Psychosocial Working Environment and Risk of Adverse Cardiac Events in Patients Treated for Coronary Heart Disease

Biering, Karin; Andersen, Johan Hviid; Lund, Thomas; Hjøllund, Niels Henrik

doi:10.1007/s10926-015-9585-2

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…Our findings agree with those of a study of patients with acute myocardial infarction from the USA, in which individuals who reported life stress had higher mortality than those free of life stress (HR 1·4, 95% CI 1·2–1·8) 14 and the few previous, small-scale prognostic studies on patients with cardiovascular disease, 23 , 24 , 25 , 26 which in combination suggest a 1·6 times (95% 1·2–2·2) increased risk of recurrent events associated with job strain. 17 The observed associations are also biologically plausible.…”

Section: Discussionsupporting

confidence: 91%

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

Kivimäki

Pentti

Ferrie

et al. 2018

The Lancet Diabetes & Endocrinology

121

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SummaryBackgroundAlthough some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.MethodsIn this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort–reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.ResultsWe identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19–2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9–44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18–3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74–21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress–mortality association were not significant, apart from effort–reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06–1·41).InterpretationIn men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and in...

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Section: Discussionsupporting

confidence: 91%

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

Kivimäki

Pentti

Ferrie

et al. 2018

The Lancet Diabetes & Endocrinology

121

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“…According to a recent meta-analysis based on five papers derived from four cohort studies, work stress ( as measured by either the JDC model or the ERI model) in employees with CVD was associated with a 65% excess risk to develop recurrent CVD events 30) . However, a recent study did not con-firm those previous findings, indicating that work stress was not associated with recurrent CVD events 31 ) . Additional studies are needed to improve our understanding of step 4.…”

Section: Step 4: Work Stress Increases the Risk Of Recurrent Cvd In Wmentioning

confidence: 71%

Work stress and cardiovascular disease: a life course perspective

Loerbroks

Bosma

et al. 2016

Journal of Occupational Health

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Individuals in employment experience stress at work, and numerous epidemiological studies have documented its negative health effects, particularly on cardiovascular disease (CVD). Although evidence on the various interrelationships between work stress and CVD has been accumulated, those observations have not yet been conceptualized in terms of a life course perspective. Using the chain of risk model, we would like to propose a theoretical model incorporating six steps: (1) work stress increases the risk of incident CVD in healthy workers. (2) Among those whose work ability is not fully and permanently damaged, work stress acts as a determinant of the process of return to work after CVD onset. (3) CVD patients experience higher work stress after return to work. (4) Work stress increases the risk of recurrent CVD in workers with prior CVD. (5) CVD patients who fully lose their work ability transit to disability retirement. (6) Disability retirees due to CVD have an elevated risk of CVD mortality. The life course perspective might facilitate an in-depth understanding of the diverse interrelationships between work stress and CVD, thereby leading to work stress management interventions at each period of the lifespan and three-level prevention of CVD.

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“…136 Work stress has been linked to an increased risk of recurrent cardiac events in patients with coronary heart disease, but the sample size in these studies has typically been small and the findings are not entirely consistent. 27,[137][138][139][140][141] A more holistic assessment of perceived life stress, irrespective of the source, has yielded clearer findings. A measure combining work, family and life-event stress predicted increased 3-year mortality in the Beta-Blocker Heart Attack Trial, and the effect was accentuated when coupled with social isolation.…”

Section: Progression Of Cardiovascular Diseasementioning

confidence: 99%

Effects of stress on the development and progression of cardiovascular disease

2017

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Cardiovascular disease remains the leading cause of disease burden globally, which underlies the continuing need to identify new complementary targets for prevention. Over the past 5-10 years, the pooling of multiple data sets into 'mega-studies' has accelerated progress in research on stress as a risk and prognostic factor for cardiovascular disease. Severe stressful experiences in childhood, such as physical abuse and household substance abuse, can damage health and increase the risk of multiple chronic conditions in adulthood. Compared with childhood stress and adulthood classic risk factors, such as smoking, high blood pressure, and high serum cholesterol levels, the harmful effects of stress in adulthood are generally less marked. However, adulthood stress has an important role as a disease trigger in individuals who already have a high atherosclerotic plaque burden, and as a determinant of prognosis and outcome in those with pre-existing cardiovascular or cerebrovascular disease. In real-life settings, mechanistic studies have corroborated earlier laboratory-based observations on stress-related pathophysiological changes that underlie triggering, such as lowered arrhythmic threshold and increased sympathetic activation with related increases in blood pressure, as well as pro-inflammatory and procoagulant responses. In some clinical guidelines, stress is already acknowledged as a target for prevention for people at high overall risk of cardiovascular disease or with established cardiovascular disease. However, few scalable, evidence-based interventions are currently available.

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Psychosocial Working Environment and Risk of Adverse Cardiac Events in Patients Treated for Coronary Heart Disease

Abstract: The psychosocial working environment was not associated with adverse cardiac events.

Cited by 8 publications

References 37 publications

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

Work stress and cardiovascular disease: a life course perspective

Effects of stress on the development and progression of cardiovascular disease

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