Work stress and coronary heart disease: what are the mechanisms?
Work stress and coronary heart disease: what are the mechanisms?
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DOI：
10.1093/eurheartj/ehm584
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发表时间：
2008-03-01
影响因子：
39.3
通讯作者：
Marmot, Michael
中科院分区：
文献类型：
--
作者：
Chandola, Tarani;Britton, Annie;Marmot, Michael
目的：确定工作压力与冠心病（CHD）的生物和行为因素。方法和结果共10 308伦敦的男性和女性公务员年龄在35-55在白厅II研究的第1阶段（1985-88）进行了研究。暴露包括工作压力（在第1和第2阶段评估），结局包括行为风险因素（第3阶段）、代谢综合征（第3阶段）、心率变异性、皮质醇晨起（第7阶段）和基于CHD死亡、非致死性心肌梗死或明确心绞痛的CHD事件（第2-7阶段）。慢性工作压力与冠心病相关，并且这种关联在50岁以下的参与者中更强（RR 1.68，95%CI 1.17-2.42）。工作压力与低体力活动、不良饮食、代谢综合征及其组成部分以及较低的心率变异性之间存在类似的关联。从横截面来看，工作压力与皮质醇的早晨升高有关。结论工作压力可能是劳动年龄人群冠心病发病的重要决定因素，工作压力通过对健康行为的间接影响和对神经内分泌应激途径的直接影响而发挥作用。
Aims To determine the biological and behavioural factors linking work stress with coronary heart disease (CHD).Methods and results A total of 10 308 London-based male and female civil servants aged 35-55 at phase 1 (1985-88) of the Whitehall II study were studied. Exposures included work stress (assessed at phases 1 and 2), and outcomes included behavioural risk factors (phase 3), the metabolic syndrome (phase 3), heart rate variability, morning rise in cortisol (phase 7), and incident CHD (phases 2-7) on the basis of CHD death, non-fatal myocardial infarction, or definite angina. Chronic work stress was associated with CHD and this association was stronger among participants aged under 50 (RR 1.68, 95% CI 1.17-2.42). There were similar associations between work stress and low physical activity, poor diet, the metabolic syndrome, its components, and lower heart rate variability. Cross-sectionally, work stress was associated with a higher morning rise in cortisol. Around 32% of the effect of work stress on CHD was attributable to its effect on health behaviours and the metabolic syndrome.Conclusion Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.