title: A longitudinal general population-based study of job strain and risk for coronary heart disease and stroke in Swedish men.
abstract: OBJECTIVE
  The aim was to investigate whether psychosocial stress based on the job-demand-control (JDC) model increased the risk for coronary heart disease (CHD) and stroke.
  
  
  METHODS
  Swedish men.
  
  
  METHODS
  The Primary Prevention Study (PPS) comprises 6070 men born between 1915 and 1925 free from previous history of CHD and stroke at baseline (1974-1977). Psychosocial workplace exposure was assessed using a job-exposure matrix (JEM) for the JDC model based on occupation at baseline. The participants were followed from baseline examination, until death, until hospital discharge or until 75 years of age, whichever occurred first, using the Swedish national register on cause of death and the Swedish hospital discharge register for non-fatal and fatal stroke and CHD events. Cox regression models were used with stroke or CHD as the outcome, using JDC model and age as explanatory variables, as well as stratified models with regard to smoking, self-reported stress, socioeconomic status, obesity, hypertension and diabetes.
  
  
  METHODS
  Risk for stroke and CHD.
  
  
  RESULTS
  There was an increased risk (HR) for CHD in relation to high strain (HR 1.31, 95% CI 1.01 to 1.70). The risk was further increased among ever-smokers and among blue-collar workers. There was a relation between low control and increased risk for CHD (HR 1.19, 95% CI 1.06 to 1.35). There was no increased risk for stroke in any of the JDC categories.
  
  
  CONCLUSIONS
  Exposure to occupational psychosocial stress defined as job strain or low control increased the risk for CHD, especially among smokers and blue-collar workers. There was no increased risk for stroke in any of the JDC categories.
authors.affiliation: Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Torén
authors.forename: Linus
authors.initials: L
authors.lastname: Schiöler
authors.forename: W K
authors.initials: WK
authors.lastname: Giang
authors.forename: Masuma
authors.initials: M
authors.lastname: Novak
authors.forename: Mia
authors.initials: M
authors.lastname: Söderberg
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology* / Q000523:psychology; D004651:Employment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000209:etiology* / Q000523:psychology; D016273:Occupational Exposure / Q000009:adverse effects*; D011209:Power, Psychological; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013315:Stress, Psychological / Q000150:complications*; D020521:Stroke / Q000209:etiology* / Q000523:psychology; D013548:Sweden; D014937:Work