If you experience chronic job strain after your first heart attack you have approximately double the risk of experiencing another coronary heart disease (CHD) event, such as unstable angina or a heart attack, compared to a person who does not experience chronic job strain after a first heart attack, says an article in the Journal of the American Medical Association (JAMA), October 10th issue.
Many studies have demonstrated that job strain raises the risk of a first CHD event. Not much is known about the effect job strain might have on recurrent CHD events, explain the authors.
Corine Aboa-Éboulé, M.D., Ph.D., Université Laval, Québec, Canada, and team carried out a study to find out whether job strain might raise the risk of recurrent CHD events following a first heart attack. Their study involved 972 males and females, aged 35-59 years. They had all returned to work after their first heart attack. They were all followed up between February 1996 and June 2005. They were interviewed at 6 weeks after they had returned to work (baseline), then again 2 years and 6 years later. They defined job strain by the extent of high psychological demands and low decision control.
206 of them had confirmed a recurrent CHD event after a follow-up of 5.9 years (average) – 111 had a non-fatal heart attack, 82 had unstable angina and 13 had fatal CHD. After adjusting for 26 possible confounding CHD-risk factors and sociodemographic, lifestyle, and clinical-prognostic and work-environment characteristics, the researchers calculated that chronic job strain doubled the risk of recurrent CHD events following a first heart attack.
The authors concluded “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).”
Accompanying Editorial
Kristina Orth-Gomér, M.D., Karolinska Institutet, Stockholm, Sweden, wrote that there needs to be a greater emphasis on evaluating job strain. “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.”
“Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events”
Corine Aboa-Éboulé, MD, PhD; Chantal Brisson, PhD; Elizabeth Maunsell, PhD; Benoît Mâsse, PhD; Renée Bourbonnais, PhD; Michel Vézina, MD, MPH; Alain Milot, MD, MSc; Pierre Théroux, MD; Gilles R. Dagenais, MD
JAMA. 2007;298:1652-1660.
—
“Job Strain and Risk of Recurrent Coronary Events”
Kristina Orth-Gomér, MD
JAMA. 2007;298:1693-1694.
—
Written by: Christian Nordqvist