title: Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program.
abstract: OBJECTIVE
  Studies investigating the prognostic role of job stress in coronary heart disease are sparse and have inconclusive findings. We aimed (i) to investigate whether job strain predicts recurrent events after acute myocardial infarction (AMI) and if so (ii) to determine behavioural and biological factors that contribute to the explanation of this association.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Ten emergency hospitals in the larger Stockholm area, Sweden.
  
  
  METHODS
  Non-fatal AMI cases from the Stockholm Heart Epidemiology Program case-control study who were employed and younger than 65 years at the time of their hospitalization (n = 676).
  
  
  RESULTS
  During the 8.5 year follow-up, 155 patients experienced cardiac death or non-fatal AMI; totally 96 patients died, 52 of cardiac causes. After adjustment for potential confounders, patients with high job strain had an increased risk for the combination of cardiac death and non-fatal AMI relative to those with low job strain, the hazard ratio (HR) and the 95% confidence interval (CI) being 1.73 (1.06-2.83). Results were similar for cardiac [HR (95% CI): 2.81 (1.16-6.82)] and total mortality [HR (95% CI): 1.65 (0.91-2.98)]. We found no evidence for mediation from lifestyle, sleep, lipids, glucose, inflammatory and coagulation markers on the association between job strain and the combination of cardiac death and non-fatal AMI.
  
  
  CONCLUSIONS
  Job strain was associated with poor long-term prognosis after a first myocardial infarction. Interventions focusing on reducing stressors at the workplace or on improving coping with work stress in cardiac patients might improve their survival post-AMI.
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. krisztina.laszlo@ki.se
authors.forename: K D
authors.initials: KD
authors.lastname: László
authors.forename: S
authors.initials: S
authors.lastname: Ahnve
authors.forename: J
authors.initials: J
authors.lastname: Hallqvist
authors.forename: A
authors.initials: A
authors.lastname: Ahlbom
authors.forename: I
authors.initials: I
authors.lastname: Janszky
mesh_terms: D000208:Acute Disease; D015415:Biomarkers; D001786:Blood Glucose; D016022:Case-Control Studies; D004651:Employment / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids