When employers think about stress, they often think about burnout, absenteeism, turnover and productivity. As a cardiologist, I think about the heart.
In recent years, I have treated a growing number of patients in their 40s with early signs of cardiovascular disease. Many do not fit the traditional risk profile. They exercise regularly. They do not smoke. Their cholesterol levels are not markedly elevated.
What they share is sustained strain: rising housing costs, childcare expenses, responsibility for aging parents and job insecurity. The pressure does not end when the workday does.
Chronic psychological stress activates the body’s stress response system. Cortisol and catecholamines remain elevated, contributing over time to higher blood pressure, endothelial dysfunction, metabolic changes and systemic inflammation. These physiologic effects are well-established contributors to atherosclerosis and cardiovascular events. Cardiovascular risk accumulates gradually, often without obvious warning signs.
The symptoms can be subtle: unexplained fatigue, shortness of breath with exertion, intermittent chest discomfort and even disrupted sleep. Patients often say, “It’s probably just stress.” However, stress is not merely emotional. It has measurable biological consequences.
For employers, this has tangible implications. Financial strain may originate outside the workplace, but its health consequences manifest within it through increased medical claims, presenteeism and long-term disability risk. Traditional wellness programs appropriately emphasize physical activity and preventive screening. Those matter. But, if financial stress is not addressed as a driver of chronic disease, an important determinant of cardiovascular risk is overlooked.
The encouraging news is that stress-related cardiovascular risk is increasingly recognized and, when identified early, progression of disease can often be slowed or prevented through risk-factor control, preventive care and sustained stress reduction. Normalizing conversations about stress, supporting access to care and integrating meaningful financial wellness resources can make a measurable difference.
Financial stress may begin outside an employer’s walls, but its health impact arrives at work each day.
Maulik Shah, M.D., is the executive director of HonorHealth Heart Care. Dr. Shah was raised in Phoenix and attended Brophy Preparatory School before attending Stanford University for his undergraduate degrees. He earned his medical degree at UCSF and has been practicing for more than 20 years.
