工作壓力增加了女性缺血性心臟病的風險
作者：Megan Brooks
出處：WebMD醫學新聞
May 10, 2010 — 根據發表於5月職業及環境醫學期刊(Occupational and Environmental Medicine)中Danish Nurse Cohort Study這項前瞻研究發現，認為自己處於工作壓力過大下的女性護士，發生缺血性心臟病(ischemic heart disease，IHD)的風險顯著增加，且與傳統冠狀動脈風險因素無關。
丹麥Glostrup大學醫院預防與健康研究中心的Karen Allesoe等人寫道，本研究增添了之前的證據基礎，認為工作上過大的心理需求有害於心臟健康，但是這在對女性的影響中很少被提出。
該研究包括了12,116名女性護士、年紀介於45- 64歲(1993年時)(年齡中位數51歲)，完成有關健康與生活型態、職業狀態與工作狀況之問卷時有被實際僱用。
研究者聚焦在她們的工作壓力程度(偏低、適當、有點高、相當高)以及對工作的影響程度(大影響、一定程度之影響、輕微或無影響)之答覆的分析。
在15年的追蹤期間，有580例偶發IHD案例，包括了369例心絞痛、138例心肌梗塞、73例其他IHD事件。
根據研究者表示，在完全校正模式中，認為自己壓力過大的護士們，共約60%，發生偶發性IHD的風險增加1.4倍(風險比1.38；95%信心區間1.04 – 1.81)。
年齡分層分析顯示，工作壓力高與IHD之間的關聯，只有在研究開始時年紀小於51歲的護士比較顯著。
研究者指出，校正年紀分析、控制傳統心血管風險因素、值班、工作時的生理活動度等之後，過大的工作壓力依舊是IHD的顯著預測因子，即便將心絞痛排除也是如此。
他們結論表示，應進行其他研究，以確認導致認為工作壓力過大的因素。
工作影響和IHD之間並未發現有顯著關聯。
根據研究者表示，基於研究世代樣本數以及追蹤期間發生的IHD案例數，該研究有足夠的統計強度，其他研究強度包括這個丹麥護士世代的高反應率，護士自己提供資料的可信度，研究根據整個丹麥護士族群的事實，使用全國醫院登記資料庫確認IHD案例。
研究發現僅根據兩個有關工作曝露因子的問題，這個事實意味著一些重要方面可能被忽視了，特別是工作控制或影響，他們指出，這也可和其他研究困難相對比。
不過，他們表示，這些發現應納入初級預防之考量。
Job Pressure Raises Risk of Ischemic Heart Disease in Women
By Megan Brooks
Medscape Medical News
May 10, 2010 — Female nurses who feel they are under "too much" pressure at work have a significantly increased risk of developing ischemic heart disease (IHD), independent of traditional coronary risk factors, according to new findings from the prospective Danish Nurse Cohort Study reported in the May issue of Occupational and Environmental Medicine.
"This study adds to the previous body of evidence suggesting harmful effects of excessive psychological demands at work on cardiac health but is one among very few that demonstrates the effect among women," write Karen Allesoe, from Research Centre for Prevention and Health, Glostrup University Hospital, Denmark, and colleagues.
The study included 12,116 female nurses who were between 45 and 64 years old in 1993 (median age, 51 years) and actively employed when they completed a questionnaire on health and lifestyle, including occupational status and working conditions.
The researchers focused their analyses on answers to 1 question on level of work pressure (too low, suitable, a little too high, or much too high) and 1 question on level of job influence (major influence, a certain influence, or minor or no influence).
During a 15-year follow-up period, there were 580 incident cases of IHD. This included 369 cases of angina pectoris, 138 myocardial infarctions, and 73 "other" IHD events.
According to the investigators, in the fully adjusted model, nurses who reported work pressure to be "much too high" — about 60% altogether — had a 1.4-fold increased risk of incident IHD (hazard ratio, 1.38; 95% confidence interval, 1.04 – 1.81).
Age-stratified analysis showed that the association between high work pressure and IHD was only significant among nurses younger than 51 years at baseline.
"Having work pressure that was much too high was a significant predictor of IHD even when angina pectoris was excluded both in age-adjusted analyses and when controlling for traditional cardiovascular risk factors, shift work, and physical activity at work," the investigators note.
"Additional work should be carried out to identify factors contributing to the perceived high work pressure," they conclude.
No significant association was found between job influence and IHD.
According to investigators, the study had sufficient statistical power given the size of the cohort and number of IHD cases that occurred during follow-up. Other strengths are the high response rates obtained in this cohort of Danish nurses, the validity of the self-reported information provided by the nurses, the fact that the study was based on the entire population of Danish nurses, and the use of a nationwide hospital register to identify IHD cases.
The fact that the findings are based on only 2 questions regarding work "exposures" means that important aspects, especially of the work control or influence, may have been overlooked. This also makes comparison with other studies difficult, they note.
Nonetheless, they say these findings "should be taken into account in the planning of primary prevention."
Occup Environ Med. 2010;67:318-322.
