title: Job strain and risk of acute recurrent coronary heart disease events.
abstract: BACKGROUND
  There is evidence that job strain increases the risk of a first coronary heart disease (CHD) event. However, little is known about its association with the risk of recurrent CHD events after a first myocardial infarction (MI).
  
  
  OBJECTIVE
  To determine whether job strain increases the risk of recurrent CHD events.
  
  
  METHODS
  Prospective cohort study of 972 men and women aged 35 to 59 years who returned to work after a first MI and were then followed up between February 10, 1996, and June 22, 2005. Patients were interviewed at baseline (on average, 6 weeks after their return to work), then after 2 and 6 years subsequently. Job strain, a combination of high psychological demands and low decision latitude, was evaluated in 4 quadrants: high strain (high demands and low latitude), active (high demands and high latitude), passive (low demands and low latitude), and low strain. A chronic job strain variable was constructed based on the first 2 interviews, and patients were divided into those exposed to high strain at both interviews and those unexposed to high strain at 1 or both interviews. The survival analyses were presented separately for 2 periods: before 2.2 years and at 2.2 years and beyond.
  
  
  METHODS
  The outcome was a composite of fatal CHD, nonfatal MI, and unstable angina.
  
  
  RESULTS
  The outcome was documented in 206 patients. In the unadjusted analysis, chronic job strain was associated with recurrent CHD in the second period after 2.2 years of follow-up (hazard ratio [HR], 2.20; 95% CI, 1.32-3.66; respective event rates for patients exposed and unexposed to chronic job strain, 6.18 and 2.81 per 100 person-years). Chronic job strain remained an independent predictor of recurrent CHD in a multivariate model adjusted for 26 potentially confounding factors (HR, 2.00; 95% CI, 1.08-3.72).
  
  
  CONCLUSIONS
  Chronic job strain after a first MI was associated with an increased risk of recurrent CHD.
authors.affiliation: Unité de Recherché en Santé des Populations, Université Laval, Québec, Canada.
authors.forename: Corine
authors.initials: C
authors.lastname: Aboa-Eboulé
authors.forename: Chantal
authors.initials: C
authors.lastname: Brisson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maunsell
authors.forename: Benoît
authors.initials: B
authors.lastname: Mâsse
authors.forename: Renée
authors.initials: R
authors.lastname: Bourbonnais
authors.forename: Michel
authors.initials: M
authors.lastname: Vézina
authors.forename: Alain
authors.initials: A
authors.lastname: Milot
authors.forename: Pierre
authors.initials: P
authors.lastname: Théroux
authors.forename: Gilles R
authors.initials: GR
authors.lastname: Dagenais
mesh_terms: D000208:Acute Disease; D000328:Adult; D000789:Angina, Unstable / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology*; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications*