High psychological stress and low control raise risk for recurrent cardiac events.
Job strain raises risk for first myocardial infarction, but the effect of job strain on recurrent cardiac disease is less clear. Researchers evaluated this association in 972 Canadian patients (91% men) with first uncomplicated MIs who returned to work after a mean of 3 months. Job strain was assessed with a validated questionnaire administered at about 6 weeks and at 2 years after return to work. Job strain was categorized according to psychological demands (high or low) and decision latitude or control (high or low), with highest strain defined as high demands and low control (experienced by about 200 subjects at both assessments).
At 6 years, fatal or nonfatal MIs or new-onset unstable angina had occurred in 206 participants (3.6 events/100 person-years). In a multivariate analysis controlling for 26 clinical and demographic factors associated with cardiac disease, recurrent events were roughly twice as common in patients who had high job strain at both assessments than in those who had low strain at either assessment.
Comment: Although these results show that job strain in cardiac patients is associated with recurrent cardiac events, whether effective interventions are available to address this problem is unclear. An editorialist notes that this study did not assess depression, which could explain the link between stress and cardiac events through biologic mechanisms, such as autonomic, inflammatory, and immunologic dysfunction.
Published in Journal Watch General Medicine October 18, 2007
Aboa-Éboulé C et al. Job strain and risk of acute recurrent coronary heart disease events. JAMA 2007 Oct 10; 298:1652.