Hlatky M A, Lam L C, Lee K L, Clapp-Channing N E, Williams R B, Pryor D B, Califf R M, Mark D B
Department of Health Research and Policy, Stanford University School of Medicine 94305-5092, USA.
Circulation. 1995 Aug 1;92(3):327-33. doi: 10.1161/01.cir.92.3.327.
It has been hypothesized that jobs that have both high psychological demands and low decision latitude ("job strain") can lead to coronary disease. The objective of this study was to test whether job strain was correlated with the presence of coronary disease at angiography or with long-term outcome in patients with angiographic coronary disease.
Employed patients under the age of 65 years undergoing diagnostic coronary angiography completed a self-administered questionnaire about their job duties and work environment. Job strain was measured by the method of Karasek. Patients were separated into three groups, based on extent of coronary disease: significant disease (> or = 75% stenosis), insignificant disease (> 0% but < 75% stenosis), and normal coronary arteries. Statistical analyses were performed using logistic regression and the Cox proportional hazards model. The 1489 patients enrolled had a median age of 52 years; 76% were male and 88% were white. By design, all patients were employed, 60% in white-collar jobs and only 16% in jobs requiring heavy labor. Traditional cardiac risk factors were most prevalent in the 922 patients with significant coronary artery disease, at intermediate levels in the 204 patients with insignificant disease, and least prevalent in the 363 patients with normal coronary arteries (all P < .01). Job strain was actually more common in patients with normal coronary arteries (35%) than in patients with insignificant (26%) or significant disease (25%, P < .002). In a multivariate analysis, job strain was not significantly correlated with the presence of coronary disease. Job strain was not correlated with angina frequency at the time of angiography. Job strain was not a predictor of cardiac events (cardiac death or nonfatal myocardial infarction) during follow-up.
Job strain was not correlated with the prevalence or severity of coronary artery disease in a cohort of patients undergoing coronary angiography. The outcome of patients with angiographically defined coronary disease was not affected by the level of job strain as measured by the method of Karasek.
据推测，那些心理需求高而决策自由度低的工作（“工作压力”）可能会导致冠心病。本研究的目的是检验工作压力是否与血管造影时冠心病的存在相关，或与血管造影确诊的冠心病患者的长期预后相关。
年龄在65岁以下接受诊断性冠状动脉造影的在职患者完成了一份关于其工作职责和工作环境的自填式问卷。采用Karasek方法测量工作压力。根据冠状动脉疾病的程度，将患者分为三组：严重疾病（狭窄≥75%）、非严重疾病（狭窄>0%但<75%）和冠状动脉正常。使用逻辑回归和Cox比例风险模型进行统计分析。纳入的1489例患者中位年龄为52岁；76%为男性，88%为白人。按照设计，所有患者均为在职人员，60%从事白领工作，只有16%从事重体力劳动工作。传统的心脏危险因素在922例严重冠状动脉疾病患者中最为普遍，在204例非严重疾病患者中处于中等水平，在363例冠状动脉正常的患者中最不普遍（均P<.01）。实际上冠状动脉正常的患者中工作压力（35%）比非严重疾病患者（26%）或严重疾病患者（25%）更常见（P<.002）。在多变量分析中，工作压力与冠心病的存在无显著相关性。工作压力与血管造影时的心绞痛频率无关。工作压力不是随访期间心脏事件（心源性死亡或非致命性心肌梗死）的预测因素。
在接受冠状动脉造影的患者队列中，工作压力与冠状动脉疾病的患病率或严重程度无关。通过Karasek方法测量的工作压力水平不会影响血管造影确诊的冠心病患者的预后。
