TitleAssociations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data.
Publication TypeJournal Article
Year of Publication2013
AuthorsKivimäki, M, Nyberg, ST, Fransson, EI, Heikkilä, K, Alfredsson, L, Casini, A, Clays, E, De Bacquer, D, Dragano, N, Ferrie, JE, Goldberg, M, Hamer, M, Jokela, M, Karasek, R, Kittel, F, Knutsson, A, Koskenvuo, M, Nordin, M, Oksanen, T, Pentti, J, Rugulies, R, Salo, P, Siegrist, J, Suominen, SB, Theorell, T, Vahtera, J, Virtanen, M, Westerholm, PJM, Westerlund, H, Zins, M, Steptoe, A, Singh-Manoux, A, Batty, GD
Corporate AuthorsIPD-Work Consortium
JournalCMAJ
Volume185
Issue9
Pagination763-9
Date Published2013 Jun 11
ISSN1488-2329
KeywordsAdult, Alcoholism, Coronary Artery Disease, Employment, Female, Humans, Life Style, Male, Obesity, Risk Factors, Sedentary behavior, Smoking, Stress, Psychological, Surveys and Questionnaires
Abstract

BACKGROUND: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.

METHODS: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).

RESULTS: There were 1086 incident events in 743,948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).

INTERPRETATION: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain.

DOI10.1503/cmaj.121735
Alternate JournalCMAJ
PubMed ID23670152
PubMed Central IDPMC3680555
Grant ListRG/13/2/30098 / / British Heart Foundation / United Kingdom
K013351 / / Medical Research Council / United Kingdom
RG/10/005/28296 / / British Heart Foundation / United Kingdom
MR/K026992/1 / / Medical Research Council / United Kingdom
/ / Wellcome Trust / United Kingdom