RT Journal Article
SR Electronic
T1 Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 763
OP 769
DO 10.1503/cmaj.121735
VO 185
IS 9
A1 Kivimäki, Mika
A1 Nyberg, Solja T.
A1 Fransson, Eleonor I.
A1 Heikkilä, Katriina
A1 Alfredsson, Lars
A1 Casini, Annalisa
A1 Clays, Els
A1 De Bacquer, Dirk
A1 Dragano, Nico
A1 Ferrie, Jane E.
A1 Goldberg, Marcel
A1 Hamer, Mark
A1 Jokela, Markus
A1 Karasek, Robert
A1 Kittel, France
A1 Knutsson, Anders
A1 Koskenvuo, Markku
A1 Nordin, Maria
A1 Oksanen, Tuula
A1 Pentti, Jaana
A1 Rugulies, Reiner
A1 Salo, Paula
A1 Siegrist, Johannes
A1 Suominen, Sakari B.
A1 Theorell, Töres
A1 Vahtera, Jussi
A1 Virtanen, Marianna
A1 Westerholm, Peter J.M.
A1 Westerlund, Hugo
A1 Zins, Marie
A1 Steptoe, Andrew
A1 Singh-Manoux, Archana
A1 Batty, G. David
A1 
YR 2013
UL http://www.cmaj.ca/content/185/9/763.abstract
AB Background: 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.Methods: 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).Results: 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).Interpretation: 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.