In the rush of 12-hour working days fuelled by fatty snacks and liquid lunches, it's easy to forget that you are utterly, utterly reliant on a small ball of muscle in your chest. We report on drive to alert executives to the danger they're in – before it's too late
One tuesday morning during last August's heat wave, Neil Kenworthy, a 61-year-old director of quantity surveyor MDA, left his Croydon office to travel by train to Victoria station in central London. He was due to have lunch with one of his company's key clients.

Kenworthy never made it to the restaurant. While the train was stopped at a signal, he suffered a fatal heart attack. An ambulance was summoned, but arrived too late to resuscitate him. A bystander tried to contact his next of kin by dialling the last number called on his mobile phone. One of Kenworthy's colleagues answered, and as he listened to the caller describing the grey-haired, bespectacled man who lay stricken on the floor of the train, the awful truth dawned.

"It was a tragic way to hear the news," recalls Charles Johnston, the chairman of MDA. "But the attack was not surprising. Neil was an extremely dedicated professional man, and he basically worked far too hard, considering his lifestyle.

"Neil was one of these people who was totally driven. He thrived on pressure and had a tremendously high work rate. He would be in the office at 7am and wouldn't leave until 7pm."

An ex-colleague of Kenworthy points to other factors that probably contributed to the heart attack: he had suffered a leg injury, which discouraged him from exercising, and he was a heavy smoker. "Neil used to go into his office, shut the door and you would see the fog of cigarette smoke rising," he says.

After Kenworthy's death, lots of people at MDA gave up cigarettes, reduced their alcohol consumption and joined gyms. "It's been a total wake-up call," says Johnston. He wants his colleague's fate to be seen as a warning not just to all MDA staff, but also to the wider construction industry. As a matter of routine, executives have to travel around the country to make business and site meetings at unsociable hours, they deal with endless on-site problems and they often find themselves in confrontational situations. Now they are starting to realise that this style of working may be shortening their life expectancy.

The British Heart Foundation warns that the stress has a wide impact on an individual's behaviour. A spokesperson for the foundation says: "Stressful day-to-day living may include a less healthy lifestyle, which could contribute to the risk factors for heart disease. For instance, stress might prevent a good night's sleep, or people suffering from stress may tend to take unhealthy snacks throughout the day, rather than taking the time to eat healthy meals. They may smoke more and drink more alcohol as a coping strategy for their stressful lifestyle."

MDA is not the only firm that is thinking hard about ways to manage the effects of stress on its executives. Many firms and top executives are looking for ways to improve their survival prospects. As a consequence of Kenworthy's death, MDA has introduced annual medical checks for all staff and it takes the effects of work stress on its employees' health more seriously.

The industry is led by middle-aged men with bulging waistlines. You can see why there would be a lot of victims

Allan McDougall, managing director, Shepherd Engineering

Johnston adds that the untimely death of Kenworthy brought home the need for a company to draw up contingency plans to deal with the sudden death of a senior manager. "Neil was in his early 60s, so the company had thought he would be working for at least another four years. When he sadly passed away, we had to have a total rethink of the hierarchy," he says.

On the subject of succession, Allan McDougall, the managing director of Shepherd Engineering, says that an employee's health and lifestyle are becoming a criterion for recruitment and promotion. He says: "There are four men vying for my job when I go, and three of these guys certainly do a lot more exercise than I did at their age."

McDougall knows whereof he speaks: six years ago, he underwent a routine operation to treat his angina. It went wrong, and surgeons had to give him an emergency bypass on the table. "I have come through it and have changed my life accordingly; I've cut down on the amount of animal fats I eat and I've long since stopped smoking."

He says it is not difficult to see why the industry must take the health of its senior executives seriously. "The industry is led by mainly middle-aged men with bulging waistlines, who do not do a lot of exercise. You can see why there would be a lot of victims." But he adds that it is never too late to make changes that can turn your life around. He mentions a Shepherd project director in his late 40s, who suffered a heart attack eight years ago, and who changed his life accordingly.

McDougall adds that the growth of partnering relationships and the advent of more collaborative ethos in the industry may be reducing the pressure on senior staff. He also points to a modernisation in working practices. The old-school contractors who expect managers to be on site at 6am and not to leave until early evening are in decline. But he warns that there are still sections of the industry that still operate in a highly pressurised working environment that could be harmful to executives' health.

