title: Job insecurity and prognosis after myocardial infarction: the SHEEP Study.
abstract: BACKGROUND
  The prognostic role of job insecurity in coronary heart disease is unknown. We aimed to analyze whether job insecurity predicts mortality and recurrent events after a first acute myocardial infarction (AMI).
  
  
  METHODS
  We studied non-fatal AMI cases involved in the Stockholm Heart Epidemiology Program who were in paid employment and younger than 65 years (n=676). Shortly after their AMI, patients completed a questionnaire about job insecurity, demographic, work-related, clinical and lifestyle factors and participated in a clinical examination three months after discharge from the hospital. They were followed for 8.5 years for mortality and cardiovascular events.
  
  
  RESULTS
  After adjusting for previous morbidity, demographic and work-related factors, job insecurity was associated with an increased risk of the combined endpoint of cardiac death and non-fatal AMI, of total mortality and of heart failure; the hazard ratios (HR) and the 95% confidence intervals (CI) were 1.50 (1.02-2.22), 1.69 (1.04-2.75) and 1.62 (1.07-2.44), respectively. Similar associations, but with less statistical power were observed between job insecurity and cardiac death (HR (95% CI): 1.57 (0.80-3.09)) and stroke (HR (95% CI): 1.46 (0.71-3.02)), respectively. Adjustment for potential mediators, i.e. sleep problems, health behaviour, hypertension, blood lipids, glucose, inflammatory and coagulation factors did not alter considerably the relationship between job insecurity and the combination of cardiac mortality and non-fatal AMI.
  
  
  CONCLUSIONS
  Our results suggest that job insecurity is an adverse prognostic factor in patients with a first AMI. Future studies are needed to confirm this finding and to determine the mechanisms underlying the observed relationship.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. krisztina.laszlo@ki.se
authors.forename: Krisztina D
authors.initials: KD
authors.lastname: László
authors.forename: Karin
authors.initials: K
authors.lastname: Engström
authors.forename: Johan
authors.initials: J
authors.lastname: Hallqvist
authors.forename: Anders
authors.initials: A
authors.lastname: Ahlbom
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology