BACKGROUND: Patients' health beliefs influence their willingness to comply with medical advice. In an earlier study, it was found that men with a previous history of information on risk factors for ischaemic heart disease expressed more feelings of threat to their health than did men without this experience. As anxiety may have adverse effects, such as making patients avoid the desired action, this could complicate adequate patient treatment. AIMS: To investigate the impact on health beliefs caused by participation in a screening programme for risk factors for ischaemic heart disease, including individualized information to patients with hypercholesterolaemia. METHODS: A random sample of middle-aged, urban men participating in a health screening completed a questionnaire on socioeconomic factors, medical history, lifestyle, and health beliefs. Blood pressures and plasma cholesterol values were measured. Four months after the initial screening, hypercholesterolaemic men and controls completed the questionnaire again. RESULTS: In a univariate analysis, no differences in health belief indices were found between cases and controls at the baseline screening. Controls achieved lower values of the indices "perceived control over illness" and "medical motivation" at follow-up. In a matched case-control design, the differences in "medical motivation" increased between cases and controls because controls reported lower values. "Perceived threat to health" did not change, and it is suggested that this is due to the supportive information to the patients. CONCLUSION: Individualized and supportive patient information on risk factors for cardiovascular disease does not increase patients' perceptions of threat.
The potential predictors of ischemic heart disease mortality were studied for 931 male foundry workers in Finland who participated in a health examination in 1973. These workers were followed up to 1993 through registers and by using a questionnaire. In 1973, the systolic and diastolic blood pressures of workers exposed to carbon monoxide (CO) were slightly higher than those of unexposed workers. The prevalence of angina pectoris showed a clear dose-response relation to CO exposure. Electrocardiogram (ECG) findings indicating past myocardial infarction or suggesting coronary artery disease as a function of smoking and/or CO exposure were not evident. In the 1987 follow-up, the rate ratio for ischemic heart disease mortality was estimated as 4.4 for CO-exposed smokers compared with unexposed nonsmokers. Ischemic heart disease mortality in 1973-1993 was analyzed by using the Cox proportional hazards model. The statistically significant predictors were age, pathologic ECG findings in 1973, regular CO exposure, and abundant alcohol drinking. Of the ECG findings, changes in Q or QS and ST-J or ST waves and in ventricular extrasystoles were statistically significant. The risk of mortality from ischemic heart disease was increased by working in iron foundries, by hypertension, and by smoking.
Stress is a consequence of different types of external demands, most of which have been shown to be associated with increased risk of ischaemic heart disease (IHD), but whether accumulation of stressors over a life-course results in additional risk of IHD remains unknown. This study investigates the impact of major life events (MLE) in childhood, adulthood and at work, singly and accumulated, on incident IHD in men and women and examines vital exhaustion (VE) and use of tranquillizers as potential mediators. Material and methods The study includes 8738 participants, 57% women, from the third wave of the Copenhagen City Heart Study, who in 1991-93 answered a range of questions on MLE, VE and use of tranquillizers. The participants were followed in a nationwide hospital discharge register until 2007.
During follow-up, 653 experienced a first-time incident of IHD. In general, there were no associations between MLE and incidence of IHD. However, being placed in care during childhood was associated with a higher risk of IHD among women [hazard ratio (HR) = 1.36; 95% confidence interval (95% CI) 0.97-1.89], but a lower risk of IHD among men (HR = 0.72; 95% CI 0.51-1.03). MLE showed a dose-response association with psychological risk factors with highest estimates for those exposed to MLE in all three life domains: VE [odds ratio (OR)?=?15.07; 95% CI 8.97-25.31] and use of tranquillizers (OR = 4.41; 95% CI 3.10-6.26).
This prospective study finds no associations between accumulated MLE and IHD. MLE is, however, strongly associated with VE and use of tranquillizers. The results underscore the problems in conceptualizing and measuring MLE.
AIMS: To test the relationship between job strain and the incidence of ischaemic heart disease (IHD) prospectively in the Danish working population. METHODS AND RESULTS: In 1986, a clinical examination was undertaken of 659 men, all employed and without known IHD, together with a questionnaire-based evaluation of living conditions and psychosocial factors at work, including items identified in the job strain model. This study was part of the World Health Organization-initiated MONICA II study. In the job strain model, job strain is defined as the combination of high psychological demands and a low degree of control in the work situation. An objective classification of the components in the job strain model was made by imputation by utilizing the participants' job title and the principles guiding the payment of their salaries/wages. In addition, a questionnaire-based subjective classification was undertaken. All participants were followed until the end of 1999 with regard to hospitalization and death as a result of IHD. Stepwise analyses were made, adjusting for age, social class, social network and established behavioural and physiological coronary risk factors. Self-reported job strain was significantly associated with IHD independently of standard coronary risk factors. Of the two components in the job strain model only high demands contributed significantly to this result. The study did not support the job strain hypothesis when an imputed, objective classification of the components in the job strain model was applied. This is in accordance with the majority of other studies in this area. An unexpected finding was that the incidence of IHD was highest among employers and managers. CONCLUSION: High psychological demands at work are a risk factor for IHD, a fact that should affect the primary and secondary prevention of IHD.
To investigate the effect of work pressure and job influence on the development of ischaemic heart disease (IHD) in women.
The effect of work pressure and job influence on the 15-year incidence of IHD in women participating in the Danish Nurse Cohort Study was prospectively studied. A total of 12 116 participants, aged 45-64 years, were examined in 1993 using a questionnaire and were followed by individual linkage in the National Register of Hospital Discharges to the beginning of 2008. Work pressure, job influence, occupational characteristics, demographic factors and known biological and behavioural risk factors for IHD were collected at baseline.
During follow-up, 580 participants were hospitalised with IHD. In the fully adjusted model, nurses who reported work pressure to be much too high had a 1.4-fold increased risk of incident IHD (95% CI 1.04 to 1.81) compared with nurses who reported work pressure to be suitable. A tendency towards a dose-response effect was found. Age-stratified analysis showed that this effect was significant only among the younger nurses (
Comment In: Occup Environ Med. 2010 May;67(5):291-220447986
To investigate a relative risk of cardiovascular complications in uncomplicated hypertensive crises (UHC) in hypertensive patients.
A questionnaire retrospective case-control study covered one-third of patients registered in the data base of a hospital or outpatient clinic. The patients were matched by basic characteristics. By frequency of UHC the patients were divided into two groups. Group 1 (n = 305) comprised patients with frequent (weekly or more often) UHC, group 2 (n = 558) consisted of patients with rare UHC (monthly or less frequent).
Patients of group 1 had a longer history of arterial hypertension (13 +/- 9 years vs 9 +/- 7.8 years, p 0.05).
Frequent UHC raise the risk of non-fatal acute disorder of cerebral circulation, chronic cardiac failure, ischemia and left ventricular hypertrophy. Frequency of UHC is not related to the risk of myocardial infarction.