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Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data

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Abstract
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 life style may substantially reduce disease risk among people with job strain.
Keywords
CARDIOVASCULAR-DISEASE, MYOCARDIAL-INFARCTION, PHYSICAL-ACTIVITY, BLOOD-PRESSURE, 52 COUNTRIES, WORK STRESS, WEIGHT-LOSS, FOLLOW-UP, HEART-DISEASE, SMOKING-CESSATION INTERVENTION

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MLA
Kivimäki, Mika, Solja T Nyberg, Eleonor I Fransson, et al. “Associations of Job Strain and Lifestyle Risk Factors with Risk of Coronary Artery Disease: a Meta-analysis of Individual Participant Data.” CANADIAN MEDICAL ASSOCIATION JOURNAL 185.9 (2013): 763–769. Print.
APA
Kivimäki, M., Nyberg, S. T., Fransson, E. I., Heikkilä, K., Alfredsson, L., Casini, A., Clays, E., et al. (2013). Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data. CANADIAN MEDICAL ASSOCIATION JOURNAL, 185(9), 763–769.
Chicago author-date
Kivimäki, Mika, Solja T Nyberg, Eleonor I Fransson, Katriina Heikkilä, Lars Alfredsson, Annalisa Casini, Els Clays, et al. 2013. “Associations of Job Strain and Lifestyle Risk Factors with Risk of Coronary Artery Disease: a Meta-analysis of Individual Participant Data.” Canadian Medical Association Journal 185 (9): 763–769.
Chicago author-date (all authors)
Kivimäki, Mika, Solja T Nyberg, Eleonor I Fransson, Katriina Heikkilä, Lars Alfredsson, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Jane E Ferrie, Marcel Goldberg, Mark Hamer, Markus Jokela, Robert Karasek, France Kittel, Anders Knutsson, Markku Koskenvuo, Maria Nordin, Tuula Oksanen, Jaana Pentti, Reiner Rugulies, Paula Salo, Johannes Siegrist, Sakari B Suominen, Töres Theorell, Jussi Vahtera, Marianna Virtanen, Peter JM Westerholm, Hugo Westerlund, Marie Zins, Andrew Steptoe, Archana Singh-Manoux, and G David Batty. 2013. “Associations of Job Strain and Lifestyle Risk Factors with Risk of Coronary Artery Disease: a Meta-analysis of Individual Participant Data.” Canadian Medical Association Journal 185 (9): 763–769.
Vancouver
1.
Kivimäki M, Nyberg ST, Fransson EI, Heikkilä K, Alfredsson L, Casini A, et al. Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data. CANADIAN MEDICAL ASSOCIATION JOURNAL. 2013;185(9):763–9.
IEEE
[1]
M. Kivimäki et al., “Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data,” CANADIAN MEDICAL ASSOCIATION JOURNAL, vol. 185, no. 9, pp. 763–769, 2013.
@article{4302069,
  abstract     = {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 life style may substantially reduce disease risk among people with job strain.},
  author       = {Kivimäki, Mika and Nyberg, Solja T and Fransson, Eleonor I and Heikkilä, Katriina and Alfredsson, Lars and Casini, Annalisa and Clays, Els and De Bacquer, Dirk and Dragano, Nico and Ferrie, Jane E and Goldberg, Marcel and Hamer, Mark and Jokela, Markus and Karasek, Robert and Kittel, France and Knutsson, Anders and Koskenvuo, Markku and Nordin, Maria and Oksanen, Tuula and Pentti, Jaana and Rugulies, Reiner and Salo, Paula and Siegrist, Johannes and Suominen, Sakari B and Theorell, Töres and Vahtera, Jussi and Virtanen, Marianna and Westerholm, Peter JM and Westerlund, Hugo and Zins, Marie and Steptoe, Andrew and Singh-Manoux, Archana and Batty, G David},
  issn         = {0820-3946},
  journal      = {CANADIAN MEDICAL ASSOCIATION JOURNAL},
  keywords     = {CARDIOVASCULAR-DISEASE,MYOCARDIAL-INFARCTION,PHYSICAL-ACTIVITY,BLOOD-PRESSURE,52 COUNTRIES,WORK STRESS,WEIGHT-LOSS,FOLLOW-UP,HEART-DISEASE,SMOKING-CESSATION INTERVENTION},
  language     = {eng},
  number       = {9},
  pages        = {763--769},
  title        = {Associations of job strain and lifestyle risk factors with risk of coronary artery disease: a meta-analysis of individual participant data},
  url          = {http://dx.doi.org/10.1503/cmaj.121735},
  volume       = {185},
  year         = {2013},
}

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