Empirical studies on job strain and cardiovascular disease (CVD), their internal validity, and the likely direction of biases were examined. The 17 longitudinal studies had the highest validity ratings. In all but two, biases towards the null dominated. Eight, including several of the largest, showed significant positive results; three had positive, nonsignificant findings. Six of nine case-control studies had significant positive findings; recall bias leading to overestimation appears to be fairly minimal. Four of eight cross-sectional studies had significant positive results. Men showed strong, consistent evidence of an association between exposure to job strain and CVD. The data of the women were more sparse and less consistent, but, as for the men, most of the studies probably underestimated existing effects. Other elements of causal inference, particularly biological plausibility, corroborated that job strain is a major CVD risk factor. Additional intervention studies are needed to examine the impact of ameliorating job strain upon CVD-related outcomes.

These results suggest that Lp(a) is a determinant of CHD in both premenopausal and postmenopausal women.

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Background: There is a scarcity of published studies of the effects of cardiac counselling among professional drivers (PD). Aims of the study were: (1) to examine explanatory variables for two classical ‘driver’ risk factors – body mass index (BMI), and smoking – and to analyse the interrelations among smoking cessation, losing weight and work-related life changes; (2) to assess the effectiveness of risk factor counselling after 6 months, and (3) to gain insight into possible discrepancies between PD perception of needed changes and compliance with the physician’s advice. Methods: There were 4 groups of male PD: 13 with ischemic heart disease, 12 hypertensives, 10 borderline hypertensives and 34 normotensives. Baseline cardiovascular risk factors as well as occupational and behavioral data were assessed via questionnaire. The counselling was aimed at smoking cessation, weight loss and promoting leisure-time physical activity. Qualitative methods were used to assess PD perceptions about the work environment and health promotion. Results: Baseline smoking intensity was best predicted by the total burden of occupational stress and number of smoking years. Baseline BMI was best predicted by long work hours behind the wheel, low availability of attachment outside work and low self-reported job strain. Self-initiated smoking cessation was best predicted by few smoking years, low coffee intake and admitting fear during driving. Physical activity was significantly increased after 6 months. Losing weight was associated with: quitting or diminishing smoking and making other, work-related, life changes. None of the heavy smokers decreased their daily number of cigarettes after 6 months, although expressing the need to do so in self-generated statements. Conclusions: Exposure to occupational stressors, mainly, long work hours and the concomitant denial of job strain, in combination with low availability of social attachment outside work, could contribute to maintenance of maladaptive behavior in PD. These findings could serve as a basis for designing standardized intervention trials and suggest that modification of the work environment, with participation of the drivers, is a needed component of such trials. Particular attention should be paid to the length and scheduling of work shifts.

Very few of these university hospital physicians with signs of psychological distress sought help from a mental-health professional. This has implications for physicians themselves and for patient care, clinical research, and education of future physicians. More study, preferably of interventional design, is warranted concerning help-seeking among these physicians in need.

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of cardiac risk among profe ssional drivers. Scand J Work Environ Health 1994;20:73-86.This literature review indicates that professional drivers have excess cardiac risk that is not fully explained by standard risk factors. The contributi on of occupation is suggested by two independent methods and by psychophysiological studies during on-the-job driving. Driving has been conceptualized as a threat-avoidance task. Stimuli encountered in traffic are not inherently aversive but become so by association with driving experie nce, a formulation corroborated by laboratory studies in which stimuli such as car headlights elicit cardiovascular hyperreactivity and electroencephalographic signs of arousal in professional drivers. More-advanced neurophysiological methods (event-related potentials) show higher cortical electrone gativity to imperative signals among professional drivers than among nondriver referents. These data are viewed in light of reports of possible associations between event-related slow potentials and cardiac risk. A clinically and ecologically relevant neurocardiological model is proposed, and preventive strategies, including workplace interventions, are suggested.K EY TERMScardiova scular disease, event-related potentials, glare, neurocardiology, professional drivers, review, work stress.Of the numerous studies performed in va rious countries on cardiovascular disease and professional driving over a sp an of almost three de cades, ne arly all have shown an exce ss ri sk of cardiovascular di sease among professional drivers. Despite rigorous se lection against these disorders at hiring and during periodic medical foll ow-up ( 1-4), a risk of hyp ertension, ventri cu lar arrhythmias, myocardial infarction, and other ischemic heart disease ha s been ob served in 28 of the 32 reports found to consider thi s question (1-32). (No ns ig nifica nt findings have be en reported in references 13, 18, 19, and 23.) Of particular note in many of these studies is the close relation between the number of work years as a driver and the untowardly yo ung ag e at which these ev e nts occur (l , 5, 7, 9 17, 26, 29, 32). For example, in studies of young myocardial infarct ion patients, fo r whom profession was determined, an unexpectedly high percentage (up to 40 %) comprised professional dri vers (9,17,26,29,32). While standard ri sk-factor status tends to be high in thi s population, these fa ctors have not been clearly shown to distinguish professional drivers from other lo wer ri sk groups (1 , 15, 16,33-35) (tab le I). Rece ntly , Ro sengren and her co-workers (27) demonstrated that the excess risk of coronary he art disease among middle-aged bus and tram drivers occurred independently of sta ndard ri sk-factor status .Thus the quest ion ari ses as to how this excess cardiac risk oc curs for professional drivers. A growing co nse ns us indicates that occupational factors must be gi ven ca reful consideration (1-3). A focus on neural mech anisms pr omises to offer meaningful insig hts into the problem (3,36,37). In...