Kowata Emi, Hozawa Atsushi, Kakizaki Masako, Tomata Yasutake, Nagai Masato, Sugawara Yumi, Kuriyama Shinichi, Tsuji Ichiro
Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine.
Nihon Koshu Eisei Zasshi. 2012 Feb;59(2):82-91.
Previous studies have indicated that stress can affect the circulatory system. Although prospective studies have examined the association between perceived stress and cardiovascular disease (CVD) mortality, the results are still controversial. The purpose of the present study was to elucidate the relationship with stratified analyses by alcohol intake category and smoking status.
The prospective Ohsaki Cohort Study covered all National Health Insurance beneficiaries aged 40 to 79 years living in the precinct of Ohsaki Public Health Center, Miyagi, Japan. A total of 45,293 Japanese (21,552 men and 23,741 women), without a history of cancer, ischemic heart disease or stroke, and who answered all items related to stress level at the baseline in 1994, were followed prospectively. Over 12 years of follow-up, 1,751 deaths from CVD occurred (994 men and 757 women). We used Cox proportional hazards models to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for CVD mortality according to the perceived stress categories. The low stress category was used as the reference in all analyses.
Perceived stress demonstrated a significant positive association with CVD mortality for men; the multivariate adjusted HR for high versus low stress was 1.43 (95% CI: 1.19, 1.87, P = 0.006). No significant relationship was noted for women. With current smokers, perceived high stress versus low had a pronounced association for both men (HR = 1.76, 95% CI: 1.28, 2.41, P = 0.001) and women (HR = 1.61, 95% CI: 1.20, 2.16, P = 0.004), and a similar tendency was noted for current drinking (HR = 1.56, 95% CI: 1.16, 2.09, P = 0.006, HR = 1.42, 95% CI: 1.08, 1.87, P = 0.001). Additionally, for both smoking and drinking men, those reporting high stress had 2 times the risk of CVD mortality of their low stress counterparts (P for trend < 0.001). The interaction of perceived stress with smoking for CVD mortality was of borderline statistical significance only for men (P for interaction = 0.04).
The results suggest that the percentage of current smoking and drinking are factors that distinguish between sexes with regard to the effects of perceived stress on the incidence of CVD mortality. Furthermore our present findings indicate that smoking and drinking habit are not the way to relieve one's stress. A review of these should be conducted and we need to enhance support for stress management as well as control over smoking and drinking habits.
以往研究表明，压力会影响循环系统。尽管前瞻性研究已考察了感知压力与心血管疾病（CVD）死亡率之间的关联，但其结果仍存在争议。本研究的目的是通过饮酒类别和吸烟状况进行分层分析，以阐明它们之间的关系。
前瞻性的大船队列研究涵盖了居住在日本宫城县大船公共卫生中心辖区内所有年龄在40至79岁的国民健康保险受益人。共有45293名日本人（21552名男性和23741名女性）参与研究，他们均无癌症、缺血性心脏病或中风病史，且在1994年基线时回答了所有与压力水平相关的问题，并接受前瞻性随访。在超过12年的随访期间，发生了1751例CVD死亡（994名男性和757名女性）。我们使用Cox比例风险模型，根据感知压力类别计算CVD死亡率的风险比（HR）和95%置信区间（CI）。在所有分析中，低压力类别用作参照。
对于男性，感知压力与CVD死亡率呈现显著正相关；高压力与低压力相比，多变量调整后的HR为1.43（95%CI：1.19，1.87，P = 0.006）。女性未发现显著关系。对于当前吸烟者，高压力与低压力相比，男性（HR = 1.76，95%CI：1.28，2.41，P = 0.001）和女性（HR = 1.61，95%CI：1.20，2.16，P = 0.004）均有明显关联，当前饮酒者也有类似趋势（HR = 1.56，95%CI：1.16，2.09，P = 0.006，HR = 1.42，95%CI：1.08，1.87，P = 0.001）。此外，对于吸烟和饮酒的男性，报告高压力者CVD死亡率是低压力者的2倍（趋势P < 0.001）。仅对于男性，感知压力与吸烟对CVD死亡率的交互作用具有边缘统计学意义（交互作用P = 0.04）。
结果表明，当前吸烟和饮酒的比例是在感知压力对CVD死亡率影响方面区分性别的因素。此外，我们目前的研究结果表明，吸烟和饮酒习惯并非缓解压力的方式。应对此进行审查，我们需要加强对压力管理的支持以及对吸烟和饮酒习惯的控制。
