Persons who reported chronic job strain after a first heart attack (myocardial infarction) had about twice the risk of experiencing another coronary heart disease event such as heart attack or unstable angina than those without chronic job strain, according to a study in the October 10 issue of JAMA.
Several studies have shown that job strain increases the risk of a first coronary heart disease (CHD) event. However, little is known about the association of job strain on the risk of recurrent CHD events, according to background information in the article.
Corine Aboa-Éboulé, M.D., Ph.D., of the Université Laval, Québec, Canada, and colleagues conducted a study to determine whether job strain increases the risk of recurrent CHD events after a first heart attack. The study included 972 men and women, age 35 to 59 years, who returned to work after a first heart attack and were then followed up between February 1996 and June 2005. Patients were interviewed at baseline (on average, 6 weeks after their return to work), then after 2 and 6 years subsequently. Job strain was defined and determined by the degree of high psychological demands and low decision control.
During the average follow-up of 5.9 years, 206 patients had a confirmed recurrent CHD event (111 nonfatal heart attack, 82 unstable angina, and 13 fatal CHD). Chronic job strain was associated with a 2-fold increase in the risk of recurrent CHD events even after adjustment for 26 potentially confounding CHD-risk factors and sociodemographic, lifestyle, and clinical-prognostic and work-environment characteristics. There were no significant statistical interactions between chronic job strain and either sex, age, marital status, education, perceived economic situation and chronic low social support at work.
"These results suggest that preventive interventions aimed at reducing job strain might have a significant impact on recurrent CHD events. Although further studies are required to establish optimal interventions, information about the results of this study should be disseminated in cardiac practice and in occupational health services with the aim of reducing job strain for workers returning to work after [a heart attack]," the authors write.
Article Reference: JAMA. 2007;298(14):1652-1660.
Editorial: Job Strain and Risk of Recurrent Coronary Events
There needs to be a greater emphasis on evaluating job strain, writes Kristina Orth-Gomér, M.D., of the Karolinska Institutet, Stockholm, Sweden, in an accompanying editorial.
"Job strain and other related psychosocial risk factors are associated with worse prognosis in patients with coronary heart disease. These influences are independent of standard risk factors and need to be addressed in clinical practice. However, knowledge is lacking on how to prevent and manage job strain in particular and psychosocial risk in general. Therefore, there is a great need for research on methods and interventions to deal with these risk factors in the clinical setting."
"Patients and physicians may benefit from widening the medical framework to include job strain evaluation. If physicians have difficulty finding adequate time to discuss job experiences with patients, this role may be adopted by other health care professionals, such as experienced cardiac rehabilitation nurses. Patients are often relieved and may spontaneously report improved quality of life and increased capacity for coping once they have their concerns assessed."
Editorial Reference: JAMA. 2007;298(14):1693-1694.
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