CHICAGO (EGMN) – Women who report high psychological job strain have a 40% increased risk of cardiovascular disease, according to a large, 10-year prospective study.

High job strain is defined by a demanding job, often involving time pressure and conflict, coupled with little decision-making authority or opportunity for personal growth.

But women with high job strain weren’t the only group at increased risk for acute MI and other cardiovascular events in this analysis of more than 17,000 working women participating in the Women’s Health Study. Those with active job strain defined as high-demand work featuring a high sense of control, based on Robert Karasek’s 14-item job strain model used in this study, had a 60% increase in total cardiovascular events compared with those reporting low job strain, Natalie Slopen, Sc.D., reported at the annual scientific sessions of the American Heart Association.

This last point regarding the cardiovascular risks associated with active job strain should be near and dear to the hearts of female physicians. Many, perhaps most, physicians fit within the Karasek active job strain category, noted Dr. Slopen, a postdoctoral research fellow in the department of society, human development, and health at Harvard School of Public Health, Boston.

The Women’s Health Study involves 17,415 female, mostly white, health professionals in good health at an average age of 57 years at enrollment in what was initially a randomized, placebo-controlled clinical trial of vitamin E and aspirin for primary prevention of cancer and cardiovascular disease. The study is now in the observational phase with 10 years of follow-up, during which 517 clinically verified nonfatal MIs, strokes, coronary revascularization procedures, and cardiovascular deaths have occurred.

In a Cox proportional hazards model adjusted for age, race, socioeconomic status, and study drug assignment, the 3,529 women who reported high job strain at baseline had a 90% increased risk of MI, a 40% increase in coronary revascularization, and a 40% increase in total cardiovascular events, compared with the 4,161 female health professionals with low job strain.

The 3,736 women who reported active job strain had a 60% increase in total cardiovascular events compared with the low job strain group.

The investigators also inquired about job insecurity. At baseline, 19% of Women’s Health Study participants indicated they were concerned about future job loss. Contrary to the study hypothesis, however, no independent association was found between job insecurity and subsequent development of cardiovascular disease.

An important clinical implication of this study is that it may be useful for physicians to ask about job stress as part of their total health assessment of women employed outside the home. Women with high job strain or active job strain can be counseled that there are data to support several beneficial interventions. These include maintaining a physically active lifestyle to help burn off psychological stress, engaging in social support networks to aid in coping with work strain, and reserving time every day – as little as 10-15 minutes – for some form of relaxation. It’s also important to limit the intrusion of work activities outside the workplace; e-mail is a big offender in this regard, according to Dr. Slopen.

The Women’s Health Study is funded by the U.S. National Institutes of Health. Dr. Slopen declared having no relevant financial disclosures.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

芝加哥(EGMN)——据一项历时10年的大型前瞻性研究显示，工作心理压力较大的女性心血管疾病风险增加40%。

这项研究名为妇女健康研究，由哈佛大学公共卫生学院社会学、人类发展学和健康学系博士后研究员Natalie Slopen博士等人完成，纳入了17,415名女性，主要是健康状态良好的白种人医务人员，入组时的平均年龄为57岁，最初入组是为了进行一项有关采用维生素E和阿司匹林对癌症和心血管疾病行一级预防的随机、安慰剂对照临床试验。此研究现在处于观察期，随访已历时10年，期间有517名受试者经临床确诊为非致死性心肌梗死、卒中、行冠脉血运重建术和心血管死亡。

结果显示，在对年龄、种族、社会经济条件和试验药分配情况进行调整后的回归比例风险模型中，与4,161名工作压力低的女医务人员相比，3,529名基线时称工作压力大的女性心肌梗死风险增加90%，冠脉血运重建风险增加40%，总体血管事件风险增加40%。基线时，有19%的受试者担心其今后会失业，但与研究假设相反，工作不稳定与随后发生的心血管疾病之间无独立相关性。

另外，工作压力大可定义为工作繁重，通常涉及时间压力和冲突，同时伴有决策权或个人发展机遇极小。不过，本研究显示，工作压力大的女性不是急性心肌梗死和其他心血管事件风险增加的惟一群体。采用Robert Karasek的14项工作压力模型(14-item job strain model)进行分析发现，与工作压力小的女性相比，3,736名存在主动性工作压力(定义为工作繁重但具有高度控制感))的女性总体心血管事件风险增加60%。

本研究的重要临床意义在于，临床医生在对职场女性进行总体健康评估时，根据该研究的结果，可询问其工作压力情况。对工作压力或主动性工作压力大的女性可以劝导其采取多种有益的干预措施，并告之在这方面已有数据支持。这些干预措施包括维持有积极体力活动的生活方式，参与社会支持网络及每天至少留出10~15 min的放松时间等等。

妇女健康研究获得美国国家卫生研究院的资助。Slopen博士声明无相关的经济内容披露。

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