Should heart attack patients return to stressful jobs ?
A paper by Hlatky et al. which appeared in Circulation last August, has received considerable media attention, since it purported to show no relationship between high job stress levels and any increase in coronary heart disease.
In a subsequent interview, Hlatky indicated that a major conclusion from the study was that heart attack patients could return to work without any risk.
Another author suggested that'people with a history of heart disease may benefit from working-even in a stressful environment.'I was asked to comment on this by a reporter from Medical Tribune, since most studies have shown a clear correlation between job stess, and coronary morbidity and mortality, as well as hypertension, which was not discussed.
My main concern was that the end point was the degree of coronary atherosclerosis as assessed by coronary angiography, which is quite different than conventional clinical criteria.
The assumption is made that this measurement is an accurate predictor of future coronary events, and several caveats should be considered.
As the authors themselves concede, coronary angiography'is an imperfect measure of coronary atherosclerosis'There is also considerable interinterpreter disagreement, and even different conclusions when the identical angiogram is reviewed by the same individual months later.
Coronary occlusion often occurs at sites quite different than those predicted by angiography.
Mots-clés Pascal : Cardiopathie coronaire, Condition travail, Activité professionnelle, Stress, Epuisement usure, Reprise travail, Facteur risque, Diagnostic, Homme, Appareil circulatoire pathologie
Mots-clés Pascal anglais : Coronary heart disease, Working condition, Professional activity, Stress, Occupational burnout, Back to work, Risk factor, Diagnosis, Human, Cardiovascular disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0594309
Code Inist : 002B30B04. Création : 01/03/1996.