职业紧张与冠心病发病和预后的相关研究进展

职业紧张是指当工作要求与工人的能力、资源或需求不满足时发生的有害的生理与心理反应,已成为重要的健康问题。近年来,冠心病在工作人群中发病率明显升高,而大约60%~80%的患者病后需回归工作岗位。因此,探讨职业紧张与冠心病的关系对预防冠心病及改善预后有重要意义。     

列车乘务人员职业紧张与高血压,冠心病关系的研究

目的： 研究职业紧张与高血压、冠心病之间的关系以及引起高血压、冠心病发病的主要职业紧张因素。方法： 应用职业紧张因素测试表（ＯＳＩ）,对５８３ 名男性列车乘务人员进行职业紧张与高血压、冠心病关系的人群调查,并进行多因素非条件Ｌｏｇｉｓｔｉｃ回归分析。结果： 在控制了非职业紧张因素条件下,职业紧张与高血压（ＲＲ＝ １．９７７,９５％ ＣＩ：１．３５３～２．８８７）、冠心病（ＲＲ＝ ２．０９２,９５％ ＣＩ：１．２５８～３．４８０）都有独立的相关关系,而且随着职业紧张程度的增加,患高血压、冠心病的危险性也增高,引起列车乘务人员高血压发病的主要职业紧张因素是职业特征和组织结构与气氛;引起冠心病发病的主要职业紧张因素是职务特征和经历与成就。结论： 职业紧张是引起高血压、冠心病发病的重要危险因素之一     

职业紧张与心血管疾病关系的研究进展

职业紧张是指个体所在工作岗位要求与个人的能力、资源或需求不匹配时出现的生理和心理反应，现已经成为全球范围内的流行病。长期以来，心血管疾病都是危及人类健康和生命的头号杀手，其致病因素虽然繁杂，但职业紧张已被多项研究证明为心血管疾病的独立危险因子。研究发现，职业紧张水平与冠心病、心律失常、心力衰竭等心血管疾病发病率有相关性，与高血压、动脉粥样硬化、糖尿病、吸烟等心血管疾病危险因素亦有关系；职业紧张主要通过生物学机制、神经生物学-行为机制、阻碍药物治疗机制诱发心血管疾病，对人体健康产生严重危害。     

职业紧张与心肌梗死的相关性研究

目的探讨职业紧张与心肌梗死的相关性。方法共调查260例患者,其中心肌梗死164例,非冠心病96例。利用付出-回报失衡问卷评价患者的职业紧张水平,同时收集患者其他冠心病危险因素,结合临床表现和冠状动脉造影结果明确患者冠心病的诊断。采用病例对照研究方法,进行多因素分析。结果高外在付出、高付出-回报失衡、高内在投入均增加心肌梗死的患病危险,调整年龄、性别、高血压病、高脂血症、糖尿病、早发冠心病家族史、吸烟、体质量指数、教育程度和婚姻等混杂因素后的OR值分别为2.4(95%CI 1.2~5.2)、2.8(95%CI 1.3~6.1)2、.7(95%CI 1.2~5.8),若高付出-回报失衡和高内在投入同时存在时,调整后OR为4.9(95%CI 1.7~14.2)。职业紧张对心肌梗死的影响存在剂量反应关系,职业紧张程度越高,心肌梗死的患病危险越高。结论职业紧张增加心肌梗死的患病危险,很可能是冠心病一个潜在的重要危险因素。     

北京地区职业紧张与冠心病的关系

冠心病是严重危害人类健康的疾病，控制冠心病的危险因素可以有效地预防冠心病的发生及改善冠心病的预后，职业紧张作为一个潜在的冠心病危险因素已引起越来越多的国内外学者的关注。本研究旨在探讨在我国职业人群中，工作要求与冠心病发病之间的关系，以期改善人们的生活和工作方式，提高生活质量，降低冠心病等心脑血管病的发生率。     

环境因素对冠心病心脏事件的影响

随着社会的发展和人们生活水平的提高,冠心病已成为对人类危害最大的疾病之一.大量流行病学研究表明.冠心病的发生、发展与多种因素有关,如高血压、高血脂、吸烟、糖尿病、肥胖等.除此之外,近年来的研究发现,环境因素与冠心病心脏事件有着密切的关系,如季节、大气污染、噪音及社会环境中的职业紧张、社会经济地位等.现就环境因素对冠心病心脏事件的影响及其病理生理机制简要综述.     

