Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data

Abstract

Background: It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease. Methods: We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death). Results: There were 1086 incident events in 743 948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000). Interpretation: The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy life style may substantially reduce disease risk among people with job strain

Behavioral and Psychosocial Health of New Mothers and Associations With Contextual Factors and Perceived Health

“…The cumulative effects of stress on the body (known as allostatic load) and its adaptive processes explain, in part, how stress and low protective factors, such as low social support, increase vulnerability to poor health (Gruenewald et al, Chronic disadvantage, such as low income or ethnic minority status, or life-stage stresses also may favor development of unhealthy lifestyle behaviors (Correa et al, 2015;Crespo, Smith, Andersen, Carter-Pokras, & Ainsworth, 2000) and depression (Katon, Russo, & Gavin, 2014;Pratt & Brody, 2008), which are early and modifiable risk factors for chronic disease. As a result, postpartum behavioral and psychosocial health domains overlap with many of the common risk factors for chronic disease development: poor diet, low physical activity, smoking, high alcohol use, and depression (CDC, 2012;Ferketich, Schwartzbaum, Frid, & Moeschberger, 2000;Kivimaki et al, 2013;Pan et al, 2011). Body image is another critical postpartum domain central to the postpartum experience (Gjerdingen et al, 2009) that has implications for depression and health behaviors such as smoking (Levine, Marcus, Kalarchian, Houck, & Cheng, 2010;Walker, Timmerman, Kim, & Sterling, 2002).…”

Association between occupational psychosocial factors and waist circumference is modified by diet among men

“…17 In contrast, it was recently reported that a healthy lifestyle could substantially decrease the risk of coronary artery disease among people with occupational stress. 18 We examined whether potentially favourable (frequent consumption of plain dairy yogurts, dark bread, porridge, fish, salad dressings, fresh and cooked vegetables, fruits and berries) and unfavourable (frequent consumption of red or processed meat, hamburgers and pizzas, fried potatoes, sugar-sweetened soft drinks and white bread) features of diet modify the association between occupational psychosocial factors and abdominal obesity among a cohort of 31-year-old Finns.…”

Commentary

“…The findings of the IPD Consortium have been published in The Lancet (5) and the Canadian Medical Association Journal (CMAJ) (6). They show a consistent and statistically significant age-and sex-adjusted relationship between job strain and MI risk, which remains even after further adjustments for country, socioeconomic position, and standard risk factors.…”