Department of Epidemiology and Public Health, University College London, London, UK.
CMAJ. 2013 Jun 11;185(9):763-9. doi: 10.1503/cmaj.121735. Epub 2013 May 13.
It is unclear whether a healthy lifestyle mitigates the adverse effects of job strain on coronary artery disease. We examined the associations of job strain and lifestyle risk factors with the risk of coronary artery disease.
We pooled individual-level data from 7 cohort studies comprising 102 128 men and women who were free of existing coronary artery disease at baseline (1985-2000). Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current smoking, physical inactivity, heavy drinking and obesity. We grouped participants into 3 lifestyle categories: healthy (no lifestyle risk factors), moderately unhealthy (1 risk factor) and unhealthy (2-4 risk factors). The primary outcome was incident coronary artery disease (defined as first nonfatal myocardial infarction or cardiac-related death).
There were 1086 incident events in 743,948 person-years at risk during a mean follow-up of 7.3 years. The risk of coronary artery disease among people who had an unhealthy lifestyle compared with those who had a healthy lifestyle (hazard ratio [HR] 2.55, 95% confidence interval [CI] 2.18-2.98; population attributable risk 26.4%) was higher than the risk among participants who had job strain compared with those who had no job strain (HR 1.25, 95% CI 1.06-1.47; population attributable risk 3.8%). The 10-year incidence of coronary artery disease among participants with job strain and a healthy lifestyle (14.7 per 1000) was 53% lower than the incidence among those with job strain and an unhealthy lifestyle (31.2 per 1000).
The risk of coronary artery disease was highest among participants who reported job strain and an unhealthy lifestyle; those with job strain and a healthy lifestyle had half the rate of disease. A healthy lifestyle may substantially reduce disease risk among people with job strain.
目前尚不清楚健康的生活方式是否可以减轻工作压力对冠状动脉疾病的不利影响。我们研究了工作压力和生活方式危险因素与冠状动脉疾病风险之间的关系。
我们汇总了 7 项队列研究的个体水平数据，这些研究共纳入了 102128 名基线时无现有冠状动脉疾病的男性和女性（1985-2000 年）。问卷调查用于测量工作压力（是/否）和 4 种生活方式危险因素：当前吸烟、身体活动不足、大量饮酒和肥胖。我们将参与者分为 3 种生活方式类别：健康（无生活方式危险因素）、中度不健康（有 1 种危险因素）和不健康（有 2-4 种危险因素）。主要结局是首发非致死性心肌梗死或与心脏相关的死亡定义的冠心病事件。
在平均 7.3 年的随访期间，共发生 1086 例冠心病事件，发生于 743948 人年。与生活方式健康的人相比，生活方式不健康的人发生冠心病的风险更高（风险比 [HR] 2.55，95%置信区间 [CI] 2.18-2.98；人群归因风险 26.4%），高于无工作压力的人发生冠心病的风险（HR 1.25，95%CI 1.06-1.47；人群归因风险 3.8%）。有工作压力和健康生活方式的参与者的 10 年冠心病发生率（1000 人年 14.7 例）比有工作压力和不健康生活方式的参与者低 53%（1000 人年 31.2 例）。
报告工作压力和不健康生活方式的参与者发生冠心病的风险最高；而工作压力和健康生活方式的参与者的疾病发生率减半。健康的生活方式可能会大大降低工作压力人群的疾病风险。
