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Kans op infarct even groot door stress als door hoge bloeddruk.*
In het grootschalige internationale Interheart-onderzoek naar
het verband tussen psychosociale factoren en hartinfarct is gebleken dat
personen met werkstress, stress thuis, financiële problemen en/of recente
stressvolle voorvallen in het leven een verhoogde kans op een eerste hartinfarct
hebben. Aan het onderzoek namen ruim 11.000 patiënten met een eerste
hartinfarct en ruim 13.000 controlepersonen deel, afkomstig uit 52 landen. Het
effect van stress is volgens de onderzoekers moeilijk van dat van andere
factoren te isoleren, maar volgens hen is het vergelijkbaar met dat van
hypertensie en abdominale obesitas en iets minder groot dan het effect van
roken.
Rosengren A, Hawken S, Ôunpuu S,
Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S.
Association of psychosocial risk factors with risk of acute myocardial
infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART
study): case-control study. Lancet 2004; 364: 953-62
Summary: Background
Psychosocial factors have been reported to be independently associated with
coronary heart disease. However, previous studies have been in mainly North
American or European populations. The aim of the present analysis was to
investigate the relation of psychosocial factors to risk of myocardial
infarction in 24767 people from 52 countries.
Methods We used a case-control
design with 11119 patients with a first myocardial infarction and 13648
age-matched (up to 5 years older or younger) and sex-matched controls from 262
centres in Asia, Europe, the Middle East, Africa, Australia, and North and South
America. Data for demographic factors, education, income, and cardiovascular
risk factors were obtained by standardised approaches. 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.
Findings People with
myocardial infarction (cases) reported higher prevalence of all four stress
factors (p<0·0001). Of those cases still working, 23·0% (n=1249)
experienced several periods of work stress compared with 17·9% (1324) of
controls, and 10·0% (540) experienced permanent work stress during the previous
year versus 5·0% (372) of controls. Odds ratios were 1·38 (99% CI 1·19-1·61)
for several periods of work stress and 2·14 (1·73-2·64) for permanent stress
at work, adjusted for age, sex, geographic region, and smoking. 11·6% (1288) of
cases had several periods of stress at home compared with 8·6% (1179) of
controls (odds ratio 1·52 [99% CI 1·34-1·72]), and 3·5% (384) of cases
reported permanent stress at home versus 1·9% (253) of controls (2·12 [1·68-2·65]).
General stress (work, home, or both) was associated with an odds ratio of 1·45
(99% CI 1·30-1·61) for several periods and 2·17 (1·84-2·55) for permanent
stress. Severe financial stress was more typical in cases than controls (14·6%
[1622] vs 12·2% [1659]; odds ratio 1·33 [99% CI 1·19-1·48]).
Stressful life events in the past year were also more frequent in cases than
controls (16·1% [1790] vs 13·0% [1771]; 1·48 [1·33-1·64]), as was
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.
Interpretation Presence of
psychosocial stressors is associated with increased risk of acute myocardial
infarction, suggesting that approaches aimed at modifying these factors should
be developed. (Dec. 2004)