Job strain predicts recurrent events after a first acute myocardial infarction: the Stockholm Heart Epidemiology Program

J Intern Med. 2010 Jun;267(6):599-611. doi: 10.1111/j.1365-2796.2009.02196.x. Epub 2009 Nov 17.


Objectives: Studies investigating the prognostic role of job stress in coronary heart disease are sparse and have inconclusive findings. We aimed (i) to investigate whether job strain predicts recurrent events after acute myocardial infarction (AMI) and if so (ii) to determine behavioural and biological factors that contribute to the explanation of this association.

Design: Prospective study.

Setting: Ten emergency hospitals in the larger Stockholm area, Sweden.

Subjects: Non-fatal AMI cases from the Stockholm Heart Epidemiology Program case-control study who were employed and younger than 65 years at the time of their hospitalization (n = 676).

Results: During the 8.5 year follow-up, 155 patients experienced cardiac death or non-fatal AMI; totally 96 patients died, 52 of cardiac causes. After adjustment for potential confounders, patients with high job strain had an increased risk for the combination of cardiac death and non-fatal AMI relative to those with low job strain, the hazard ratio (HR) and the 95% confidence interval (CI) being 1.73 (1.06-2.83). Results were similar for cardiac [HR (95% CI): 2.81 (1.16-6.82)] and total mortality [HR (95% CI): 1.65 (0.91-2.98)]. We found no evidence for mediation from lifestyle, sleep, lipids, glucose, inflammatory and coagulation markers on the association between job strain and the combination of cardiac death and non-fatal AMI.

Conclusions: Job strain was associated with poor long-term prognosis after a first myocardial infarction. Interventions focusing on reducing stressors at the workplace or on improving coping with work stress in cardiac patients might improve their survival post-AMI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Biomarkers
  • Blood Glucose
  • Case-Control Studies
  • Employment / psychology*
  • Female
  • Follow-Up Studies
  • Health Behavior
  • Humans
  • Life Style
  • Lipids / blood
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / psychology*
  • Predictive Value of Tests
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Stress, Psychological / complications*
  • Sweden / epidemiology


  • Biomarkers
  • Blood Glucose
  • Lipids