Wednesday, August 24, 2005

Stress and MI - Lancet

Another paper linking psychosocial risk factors, especially stress at work, to MI’s. BrooklynDodger actually hesitated because the cross cultural issues might obscure an effect, but neverthe less an effect was found.

The Lancet Volume 364, Issue 9438 , 11 September 2004-17 September 2004, Pages 953-962

Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study

ProfAnnika Rosengren MDb, Steven Hawken MSca, Stephanie Ôunpuu PhDa, ProfKaren Sliwa MDc, Mohammad Zubaid MDd, Wael A Almahmeed MDf, ProfKathleen Ngu Blackett MDe, ProfChitr Sitthi-amorn MDg, Hiroshi Sato MDh, ProfSalim Yusuf FRCP, a, and for the INTERHEART investigators aMcMaster University, Hamilton Health Sciences, Hamilton, ON, CanadabSahlgrenska University Hospital/Ostra, Göteborg, SwedencBaragwanath Hospital, Johannesburg, South AfricadKuwait University, Kuwait City, KuwaiteCHU, Yaoundé, CameroonfAl-Jazeira and Central Hospitals, Abu Dhabi, United Arab EmiratesgDepartment of Medicine, Chulalongkorn University, Bangkok, ThailandhOsaka University Graduate School of Medicine, Suita, Japan

.... We used a case-control design with 11119 patients with a first myocardial infarction and 13648 controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. …Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression.
People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0·0001). …[Elevated risks were found for] several periods of work stress……permanent work stress during the previous year .. several periods of work stress … permanent stress at work…Cases had several periods of stress at home,… permanent stress at home … General stress (work, home, or both) … Severe financial stress w… Stressful life events in the past year …[and] depression (24·0% [2673] vs 17·6% [2404]; odds ratio 1·55 [1·42–1·69]). These differences were consistent across regions, in different ethnic groups, and in men and women.
Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.

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