110例冠心病患者二级预防现况调查及随访分析

目的:对冠心病患者危险因素及二级预防的情况进行调查,了解冠心病二级预防的现状,探讨推广冠心病二级预防规范化治疗的效果。方法:对明确诊断为冠心病,并曾住院治疗的110例患者进行住院前及后续2年随访对危险因素的知晓及二级预防用药的情况。结果:110例冠心病患者与住院前比较,随访时对冠心病危险因素及二级预防,在知晓率、控制情况方面均有明显提高(P<0.05);住院时患者二级预防药物的使用是规范的(P<0.05),但除阿司匹林的服药率在随访2年时仍保持较高比例,与院内比率相近(P>0.05)外,冠心病患者未能长期坚持服用他汀类调脂药、β-受体阻滞剂、血管紧张素转化酶抑制剂或血管紧张素受体拮抗剂(P<0.05)3种药物。结论:冠心病二级预防规范化管理是提高冠心病患者二级预防依从性的重要手段之一。     

职业紧张对血糖、血脂影响的研究

目的探讨职业紧张与血糖、血脂之间的关系.方法应用职业紧张测量表(OSI)于2002年对福州铁路系统及福州某工厂共289名男性职工进行职业紧张与血脂、血糖关系的人群调查,并进行LSD检验及叉生分析.结果在控制了非职业紧张因素的条件下,职业紧张与血糖升高(RR=2.46)、血脂升高(RR=1.23)都有独立的相关关系,并且与常见的主要危险因素有协同作用.结论职业紧张是引起男性职工血糖、血脂升高的重要危险因素之一.     

职业紧张因素与高血压发病关系的配对病例对照研究

目的探讨职业紧张与高血压的关系以及引起高血压发病的主要职业紧张因素.方法应用职业紧张因素测试表(OSI),对96例高血压患者1∶1配对病例对照研究进行多因素条件Logistic回归分析.结果在控制了非职业紧张因素条件下,职业紧张仍与高血压发病关系密切(OR=2.707,95%CI1.389～5.275),而且随着职业紧张程度的增加,患高血压的危险性也增加.引起男性铁路乘务人员高血压发病的主要职业紧张因素是职务特征.结论进一步证实了职业紧张是引起男性铁路乘务人员高血压发病的重要危险因素,以及造成这个职业人群高血压发病的主要职业紧张因素是职务特征.     

职业紧张因素与高血压发病关系的配对病例对照研究

目的 探讨职业紧张与高血压的关系以及引起高血压发病的主要职业紧张因素。方法 应用职业紧张因素测试表（OSI）,对96例高血压患者1：1配对病例对照研究进行多因素条件Logistic回归分析。结果 在控制了非职业紧张因素条件下,职业紧张仍与高血压发病关系密切（OR＝2．707,95％CI：1．389－5．275）,而且随着职业紧张程度的增加,患高血压的危险性也增加。引起男性铁路乘务人员高血压发病的主要职业紧张因素是职务特征。结论 进一步证实了职业紧张是引起男性铁路乘务人员高血压发病的重要危险因素,以及造成这个职业人群高血压发病的主要职业紧张因素是职务特征。     

Mental stress as a causal factor in the development of hypertension and cardiovascular disease

Chronic mental stress can come in a variety of forms, and may originate in the external environment, as an interaction between the individual and the environment, or from within the individual. Examples of things causing mental stresss include earthquakes, job stress, and several measures of negative affect; all have been shown in prospective studies have adverse effects on the development of hypertension and coronary artery disease. After the Hanshin-Awaji earthquake in Japan, there were increases of blood pressure and deaths from myocardial infarction that persisted for several months. Job strain, which is defined as a combination of low control and high demands at work, has been associated with increased blood pressure and coronary heart disease outcomes, particularly in men. Negative affect, which may manifest itself as depression, anxiety, anger, or hostility, has similarly been related to hypertension and coronary heart disease. Depression is emerging as the most important component with respect to cardiovascular disease. A common link for all these factors is a perceived loss of control over one’s environment.     

Job control, job demands and social support at work in relation to cardiovascular risk factors in MONICA 1995, Göteborg

BACKGROUND: Job control and work environment are related to risk of coronary heart disease (CHD), but there is limited understanding of the independent risks associated with these factors. OBJECTIVE: To investigate the association between psychosocial work characteristics and biological risk factors for both sexes for a random population sample in G?teborg, Sweden. DESIGN: A cross-sectional study. METHODS: We used an age-stratified random sample of men and women aged 25-64 years comprising 1200 men and 1412 women, from which 746 men and 872 women responded to the invitation for screening, which included questionnaires and physical/laboratory investigations in 1995. RESULTS: Women had lower job control than did men (P=0.00001); job demands were equal and social support at work slightly higher among women (P=0.04). Job control was positively related to education and social group. Smoking women had low job control and high job demands. Women with high grades of psychological stress had low job control and low social support at work (P=0.001 and P=0.01). For both sexes job demands were high (P=0.0001) among those who reported high psychological stress. Men with high job control and high social support at work were more physically active during leisure time. Subjects with job strain had low social support (P=0.01). Job-stress factors were not related to biological coronary risk factors. CONCLUSIONS: Women had lower job control than did men. Job control was positively related to education, social class and physical activity. Psychosocial factors were not related to biological coronary risk factors.     