The media spotlight is an additional source of stress. The modern-day construction industry attracts intense and often intensely hostile press attention when projects go wrong. Chief executives and senior executives are often held personally to account for business performance, and are under considerable pressure to present themselves and their companies favourably to the media. Listed companies have must also account for themselves to the City.

One victim of this trend may have been the late Chris Powell, a former Atkins regional director and a vice president of the RICS. In 2002, Powell was in charge of an Atkins PFI project. It is understood that the job was not going well for Powell, and that he was depressed by the negative coverage of PFI procurement in the national press. On a Friday afternoon in October 2002, Powell was made redundant. He suffered a heart attack and died on the following Sunday. He was 57 years old.

Stressed people may tend to take unhealthy snacks, rather than taking the time to eat healthy meals. They may smoke more and drink more alcohol as a coping strategy

British Heart Foundation

A friend of Powell's says: "It was very sad when Chris passed away. He worked tremendously hard but he had huge amounts of pressure piling up on him at Atkins. I am sure this contributed to the heart attack. It should be seen as a lesson to us all."

One company boss trying to deal with health problems before they arise is Steve Pycroft, the 45-year-old chief operating officer at Mace. He had a health check in autumn 2002, and was given the chilling news that he was a prime candidate for a heart attack. His father died from that cause in his 60s, and his weight was more than 15 stone, which put him in the obese category. Pycroft decided to do between three and five hours a week on a cycling machine while wired to a heart monitor. He also cut down on his intake of crisps, peanuts, bread and desserts, and switched to drinking white wine instead of beer. "I feel much better physically," he says.

But Pycroft does not think of himself as a victim of stress. "The job has always been about long hours. I've never really felt the burden of it, but I suppose people outside the industry would see that lifestyle as being potentially stressful."

According to Graham Rice, the managing director of Heery, the new generation of young people entering the industry recognises the problems associated with moving up the corporate ladder. Reed has noticed a growing trend for young people to turn down promotions on the grounds that the job would involve more stress than it is worth.

"In my day, you would join a company and want to become a director as quickly as you could. But things have changed now; young people just do not want the responsibility – they worry more about finding time to enjoy themselves and go travelling. It's a definite trend," he says.

The trend is a symptom of a serious problem in the industry. Heery recently began distributing blood-pressure monitors to their sites so that all staff, from site operatives to senior executives, could check their readings. "It has been used quite widely," says Rice. "We have had people who have had to go to the doctors or hospital for further medical treatment."

Ian Davis, director general of the Federation of Master Builders, stresses that it is not just the top end of sector that is prone to risk of heart attack. For the thousands of smaller and medium-sized builders that the FMB represents, the possibility of death or disability as a result of heart failure is ever present.

Smaller builders usually have a single managing director. According to Davis, many do not plan for the possibility that their jobs will undermine their health. "Often the smaller builders do not take out appropriate insurance to cover against losses due to illness and become unstuck," he says.

Davis says this could be the result of the industry's macho culture, which encourages bosses to take pride in the incredible amounts of financial and business pressure they can endure.

Heart disease — the facts

  • The UK has one of the highest death rates from heart disease in the world. One adult dies from heart disease every three minutes. Strokes are the country’s third biggest killer, claiming 70,000 lives each year.

  • Heart attacks occur when blood flow is blocked, often by a blood clot; strokes are caused either by a blocked or burst blood vessels in the brain.

  • Smokers are twice as likely to suffer heart attacks as non-smokers.

  • Heart disease can lead to a range of conditions including heart failure, when blood is not properly pumped around the body.

  • Four out of five people who die from a coronary heart disease are aged 65 or older. The risk of stroke doubles with each decade after the age of 55.

  • Men are more at risk than women of developing heart problems, and have attacks earlier in life. But the death rates from heart disease and strokes for women are twice as high as those from cancer.

  • Drinking an average of more than one alcoholic drink a day for women, or more than two drinks a day for men, increases the risk of heart disease and stroke because of the effect on blood pressure, weight and fat levels.

  • High blood pressure increases the heart’s workload, causing it to enlarge and weaken over time.

  • Failure to exercise can be a cause of coronary heart disease, as physical activity helps control cholesterol levels, diabetes and, in some cases, can lower blood pressure.

  • People who are overweight are more likely to suffer from heart disease and stroke as the extra body mass that must be supplied with blood strains the heart.

  • Links have been made between stress and heart disease, as stress encourages people to eat more, makes it harder to give up smoking, or to smoke more.