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Prevention of work-related Cardiovascular Diseases
Promotion of cardiovascular health in the workplace
There are various possibilities for the prevention of cardiovascular diseases (CVD) in the workplace. Primary, secondary and tertiary preventive approaches should be considered.
Current knowledge on the occupational causes of a CVD indicates the possibility of reducing the risk for these diseases through measures for work structuring, e.g. work organisation and workplace design.
Prevention aims to avoid the disease or to delay to its emergence. For this purpose, appropriate measures for work structuring and individual lifestyle changes are crucial. Questions of work structuring with regard to cardiovascular health are subject to various projects conducted by the Federal Institute for Occupational Safety and Health (BAuA).
Workplace health promotion
Workplace health promotion can help to asses cardiovascular risks. Risk factors can be identified, such as undetected hypertension or prediabetes. In combination with (lifestyle) counselling, employees can learn about how to influence their risk factors.
For the prevention of cardiovascular diseases in the workplace environment it is important that all parties in the company – above all employers, employees, company doctors and safety specialists - are sufficiently sensitised and informed on the subject of work and cardiovascular health. The population attributable risk (PAR) is a suitable measure for this. The PAR states the percentage by which the incidence of a disease among the population can be reduced if the risk factor were eliminated. Lifestyle risk factors such as nicotine consumption and physical inactivity are accepted as significant for the development of a cardiovascular disease. In comparison to a PAR of over 30 per cent for nicotine consumption, the PAR for physical inactivity is relatively low at 8 per cent. Physical inactivity is regarded as less than 150 minutes of moderate activity per week. PARs determined for occupational risk factors lie within a similar range: shift work at 4 to 5 per cent, overlong working hours at 5 to 8 per cent. This indicates a potential not only for behavioural prevention, i.e. support for lifestyle changes, but also for organisational prevention, i.e. changes in the work environment or work restructuring. BAuA's research project F 2316 compares the importance of occupational and general CVD risk factors.
Preventive occupational medical care
In accordance with the German Ordiance of Occupational Healthcare Regulations (Verordnung zur arbeitsmedizinischen Vorsorge, ArbMedVV), cardiac efficiency must be measured in occupational health check-ups to evaluate the stress and the resilience of the cardiovascular system with some occupational demands, e.g. if the employee wears breathing apparatus. An exercise ECG is suitable for this. This is also a standard examination for the early detection of CVD in employees who work with chemical substances such as carbon monoxide or trichlorethane.
In case of occupational risk factors of CVD, such as shift work, the cardiovascular risk (risk score) can be ascertained. For this purpose, the doctor compiles data on the probability of myocardial infarction - i.e., blood pressure, plasma lipid levels, genetic disposition and lifestyle factors - in order to inform those affected at an early stage and to intervene where necessary.
As part of the update and upgrade to classification S2k of the guidelines on "Health aspects and structuring night work and shift work" ("Gesundheitliche Aspekte und Gestaltung von Nacht- und Schichtarbeit"), the level of scientific knowledge on the effects of night work and shift work on employees' health, that is on the cardiovascular system as well, is summarised. Starting from this, recommendations on the structuring of night work and shift work and recommendations for preventive and compensatory measures will be derived and consented.
Workplace integration management
According to data from the German pension insurance (Deutsche Rentenversicherung), benefits for medical rehabilitation with the indication of coronary heart disease or myocardial infarction have increased by about 30 per cent in the last ten years. In 2014, five per cent of all medical rehabilitation benefits were the result of coronary heart disease or myocardial infarction. The average age of rehabilitants was 54.5. Women of working age are much less affected by coronary heart disease than men: according to the Rehabilitation Report 2015 (Reha-Bericht 2015), only 17 per cent of the rehabilitation benefits were claimed by women. After completion of rehabilitation, the capacity - in relation to the last occupation - is restored for approximately 90 per cent of cardiology patients.
Returning to work after the illness is very important for those affected, as working secures their financial existence and means taking part in social life. Both personal and occupational factors play a part in the success of the reintegration process. As occupational factors, both high physical workload and psychosocial risk factors are discussed as determinants for the reintegration process.
In BAuA's project F 2354 a Cochrane Review is conducted to evaluate interventions for supporting patients with coronary heart disease in returning to work process.
Compensation for occupational diseases
The German Social Accident Insurance (DGUV) regards CVD as "widespread diseases" that are only recognised as occupational diseases under specific conditions.