Theorell T, Perski A, Orth-Gomér K, Hamsten A, de Faire U
National Institute for Psychosocial Factors and Health, Stockholm, Sweden.
Int J Cardiol. 1991 Jan;30(1):61-7. doi: 10.1016/0167-5273(91)90125-9.
Seventy-nine men who had suffered a myocardial infarction before the age of 45 while they were vocationally active in the greater Stockholm area were followed for five years. Forty-nine survived without cardiac complications and 13 died due to ischaemic heart disease during the period of follow-up. These two contrasting groups were compared with regard to psychosocial risk factors at work before the first myocardial infarction (as reported by the patient when he was interviewed during the weeks after the onset of disease). It was hypothesized that returning to stressful work (high demands and limited possibilities of influencing decisions and developing skills) would be associated with an increased risk of death. All the subjects who died had returned to the work that they had performed prior to the first myocardial infarct. Work performed by these patients was described as having significantly higher psychological demands in relation to the possibility of learning new things and higher demands in relation to variety as well as almost significantly higher demands in relation to influence. Multivariate logistic regression with these factors concerning employment, together with biomedical risk factors recorded at the same time, showed that increasing age, increasing degree of coronary atherosclerosis and number of stenosed coronary arteries, as well as high demands in relation to the possibility of learning new things, were independent predictors of death due to coronary arterial disease. The remaining 17 subjects either survived a re-infarction, or had coronary arterial by-pass surgery during the period of follow-up. This heterogeneous group occupied intermediate positions with regard to psychosocial job factors.
对79名在45岁之前曾患心肌梗死且当时在大斯德哥尔摩地区仍从事职业活动的男性进行了为期五年的随访。49人存活且无心脏并发症，13人在随访期间死于缺血性心脏病。将这两个形成对比的组在首次心肌梗死之前工作时的社会心理风险因素方面进行了比较（这些信息由患者在疾病发作后的几周内接受访谈时提供）。研究假设，回到压力大的工作岗位（高要求且影响决策和提升技能的可能性有限）会增加死亡风险。所有死亡的受试者都回到了首次心肌梗死之前从事的工作岗位。这些患者所从事的工作在学习新事物的可能性方面心理要求显著更高，在多样性方面要求更高，在影响力方面要求几乎显著更高。将这些与就业相关的因素以及同时记录的生物医学风险因素纳入多变量逻辑回归分析，结果显示，年龄增长、冠状动脉粥样硬化程度增加、冠状动脉狭窄数量增加以及在学习新事物可能性方面的高要求，都是冠状动脉疾病导致死亡的独立预测因素。其余17名受试者在随访期间要么再次发生心肌梗死存活下来，要么接受了冠状动脉搭桥手术。这个异质性群体在社会心理工作因素方面处于中间位置。
