RT Journal Article
SR Electronic
T1 Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 763
OP 769
DO 10.1503/cmaj.121735
VO 185
IS 9
A1 Mika Kivimäki
A1 Solja T. Nyberg
A1 Eleonor I. Fransson
A1 Katriina Heikkilä
A1 Lars Alfredsson
A1 Annalisa Casini
A1 Els Clays
A1 Dirk De Bacquer
A1 Nico Dragano
A1 Jane E. Ferrie
A1 Marcel Goldberg
A1 Mark Hamer
A1 Markus Jokela
A1 Robert Karasek
A1 France Kittel
A1 Anders Knutsson
A1 Markku Koskenvuo
A1 Maria Nordin
A1 Tuula Oksanen
A1 Jaana Pentti
A1 Reiner Rugulies
A1 Paula Salo
A1 Johannes Siegrist
A1 Sakari B. Suominen
A1 Töres Theorell
A1 Jussi Vahtera
A1 Marianna Virtanen
A1 Peter J.M. Westerholm
A1 Hugo Westerlund
A1 Marie Zins
A1 Andrew Steptoe
A1 Archana Singh-Manoux
A1 G. David Batty
A1 ,
YR 2013
UL http://www.cmaj.ca/content/185/9/763.abstract
AB 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.