Documents ischaemia 10 results

"Objective Increased risk of ischemic heart disease (IHD) mortality from high physical work demands has been observed among men with low physical fitness and leisure time physical activity. We tested whether hypertensive men are at a particularly high risk of IHD mortality when exposed to high physical work demands. Method We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 gainfully employed men aged 40–59 years. Of these, 274 men with a history of myocardial infarction or prevalent symptoms of angina pectoris or intermittent claudication were excluded from the follow-up. Men were classified as having hypertension when any of the following factors was present: (i) treatment for hypertension, (ii) a systolic blood pressure of >160 mm Hg, or (iii) a diastolic blood pressure of >90 mm Hg. Physical work demands were determined by two self-reported questions. Results Of the eligible study population, 587 men (11.9%) died due to IHD. Hypertensive men had more than a doubled risk of IHD mortality [hazard ratio (HR) 2.16, 95% confidence interval (95% CI) 1.80–2.59]. Cox analyses – adjusted for age, smoking, alcohol, body mass index, diabetes, physical fitness, leisure time physical activity, and social class – showed that high physical work demands were associated with an increased risk of IHD and all-cause mortality among normotensive men (N=4127, HR 1.36, 95% CI 0.96–1.92 and HR 1.24, 95% CI 1.06–1.44, respectively), but not among the hypertensive men (N=808, HR 1.07, 95% CI 0.63–1.81 and HR 1.07, 95% CI 0.80–1.42, respectively) using men with low physical work demands as the reference. Conclusion Compared to normotensive men, hypertensive men did not have a higher risk of IHD or all-cause mortality from high physical work demands."

"Objectives
The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees.
Methods
The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality.
Results
Within the 1976–2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women.
Conclusions
Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment."

"Empirical studies on job strain and cardiovascular disease (CVD), their internal validity, and the likely direction of biases were examined. The 17 longitudinal studies had the highest validity ratings. In all but two, biases towards the null dominated. Eight, including several of the largest, showed significant positive results; three had positive, nonsignificant findings. Six of nine case-control studies had significant positive findings; recall bias leading to overestimation appears to be fairly minimal. Four of eight cross-sectional studies had significant positive results. Men showed strong, consistent evidence of an association between exposure to job strain and CVD. The data of the women were more sparse and less consistent, but, as for the men, most of the studies probably underestimated existing effects. Other elements of causal inference, particularly biological plausibility, corroborated that job strain is a major CVD risk factor. Additional intervention studies are needed to examine the impact of ameliorating job strain upon CVD-related outcomes."

"Angina pectoris, abdominal or intestinal angina, and claudicatio intermittens are all well-known clinical pain syndromes related to ischemia as a result of regional atherosclerotic arteries. A decade ago Kauppila (1) hypothesized that low-back pain could be due to atherosclerosis of the small lumbar arterial vessels. The hypothesis was later supported by studies using magnetic resonance (MR) (2), which has shown occlusion in these arteries more often in patients with low-back pain than in controls, and, in postmortem studies, occluded or narrowed arteries were more often found in patients with low-back pain (3). Most of the studies have been cross-sectional or have at least collected information on low-back pain in retrospect, with the risk of information bias.In this issue of the Scandinavian Journal of Work Environment & Health, Leino-Arjas and her co-workers report a cohort study (4) in which risk factors for cardiovascular disease (CVD) were related to the development of low-back pain 28 years later among industrial employees. The paper finds that, especially for the men, smoking, high body mass index (BMI), high cholesterol, high triglycerides, and high blood pressure, alone and in combination, predict low-back pain and thus support the atherosclerotic origin of low-back pain. ..."

"Background
Ischaemic heart disease (IHD) incidence is elevated in people reporting psychological distress. The extent to which this relationship is causal or related to reverse causality—that is, undiagnosed disease causing distress—is unclear. We quantified the relationship between psychological distress and IHD, with consideration of confounding and undiagnosed disease.
Methods
Questionnaire data (2006–2009) from 151 811 cardiovascular disease-free and cancer-free Australian general population members aged ≥45years (45 and Up Study) were linked to hospitalisation and mortality data, to December 2013. A two-stage approach estimated HRs for incident IHD (IHD-related hospitalisation or death) for low (Kessler-10 scores: 10–<12), mild (12–<16), moderate (16–<22) and high (22–50) psychological distress, adjusting for demographic and behavioural characteristics, and then restricting to those with no/minor functioning limitations (likely free from undiagnosed disease).
Results
Over 859 396 person-years, 5230 incident IHD events occurred (rate: 6.09/1000person-years). IHD risk was increased for mild (age-adjusted and sex-adjusted HR: 1.18, 95% CI 1.11 to 1.26), moderate (1.36, 1.25 to 1.47), and high (1.69, 1.52 to 1.88) versus low distress. HRs attenuated to 1.15 (1.08 to 1.22), 1.26 (1.16 to 1.37) and 1.41 (1.26 to 1.57) after adjustment for demographic and behavioural characteristics and were further attenuated by 35%–41% in those with no/minor limitations, leaving a significant but relatively weak dose-response relationship: 1.11 (1.02 to 1.20), 1.21 (1.08 to 1.37) and 1.24 (1.02 to 1.51) for mild, moderate and high versus low distress, respectively. The observed adjustment-related attenuation suggests measurement error/residual confounding likely contribute to the remaining association.
Conclusion
A substantial part of the distress-IHD association is explained by confounding and functional limitations, an indicator of undiagnosed disease. Emphasis should be on psychological distress as a marker of healthcare need and IHD risk, rather than a causative factor."