This Article Full Text Full Text (PDF) An erratum has been published Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kivimäki, M. Articles by Shipley, M. J. Search for Related Content PubMed PubMed Citation Articles by Kivimäki, M. Articles by Shipley, M. J. Related Collections Stress and Coping Coronary Artery Disease

Why Is Evidence on Job Strain and Coronary Heart Disease Mixed? An Illustration of Measurement Challenges in the Whitehall II Study

From the University of Helsinki, Helsinki, Finland (M.K.); the University College London Medical School, London, UK (J.H., M.J.S., J.E.F., E.B., M.G.M.); the Finnish Institute of Occupational Health, Helsinki, Finland (M.K., J.V.).

Address correspondence and reprint requests to Mika Kivimäki, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland. E-mail: mika.kivimaki{at}ttl.fi

Objective: Evidence regarding the status of job strain as a risk factor for coronary heart disease (CHD) is mixed, including both results supporting the risk status and null findings. However, previous studies have typically assessed job strain at one point in time only. We examined whether the failure of such measurement to reflect long-term job strain could contribute to false null findings.

Methods: Job strain and its components, as stress indicators, were assessed twice (3-year time lag) for 5043 men and 2210 women who were free of apparent CHD at baseline. Incident CHD after the stress measurement comprised CHD death, a first nonfatal myocardial infarction, or definite angina (mean follow-up, 10.4 years). The data analysis was based on Cox proportional-hazard models adjusted for age, sex, and employment grade and corrected using regression dilution ratios calculated from short-term repeat data in a random subsample.

Results: In the total cohort, incidence of new CHD was higher for higher levels of job strain and demands. For these stress indicators, the corrected excess CHD risk was 30% and 29% higher than the corresponding uncorrected estimates, whereas the corresponding increase for job control was only 13%. Effects of job strain and work demands, but not job control, were stronger for a subgroup, with consistent exposure measurements over time than for the total cohort.

Conclusion: This evidence suggests that use of single-time exposure measures may underestimate the status of long-term job strain as a CHD risk factor.

Key Words: psychosocial factors • stress • coronary heart disease • measurement • epidemiologic studies

Abbreviations: CHD = coronary heart disease; ECG = electrocardiogram.

This article has been cited by other articles:

				A. Vaananen, A. Koskinen, M. Joensuu, M. Kivimaki, J. Vahtera, A. Kouvonen, and P. Jappinen Lack of Predictability at Work and Risk of Acute Myocardial Infarction: An 18-Year Prospective Study of Industrial Employees Am J Public Health, December 1, 2008; 98(12): 2264 - 2271. [Abstract] [Full Text] [PDF]

				M Kivimaki, T Theorell, H Westerlund, J Vahtera, and L Alfredsson Job strain and ischaemic disease: does the inclusion of older employees in the cohort dilute the association? The WOLF Stockholm Study J Epidemiol Community Health, April 1, 2008; 62(4): 372 - 374. [Abstract] [Full Text] [PDF]

				A. Kouvonen, M. Kivimaki, M. Elovainio, A. Vaananen, R. De Vogli, T. Heponiemi, A. Linna, J. Pentti, and J. Vahtera Low organisational justice and heavy drinking: a prospective cohort study Occup. Environ. Med., January 1, 2008; 65(1): 44 - 50. [Abstract] [Full Text] [PDF]

				M. Kivimaki, J. E. Ferrie, M. Shipley, D. Gimeno, M. Elovainio, R. de Vogli, J. Vahtera, M. G. Marmot, and J. Head Effects on Blood Pressure Do Not Explain the Association Between Organizational Justice and Coronary Heart Disease in the Whitehall II Study Psychosom Med, January 1, 2008; 70(1): 1 - 6. [Abstract] [Full Text] [PDF]

				C. Aboa-Eboule, C. Brisson, E. Maunsell, B. Masse, R. Bourbonnais, M. Vezina, A. Milot, P. Theroux, and G. R. Dagenais Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events JAMA, October 10, 2007; 298(14): 1652 - 1660. [Abstract] [Full Text] [PDF]

				M. Kivimaki, J. Vahtera, M. Elovainio, M. Virtanen, and J. Siegrist Effort-reward imbalance, procedural injustice and relational injustice as psychosocial predictors of health: complementary or redundant models? Occup. Environ. Med., October 1, 2007; 64(10): 659 - 665. [Abstract] [Full Text] [PDF]