The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort

OBJECTIVE: Work stress contributes to risk of coronary heart disease and hypertension. This study tested the influence of job control on ambulatory blood pressure, and ratings of perceived stress and happiness in men and women systematically sampled by socio-economic status from the Whitehall II epidemiological cohort. PARTICIPANTS: A total of 227 men and women aged 47-59 years sampled from higher, intermediate and lower employment grades. OUTCOME MEASURES: Ambulatory blood pressure and ratings of stress, perceived control and happiness. METHODS: Participants completed standard measures of job demands and job control, and undertook ambulatory monitoring with measures of blood pressure and subjective state every 20 min from early in the working day until going to bed. RESULTS: Systolic and diastolic blood pressure were greater in participants reporting low rather than high job control (means 125.7/81.5 versus 122.4/78.6 mmHg, P < 0.05), independently of gender, employment grade, body mass index, age, smoking status, and physical activity. Differences persisted into the evening after work. Job demands and job strain (high demand/low control) were not associated with blood pressure. Participants reporting low job control experienced stress more frequently over the working day than did those with high job control. Higher socio-economic status participants and women were more stressed by low job control than were men and people of lower socio-economic status. CONCLUSIONS: Job control plays an important role in modulating cardiovascular and affective responses over the working day, and these responses may contribute to increased cardiovascular disease risk.     

Hypertension is not the link between job strain and coronary heart disease in the Whitehall II study

BACKGROUND: Hypertension is assumed to be one of the mechanisms through which job strain (a combination of high work demands and low job control) increases coronary heart-disease risk. However, direct tests of this hypothesis are lacking. METHODS: We examined whether hypertension mediated the association between job strain and incident coronary heart disease among 5630 men and 2456 women free of coronary heart disease at study entry. Job strain was assessed at phase 1 (1985 to 1988); hypertension and systolic and diastolic blood pressure (BP) were assessed at phases 1, 3 (1992 to 1993), and 5 (1997 to 1999); and incident coronary heart disease was assessed from the end of phase 1 to phase 7 (2003 to 2004) (698 events; median follow-up, 16.1 years). RESULTS: After adjustment for age, sex, ethnicity, and employment grade, job strain was associated with an increased incidence of coronary heart disease. Further adjustments, for hypertension, systolic BP, and diastolic BP at phase 1 and across phases 1, 3, and 5, and the slope of hypertension and BP over time, had little effect on this association, although measures of hypertension and BP were strongly related to incident coronary heart disease. CONCLUSIONS: Data, including repeated casual measurements of hypertension and BP, suggest that the development of chronic hypertension is not a key mechanism linking job strain and coronary heart disease. Further research on ambulatory measurements is needed to determine whether episodic BP elevations have a role in this association.     

The Role of Stress and the Sympathetic Nervous System in Hypertension and Ischemic Heart Disease: Advantages of Therapy with β-Receptor Blockers

Human and animal studies link social and environmental factors to hypertension and ischemic heart disease. Job stress and undesirable life events may precede the development of raised blood pressure. Hypertension and ischemic heart disease vanquished many of the survivors of the seige of Leningrad.

Specific behavior patterns of some patients with ischemic heart disease and the pschological ambience of others with hypertension have been associated with raised neural tone as reflected by levels of plasma norepinephrine and epinephrine. Sympathoneural hypertonicity is a factor in left ventricular hypertrophy and the latter has been a prophet for sudden cardiac death. Sympathoadrenal surges may contribute to both reduced coronary reserve in hypertensives and increased vulnerabily to ventricular dysrhythmia.

The “coronary epidemic” of our modern times appears related in part to outdated survival mechanisms, not suitable to human behavior in our urban milieu. Beta receptor blocking agents are effective antidotes providing protection from adrenomedullary overdrive and even perhaps, modification of that behavior. Stress and the sympathetic nervous system are important co-conspirators in hypertension and sudden cardiac death.     

Relation between job strain, alcohol, and ambulatory blood pressure.

