Job strain and risk of acute
recurrent coronary heart disease events.
Unité de
Recherché en Santé des Populations, Université Laval, Québec,
Canada.
CONTEXT: There is
evidence that job strain increases the risk of a first
coronary heart disease (CHD) event. However, little is known
about its association with the risk of recurrent CHD events
after a first myocardial infarction (MI).
OBJECTIVE: To determine whether job strain increases the risk of recurrent
CHD events.
DESIGN, SETTING,
AND PATIENTS: Prospective cohort study of 972 men and women
aged 35 to 59 years who returned to work after a first MI
and were then followed up between February 10, 1996, and
June 22, 2005. Patients were interviewed at baseline (on
average, 6 weeks after their return to work), then after 2
and 6 years subsequently. Job strain, a combination of high
psychological demands and low decision latitude, was
evaluated in 4 quadrants: high strain (high demands and low
latitude), active (high demands and high latitude), passive
(low demands and low latitude), and low strain. A chronic
job strain variable was constructed based on the first 2
interviews, and patients were divided into those exposed to
high strain at both interviews and those unexposed to high
strain at 1 or both interviews. The survival analyses were
presented separately for 2 periods: before 2.2 years and at
2.2 years and beyond. MAIN
OUTCOME MEASURE:
The outcome was a composite of fatal CHD, nonfatal MI, and
unstable angina.
RESULTS: The
outcome was documented in 206 patients. In the unadjusted
analysis, chronic job strain was associated with recurrent
CHD in the second period after 2.2 years of follow-up (hazard
ratio [HR], 2.20; 95% CI, 1.32-3.66; respective event rates
for patients exposed and unexposed to chronic job strain,
6.18 and 2.81 per 100 person-years). Chronic job strain
remained an independent predictor of recurrent CHD in a
multivariate model adjusted for 26 potentially confounding
factors (HR, 2.00; 95% CI, 1.08-3.72)
CONCLUSION: Chronic
job strain after a first MI was associated with an increased
risk of recurrent CHD.
PMID: 17925517 [PubMed
- indexed for MEDLINE]
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