Survivors of a first myocardial infarction who report chronic job stress have roughly twice the risk of a subsequent major event such as recurrent myocardial infarction or unstable angina as peers who do not perceive chronic job stress, according to an article in the October 10 issue of the Journal of the American Medical Association.

Several studies have shown that job strain increases the risk of a first coronary heart disease event. However, little is known about the association of job strain on the risk of recurrent events, according to background information in the article.

Corine Aboa-Eboule, MD, PhD, of the Universite Laval, Quebec, Canada, and colleagues conducted a study to determine whether job strain increases the risk of recurrent coronary heart disease events after a first infarction. The study included 972 men and women, age 35 to 59 years, who returned to work after a first infarction and were followed between February 1996 and June 2005.

Patients were interviewed at baseline (on average, six weeks after return to work), then after two and six years subsequently. Job strain was defined and determined by the degree of high psychological demand and low decision control.

During the average follow-up of 5.9 years, 206 patients had a confirmed recurrent coronary event (111 nonfatal infarctions, 82 episodes of unstable angina, and 13 coronary deaths).

Chronic job strain was associated with a two-fold increase in the risk of recurrent coronary events even after adjustment for 26 potentially confounding risk factors and sociodemographic, lifestyle, and clinical-prognostic and work-environment characteristics.

There were no significant statistical interactions between chronic job strain and either sex, age, marital status, education, perceived economic situation and chronic low social support at work.

“These results suggest that preventive interventions aimed at reducing job strain might have a significant impact on recurrent coronary heart disease events. Although further studies are required to establish optimal interventions, information about the results of this study should be disseminated in cardiac practice and in occupational health services with the aim of reducing job strain for workers returning to work after [a heart attack],” wrote the authors.

There needs to be a greater emphasis on evaluating job strain, wrote Kristina Orth-Gomer, MD, of the Karolinska Institutet, Stockholm, Sweden, in an accompanying editorial.

“Job strain and other related psychosocial risk factors are associated with worse prognosis in patients with coronary heart disease. These influences are independent of standard risk factors and need to be addressed in clinical practice. However, knowledge is lacking on how to prevent and manage job strain in particular and psychosocial risk in general. Therefore, there is a great need for research on methods and interventions to deal with these risk factors in the clinical setting.”

“Patients and physicians may benefit from widening the medical framework to include job strain evaluation. If physicians have difficulty finding adequate time to discuss job experiences with patients, this role may be adopted by other health care professionals, such as experienced cardiac rehabilitation nurses. Patients are often relieved and may spontaneously report improved quality of life and increased capacity for coping once they have their concerns assessed.”