anti-oxLDL IgG antibody hsCRP Intima-media thickness (IMT) and atherosclerotic plaque 1986 Statistical analysis t r α Results Assessment of work-related stress σ σ σ 1951 2001 2 Table 2 Results of psychological examination Studied groups Work-related stress Coping Mean Stens  Mean Stens  Managers 154 6 6 40 5 6 Office workers 145 5 5 38 5 5 Total 151 6 5 40 5 6 Assessment of coping The level of coping measured with OSI-2’s Coping scale was as follows: managers—mean = 40, office workers—mean = 38, both groups—mean = 40. According to Polish sten norms the managers’ mean falls on sten five for men and on sten six for women. The office workers’ mean falls on sten five (for both genders). Thus, it can be said that the coping results were in the average range. Laboratory findings The abnormality most frequently disclosed in biochemical findings were elevated levels of total cholesterol, LDL and triglycerides (in 52, 39 and 22% of the studied individuals, respectively). Decreased levels of HDL and increased levels of glucose were less frequent and were found in 12% of cases each. 2 Ultrasound examination of carotid arteries 3 Table 3 Results of ultrasound examination of carotid arteries in studied groups  n n n  Number of individuals without changes 74 (74%) 33 (66%) 107 (71%)  Number of individuals with plaque 26 (26%) 17 (34%) 43 (29%)  Intima-media measurement values  0.0620 ± 0.014 0.0610 ± 0.012 0.0618 ± 0.013 Correlation between IMT and the presence of plaque in carotid arteries with atherosclerosis risk factors r P r P r P r P r P r P r P r P r P r P r P r P r P r P r P r P r P r P 4 Table 4 r Risk factor IMT Plaque Age  0.42** 0.43** BMI  0.12 0.04 Systolic blood preasure  0.13 0.06 Diastolic blond preasure  0.20* 0.10 Cigarette smoking  0.13 0.18* Physical activity −0.02 0.07 LDL 0.28** 0.30** HDL  −0.16 −0.05 Triglycerides 0.04  0.05 Glucose  0.08 0.02 hsCRP  0.05 0.02 Anti-HSP  0.16 0.19 aCl–IgG  −0.20* −0.10 aCl–IgM  −0.14 −0.15 Anti-oxLDL  −0.10 −0.17 Workload  −0.15  −0.24** Relationships −0.23**  −0.18* Home–work balance  −0.19* −0.33** Managerial role  −0.24* −0.14 Personal responsibility  −0.14 −0.25** Hassle at work  −0.11 −0.14 Recognition  −0.25** −0.15 Organizational climate  −0.22** −0.15 Total index of coping  −0.12 −0.01 Coping through control  −0.05 0.02 Global level of stress −0.26** −0.28** * Correlation is significant at 0.01 (2-tailed) ** Correlation is significant at 0.05 (2-tailed) Correlation between LDL/smoking and global stress level r P r P Work-related stress, coping, lifestyle and IMT P P Discussion 2006 2 1997 1991 2001 2001 2002 2003 The present study was undertaken to extend the investigation of psychosocial stress and atherosclerosis. We looked in depth for correlation between preclinical atherosclerosis and work-related stress; correlations with other risk factors of CHD were done in parallel. As expected, we found correlation between IMT and age, diastolic blood pressure, LDL and anti-HSP antibodies, and correlation between plaque and age, smoking and LDL. Surprisingly, our results revealed that early atherosclerotic changes negatively correlated with the level of global job strain and some of its components (interpersonal relations, work–home balance, managerial role, organization climate—for IMT; work load, interpersonal relations, work–home balance, responsibility—for plaque). 2002 1997 2005 2001 1995 By searching for a relationship between work-related stress and atherosclerosis, we wanted to prove that the correlation found between early atherosclerotic changes and LDL and smoking is, at least partly, caused by a higher stress reaction in the studied individuals. It was assumed that individuals with a level of high stress undertook unhealthy behaviour: smoking or excessive food intake. However, for both LDL and smoking the correlation with stress was negative. One should keep in mind that only 39% of the studied individuals had elevated levels of LDL and 47% reported smoking. Therefore, these results should be interpreted causally. We explored in depth the negative correlation we found between IMT and the presence of plaque, and the level of work-related stress. Being aware that OSI-2 measured perceived stress, another hypothesis was formulated; persons with a high level of work-related stress (conscious stress) undertake preventive activities at the level of coping or healthy lifestyle. 1998 2002 2005 2005 2002 2004 2004 2001 2002 2004 2005 2003 2002 In our study on preclinical atherosclerosis and work-related stress, we were not able to confirm the hypothesis about the above-mentioned prophylactic activities. An analysis of correlation showed no significant relations between work-related stress and coping, between coping and IMT, between work-related stress and healthy lifestyle, or between healthy lifestyle and IMT. 2005 The most probable interpretation of the negative correlation between perceived work- related stress and preclinical atherosclerosis is that in the case of individuals with a low level of perceived work-related stress, somatization of stress took place, i.e., stress is not perceived at the conscious level but it leads to somatic effects (e.g., IMT). We are aware of some limitations of our study. Firstly, the results regarding work-related stress were based on self-reported data, which per se could always be a matter of some bias. Secondly, the number of employees studied was limited to 150. Voluntary participation of employees and fully unselected method of recruitment can guarantee the objectivity of the results. Thirdly, it was a cross-sectional study. A prospective type of research on risk assessment is preferable nowadays. However, our study did not aim to assess risk of CHD but to find correlation between work-related stress and early atherosclerosis, so we believe the measure taken for this purpose was appropriate. We are more than convinced that to achieve full understanding of negative correlation between work-related stress and early atherosclerosis requires further interdisciplinary studies and we would be happy to continue exploration into this intriguing field.