"Job strain" (defined as high psychological demands and low decision latitude on the job) has been previously reported to be associated with increased risk of hypertension and increased left ventricular mass index (LVMI) in a case-control study of healthy employed men, aged 30-60 years, without evidence of coronary heart disease. We hypothesized that job strain would be associated with increased ambulatory blood pressure (AmBP). A total of 264 men at eight work sites wore an AmBP monitor for 24 hours on a working day. In an analysis of covariance model, job strain was associated with an increase in systolic AmBP of 6.8 mm Hg (p = 0.002) and diastolic AmBP of 2.8 mm Hg at work (p = 0.03) after adjusting for age, race, body mass index, Type A behavior, alcohol behavior, smoking, work site, 24-hour urine sodium, education, and physical demand level of the job. Alcohol use also had a significant effect on AmBP. However, among subjects not in high-strain jobs, alcohol had no apparent effect on AmBP at work. Instead, alcohol use and job strain interacted such that workers in high-strain jobs who drank regularly had significantly higher systolic AmBP at work (p = 0.007). Among the other risk factors, only age, body mass index, and smoking had significant effects on AmBP. Job strain also had significant effects on AmBP at home and during sleep as well as on LVMI.(ABSTRACT TRUNCATED AT 250 WORDS)     

Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program

Abstract. László KD, Ahnve S, Hallqvist J, Ahlbom A, Janszky I. (Karolinska Institute, Stockholm, Sweden; Semmelweis University, Budapest, Hungary; Uppsala University, Uppsala, Sweden; and Karolinska Institute, Stockholm, Sweden). Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program. J Intern Med 2010; 267 :599–611. Objectives. Studies investigating the prognostic role of job stress in coronary heart disease are sparse and have inconclusive findings. We aimed (i) to investigate whether job strain predicts recurrent events after acute myocardial infarction (AMI) and if so (ii) to determine behavioural and biological factors that contribute to the explanation of this association. Design. Prospective study. Setting. Ten emergency hospitals in the larger Stockholm area, Sweden. Subjects. Non‐fatal AMI cases from the Stockholm Heart Epidemiology Program case–control study who were employed and younger than 65 years at the time of their hospitalization (n = 676). Results. During the 8.5 year follow‐up, 155 patients experienced cardiac death or non‐fatal AMI; totally 96 patients died, 52 of cardiac causes. After adjustment for potential confounders, patients with high job strain had an increased risk for the combination of cardiac death and non‐fatal AMI relative to those with low job strain, the hazard ratio (HR) and the 95% confidence interval (CI) being 1.73 (1.06–2.83). Results were similar for cardiac [HR (95% CI): 2.81 (1.16–6.82)] and total mortality [HR (95% CI): 1.65 (0.91–2.98)]. We found no evidence for mediation from lifestyle, sleep, lipids, glucose, inflammatory and coagulation markers on the association between job strain and the combination of cardiac death and non‐fatal AMI. Conclusions. Job strain was associated with poor long‐term prognosis after a first myocardial infarction. Interventions focusing on reducing stressors at the workplace or on improving coping with work stress in cardiac patients might improve their survival post‐AMI.     

内质网应激与冠状动脉粥样硬化性心脏病关系的研究进展

内质网应激是指由于某些原因引起的细胞内质网生理功能发生紊乱的一种亚细胞器病理状态,其过度应激可导致细胞凋亡、炎症反应及自噬等多个参与动脉粥样硬化发生发展的病理生理过程。近期,内质网应激在冠状动脉粥样硬化性心脏病发生发展过程中的重要作用受到广泛的关注,内质网应激可能成为治疗该疾病的新靶点。本文就内质网应激与冠状动脉粥样硬化性心脏病关系的研究新进展作一综述。     

Triad of metabolic syndrome, chronic kidney disease, and coronary heart disease with a focus on microalbuminuria death by overeating

Coronary heart disease remains a major cause of morbidity and mortality in the United States, and its incidence is rising worldwide. Because atherosclerosis is a chronic process, and it is often associated with certain lifestyle and risk factors such as hypertension, dyslipidemia, and insulin resistance, much emphasis is being placed on lifestyle modification and control of risk factors. It is being recognized that some lifestyle patterns such as overeating result in metabolic syndrome, which may play a role in the development of chronic kidney disease and coronary heart disease. Here, we focus on an important relationship between these 3 conditions, and we provide evidence that microalbuminuria develops in many patients with metabolic syndrome, may be an important correlate of chronic kidney disease and coronary heart disease, and may represent an important prognostic marker. Although the pathogenesis of microalbuminuria in metabolic syndrome is not clear, we suggest that microalbuminuria, chronic kidney disease, and coronary heart disease share common pathways involving inflammation and oxidative stress. We also discuss that a healthy lifestyle is essential for preventing and treating chronic kidney disease and coronary heart disease seen in patients with metabolic syndrome.