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Job Strain After First MI Linked to Future Heart Problems

High demands, low decision latitude play role in doubled risk of future coronary heart disease

WEDNESDAY, Oct. 10 (HealthDay News) -- People who return to work after a first heart attack and deal with chronic job-related strain face an increased risk of recurrent coronary heart disease events, according to research published in the Oct. 10 issue of the Journal of the American Medical Association.

Corine Aboa-Eboule, M.D., Ph.D., of the Centre Hospitalier Affilie Universitaire de Quebec in Canada, and colleagues analyzed data from a prospective cohort of 972 men and women aged 35 to 59. The investigators interviewed subjects shortly after they returned to work, then again two and six years later. They categorized job strain into four groups, based on whether subjects faced high or low demands on the job, and whether they had high or low decision-making latitude.

Job strain was an independent predictor of recurrent coronary heart disease (hazard ratio 2.00) at 2.2 years and beyond, even after adjusting for 26 potential confounders.

The authors suggest one explanation for the findings could be "a direct effect of job strain via an increased activation of the sympathetic and the renin-angiotensin-aldosterone systems contributing most likely to an accentuated inflammation of the arterial wall and subsequently to the formation of thrombosis." Another, which they deem unlikely, is that "there is an indirect effect of job strain on recurrent coronary heart disease, mediated by a lack of adherence to a healthier lifestyle and drug therapy."

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