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(Circulation. 1995;92:327-333.)
© 1995 American Heart Association, Inc.
Articles |
Job Strain and the Prevalence and Outcome of Coronary Artery Disease
From the Division of Health Services Research, Department of Health Research and Policy, and the Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, Calif; and the Division of Cardiology, Department of Medicine, and the Division of Behavioral Medicine, Department of Psychiatry, Duke University Medical Center, Durham, NC.
Correspondence to Mark A. Hlatky, MD, Stanford University School of Medicine, HRP Redwood Bldg, Room 265, Stanford, CA 94305-5092.
Background It has been hypothesized that jobs that have both high psychological demands and low decision latitude ("job strain") can lead to coronary disease. The objective of this study was to test whether job strain was correlated with the presence of coronary disease at angiography or with long-term outcome in patients with angiographic coronary disease.
Methods and Results Employed patients under the age of 65 years
undergoing diagnostic coronary angiography
completed a self-administered questionnaire about their job duties and
work environment. Job strain was measured by the method of Karasek.
Patients were separated into three groups, based on extent of
coronary disease: significant disease (
75%
stenosis), insignificant disease (>0% but <75%
stenosis), and normal coronary arteries. Statistical
analyses were performed using logistic regression and the Cox
proportional hazards model. The 1489 patients enrolled had a median age
of 52 years; 76% were male and 88% were white. By design, all
patients were employed, 60% in white-collar jobs and only 16% in jobs
requiring heavy labor. Traditional cardiac risk factors were most
prevalent in the 922 patients with significant coronary artery
disease, at intermediate levels in the 204 patients with insignificant
disease, and least prevalent in the 363 patients with normal
coronary arteries (all P<.01). Job strain was
actually more common in patients with normal coronary arteries
(35%) than in patients with insignificant (26%) or significant
disease (25%, P<.002). In a multivariate
analysis, job strain was not significantly correlated with the
presence of coronary disease. Job strain was not correlated
with angina frequency at the time of angiography. Job strain was not a
predictor of cardiac events (cardiac death or nonfatal myocardial
infarction) during follow-up.
Conclusions Job strain was not correlated with the prevalence or severity of coronary artery disease in a cohort of patients undergoing coronary angiography. The outcome of patients with angiographically defined coronary disease was not affected by the level of job strain as measured by the method of Karasek.
Key Words: stress • coronary disease • prognosis
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