title: Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees.
abstract: OBJECTIVE
  To examine the association between work stress, according to the job strain model and the effort-reward imbalance model, and the risk of death from cardiovascular disease.
  
  
  METHODS
  Prospective cohort study. Baseline examination in 1973 determined cases of cardiovascular disease, behavioural and biological risks, and stressful characteristics of work. Biological risks were measured at 5 year and 10 year follow up.
  
  
  METHODS
  Staff of a company in the metal industry in Finland.
  
  
  METHODS
  812 employees (545 men, 267 women) who were free from cardiovascular diseases at baseline.
  
  
  METHODS
  Cardiovascular mortality 1973-2001 from the national mortality register.
  
  
  RESULTS
  Mean length of follow up was 25.6 years. After adjustment for age and sex, employees with high job strain, a combination of high demands at work and low job control, had a 2.2-fold (95% confidence interval 1.2 to 4.2) cardiovascular mortality risk compared with their colleagues with low job strain. The corresponding risk ratio for employees with effort-reward imbalance (low salary, lack of social approval, and few career opportunities relative to efforts required at work) was 2.4 (1.3 to 4.4). These ratios remained significant after additional adjustment for occupational group and biological and behavioural risks at baseline. High job strain was associated with increased serum total cholesterol at the 5 year follow up. Effort-reward imbalance predicted increased body mass index at the 10 year follow up.
  
  
  CONCLUSIONS
  High job strain and effort-reward imbalance seem to increase the risk of cardiovascular mortality. The evidence from industrial employees suggests that attention should be paid to the prevention of work stress.
authors.affiliation: Department of Psychology, University of Helsinki, PO Box 13, FIN-00014, Finland. mika.kivimaki@occuphealth.fi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Päivi
authors.initials: P
authors.lastname: Leino-Arjas
authors.forename: Ritva
authors.initials: R
authors.lastname: Luukkonen
authors.forename: Hilkka
authors.initials: H
authors.lastname: Riihimäki
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Juhani
authors.initials: J
authors.lastname: Kirjonen
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013315:Stress, Psychological / Q000401:mortality*; D011795:Surveys and Questionnaires