Associations of job strain and lifestyle risk factors with risk of coronary artery disease

Source: http://www.cmaj.ca/content/early/2013/05/27/cmaj.121735

Via: Salud Juntos

Influencia del estilo de vida sobre el riesgo de enfermedad coronaria en las personas con estrés laboral -> Las personas con estrés laboral y una vida sana tienen la mitad de riesgo de enfermedad arterial coronaria, respecto de las que tienen un estilo de vida poco saludable. Un estilo de vida saludable puede reducir el riesgo de enfermedad en las personas con tensión laboral.

CMAJ, 13/05/2013 "Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data".

Antecedentes: No está claro si un estilo de vida saludable reduce los efectos adversos del estrés laboral sobre la enfermedad de las arterias coronarias. Se examinaron las asociaciones de tensión en el trabajo y los factores de riesgo del estilo de vida con el riesgo de enfermedad de las arterias coronarias. Métodos: Se agruparon los datos a nivel individual de 7 estudios de cohortes que comprenden 102.128 hombres y mujeres libres de enfermedad de las arterias coronarias al inicio del estudio (1985-2000). Se utilizaron cuestionarios para medir la tensión laboral (si v no) y 4 factores de riesgo del estilo de vida: tabaquismo, inactividad física, consumo excesivo de alcohol y obesidad. Se agruparon los participantes en 3 categorías: estilo de vida saludable (sin factores de riesgo de estilo de vida), moderadamente saludables (1 factor de riesgo) y no saludables (2-4 factores de riesgo). El resultado primario fue la enfermedad de la arteria coronaria incidente (definida como primer infarto de miocardio no fatal o muerte relacionada con el corazón). Resultados: Hubo 1.086 incidentes de eventos en 743.948 años-persona en riesgo durante un seguimiento medio de 7,3 años. El riesgo de enfermedad arterial coronaria en las personas que no tenían un estilo de vida saludable en comparación con aquellos que tenían un estilo de vida saludable (hazard ratio [HR] fue de 2,55, intervalo de confianza del 95% [IC]: 2,18 a 2,98; riesgo poblacional atribuible del 26,4%) fue mayor que el riesgo entre los participantes que tenían tensión laboral en comparación con aquellos que no tenían tensión laboral (HR 1,25, IC del 95%: 1,06 a 1,47; riesgo atribuible poblacional del 3,8%). La incidencia en 10 años de enfermedad coronaria entre los participantes con tensión laboral y de un estilo de vida saludable (14,7 por 1.000) fue un 53% menor que la incidencia entre las personas con la tensión laboral y de un estilo de vida saludable (31,2 por 1.000). Interpretación: El riesgo de enfermedad arterial coronaria fue mayor entre los participantes que informaron estrés laboral y un estilo de vida poco saludables. Las personas con la tensión laboral y una vida sana tenían la mitad de la tasa de enfermedad. Un estilo de vida saludable puede reducir sustancialmente el riesgo de enfermedad en las personas con tensión laboral.

Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data

1. Mika Kivimäki,
2. Solja T. Nyberg,
3. Eleonor I. Fransson,
4. Katriina Heikkilä,
5. Lars Alfredsson,
6. Annalisa Casini,
7. Els Clays,
8. Dirk De Bacquer,
9. Nico Dragano,
10. Jane E. Ferrie,
11. Marcel Goldberg,
12. Mark Hamer,
13. Markus Jokela,
14. Robert Karasek,
15. France Kittel,
16. Anders Knutsson,
17. Markku Koskenvuo,
18. Maria Nordin,
19. Tuula Oksanen,
20. Jaana Pentti,
21. Reiner Rugulies,
22. Paula Salo,
23. Johannes Siegrist,
24. Sakari B. Suominen,
25. Tores Theorell,
26. Jussi Vahtera,
27. Marianna Virtanen,
28. Peter J.M. Westerholm,
29. Hugo Westerlund,
30. Marie Zins,
31. Andrew Steptoe,
32. Archana Singh-Manoux,
33. G. David Batty

+ Author Affiliations

1. From the Department of Epidemiology and Public Health (Kivimäki, Ferrie, Hamer, Steptoe, Singh-Manoux, Batty), University College London, London, UK; the Centre of Expertise for the Development of Work and Organizations (Nyberg, Heikkilä, Oksanen, Pentti, Salo, Vahtera, Virtanen), Finnish Institute of Occupational Health, Helsinki, Finland; the School of Health Sciences (Fransson), Jonkoping University, Jonkoping, Sweden; the Institute of Environmental Medicine (Fransson, Alfredsson), Karolinska Institutet, Stockholm, Sweden; the Centre for Occupational and Environmental Medicine (Alfredsson), Stockholm County Council, Stockholm, Sweden; the Stress Research Institute (Fransson, Theorell, Westerlund), Stockholm University, Stockholm, Sweden; the School of Public Health (Casini, Kittel), Universite Libre de Bruxelles, Brussels, Belgium; the Department of Public Health (Clays, De Bacquer), Ghent University, Ghent, Belgium; the Department of Medical Sociology (Dragano, Siegrist), University of Dusseldorf, Dusseldorf, Germany; the School of Community and Social Medicine (Ferrie), University of Bristol, Bristol, UK; Inserm U1018 (Goldberg, Singh-Manoux, Zins), Institut national de la sante et de la recherche medicale, Villejuif Cedex, France; Versailles–Saint Quentin University (Goldberg, Zins), Versailles, France; the Institute of Behavioral Sciences (Jokela) and the Department of Public Health (Koskenvuo), University of Helsinki, Helsinki, Finland; the Department of Work Environment (Karasek), University of Massachusetts, Lowell, Mass.; the Department of Health Sciences (Knutsson), Mid Sweden University, Sundsvall, Sweden; the Department of Psychology (Nordin), Umea University, Umea, Sweden; the National Research Centre for the Working Environment (Rugulies), Copenhagen, Denmark; the Departments of Public Health and Psychology (Rugulies), University of Copenhagen, Copenhagen, Denmark; the Department of Psychology (Salo) and the Department of Public Health (Suominen, Vahtera), University of Turku, Turku, Finland; the Folkhälsan Research Center (Suominen), Helsinki, Finland; the Nordic School of Public Health, (Suominen), University of Gothenburg, Gothenburg, Sweden; Turku University Hospital (Vahtera), Turku, Finland; Occupational and Environmental Medicine (Westerholm), Uppsala University, Uppsala, Sweden; and the Centre for Cognitive Ageing and Cognitive Epidemiology (Batty), University of Edinburgh, Edinburgh, UK

1. Mika Kivimäki, E-mail m.kivimaki@ucl.ac.uk

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.

• © Canadian Medical Association

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Acetaminophen Increases Blood Pressure in Patients With Coronary Artery Disease.

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Sudano I, Flammer AJ, Periat D, et al. Acetaminophen Increases Blood Pressure in Patients With Coronary Artery Disease. Circulation. 2010 Oct 18. (Original) PMID: 20956208
BACKGROUND: -Because traditional nonsteroidal antiinflammatory drugs are associated with increased risk for acute cardiovascular events, current guidelines recommend acetaminophen as the first-line analgesic of choice on the assumption of its greater cardiovascular safety. Data from randomized clinical trials prospectively addressing cardiovascular safety of acetaminophen, however, are still lacking, particularly in patients at increased cardiovascular risk. Hence, the aim of this study was to evaluate the safety of acetaminophen in patients with coronary artery disease. Methods and Results-The 33 patients with coronary artery disease included in this randomized, double-blind, placebo-controlled, crossover study received acetaminophen (1 g TID) on top of standard cardiovascular therapy for 2 weeks. Ambulatory blood pressure, heart rate, endothelium-dependent and -independent vasodilatation, platelet function, endothelial progenitor cells, markers of the renin-angiotensin system, inflammation, and oxidative stress were determined at baseline and after each treatment period. Treatment with acetaminophen resulted in a significant increase in mean systolic (from 122.4+/-11.9 to 125.3+/-12.0 mm Hg P=0.02 versus placebo) and diastolic (from 73.2+/-6.9 to 75.4+/-7.9 mm Hg P=0.02 versus placebo) ambulatory blood pressures. On the other hand, heart rate, endothelial function, early endothelial progenitor cells, and platelet function did not change. Conclusions-This study demonstrates for the first time that acetaminophen induces a significant increase in ambulatory blood pressure in patients with coronary artery disease. Thus, the use of acetaminophen should be evaluated as rigorously as traditional nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors, particularly in patients at increased cardiovascular risk. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00534651.

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