The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Research Samples
2.3. Methods
- A complete clinical examination;
- An ECG, conducted using Heart Screen 80 G (Innomed Medical, Budapest, Hungary);
- A transthoracic echocardiogram, conducted using a Fukuda Denshi 850 XTD (Fukuda Denshi in Tokyo, Japan);
- An ECCT, only for CCS patients. The Agatston ECCT score describes the severity of coronary artery calcification, as detailed in Table 4;
- 5.
- Lipid profile, glycemia, hs-CRP, and AUER, determined by chemistry laboratories;
- 6.
- PHQ-9 questionnaire [17,18]. The PHQ-9 is a psychological tool for depression assessment. The test has nine specific questions. The level of depression is considered mild if the PHQ-9 score is 5–9. These patients should repeat the test after 1 month. The same PHQ-9 score, after 6 months, requires counseling. Moderate (PHQ-9 score = 10–14) and moderately severe (PHQ-9 score = 15–19) depression require counseling and medication. Severe depression (PHQ-9 score) requires immediate and active psychiatric intervention;
- 7.
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Groups (CCS and No-CCS)
3.2. Secondary-Level Testing Results: EKG, Echocardiography, and ECCT
3.3. Questionnaire Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Objective | Description |
---|---|
1 | Establish the prevalence of job distress in CCS patients compared with no-CCS patients. |
2 | Discover the role of hs-CRP and AUER as possible mediators in this relationship. |
3 | Determine the association between secondary-level testing and job strain. |
Inclusion Criteria | |
---|---|
1 | Age ≥ 18 years |
2 | Informed consent and consent for publication |
3 | CCS diagnosis/no-CCS diagnosis with cardiovascular risk factors: smoking/obesity/hypercholesterolemia/arterial hypertension/diabetes mellitus. |
Exclusion Criteria | |
---|---|
1 | Progressive cancer |
2 | Autoimmune disorder |
3 | Pregnancy |
4 | Difficult transportation to cardiology center |
5 | Acute myocardial infarction |
6 | Unstable angina pectoris (de novo/worsened) |
Scoring | Interpretation |
---|---|
0 | No measurable calcified plaque |
1–10 | Minimal |
11–100 | Mild |
100–400 | Moderate |
>400 | Extensive |
Affirmation |
---|
a. “Generally speaking, my work corresponds with what I want in my life” |
b. “My working conditions are excellent” |
c. “I am satisfied with my work” |
d. “I have achieved things important to me at work, until now” |
e. “If I could change something at my workplace, I wouldn’t change anything” |
Likert Score | Patient’s Answer |
---|---|
1 | “totally disagree” |
2 | “partially disagree” |
3 | “almost agree” |
4 | “agree” |
5 | “totally agree” |
Characteristics | Total (210) | CCS (105) | No-CCS (105) | p Value |
---|---|---|---|---|
Age, years, median (IQR) | 60 (22) | 69 (16) | 52 (18) | 0.01 |
Sex, female, n (%) | 130 (61.9) | 58 (55.2) | 74 (70.5) | 0.03 |
Education n (%) | 1. Elementary school 42 (20) 2. High school 128 (61) 3. Higher education 40 (19) | 1. Elementary school 28 (26.6) 2. High school 59 (56.2) 3. Higher education 18 (17.2) | 1. Elementary school 14 (13.3) 2. High school 69 (65.7) 2. Higher education 22 (21) | 0.04 |
Total cholesterol (mg/dL) median (IQR) | 248 (55) | 260 (59) | 246 (52) | 0.16 |
LDL cholesterol (mg/dL) median (IQR) | 182 (61) | 186 (52) | 177.5 (59.75) | 0.03 |
Smoking n (%) | 50 (23.8) | 21 (20) | 29 (27.6) | 0.032 |
Obesity n (%) | 124 (59) | 66 (62.8) | 58 (55.2) | 0.04 |
Arterial hypertension n (%) | 119 (56.6) | 67 (63.8) | 52 (49.5) | 0.03 |
Diabetes mellitus n (%) | 77 (36.6) | 43 (41) | 34 (32.4) | 0.02 |
AUER/24 h | hs-CRP | ||||
---|---|---|---|---|---|
Likert Score | n | Mean ± SD | ANOVA Test | Mean ± SD | ANOVA Test |
1 | 35 | 50.943 ± 11.0302 | p < 0.001 ** | 0.6260 ± 0.20291 | p < 0.001 ** |
2 | 52 | 42.917 ± 10.6151 | 0.4283 ± 0.16049 | ||
3 | 46 | 31.546 ± 8.4571 | 0.3135 ± 0.10382 | ||
4 | 50 | 25.014 ± 7.6477 | 0.2270 ± 0.08981 | ||
5 | 27 | 20.363 ± 8.0228 | 0.1804 ± 0.10607 | ||
Total | 210 | 34.601 ± 14.0203 | 0.3563 ± 0.20116 |
Likert Score | n | hs-CRP | ||||
---|---|---|---|---|---|---|
CCS | no CCS | |||||
Mean ± SD | ANOVA Test | n | Mean ± SD | ANOVA Test | ||
1 | 22 | 0.7477 ± 0.14105 | p < 0.001 ** | 13 | 0.4200 ± 0.09327 | p < 0.001 ** |
2 | 28 | 0.5489 ± 0.11561 | 24 | 0.2875 ± 0.05495 | ||
3 | 21 | 0.4105 ± 0.05714 | 25 | 0.2320 ± 0.04839 | ||
4 | 20 | 0.3245 ± 0.04936 | 30 | 0.1620 ± 0.03326 | ||
5 | 14 | 0.2757 ± 0.03797 | 13 | 0.0777 ± 0.02803 | ||
Total | 105 | 0.4837 ± 0.19082 | 105 | 0.2289 ± 0.11009 |
Likert Score | n | AUER/24 h | |||
---|---|---|---|---|---|
CCS | no CCS | ||||
Mean ± SD | ANOVA Test | Mean ± SD | ANOVA Test | ||
1 | 35 | 57.200 ± 7.8104 | p < 0.001 ** | 40.354 ± 6.6866 | p < 0.001 ** |
2 | 52 | 50.104 ± 8.6739 | 34.533 ± 5.0315 | ||
3 | 46 | 38.719 ± 6.7456 | 25.520 ± 3.6522 | ||
4 | 50 | 31.915 ± 5.1729 | 20.413 ± 5.1528 | ||
5 | 27 | 27.014 ± 4.1203 | 13.200 ± 3.7240 | ||
Total | 210 | 42.770 ± 12.8658 | 26.432 ± 9.7338 |
Likert Score | ST Depression and Negative T-Waves | Total | Pearson Chi-Square Test | ||||
---|---|---|---|---|---|---|---|
Absent | Present | ||||||
n | % | n | % | n | % | ||
1 | 16 | 30.8% | 6 | 11.3% | 22 | 21.0% | Chi2 = 19.928 |
2 | 19 | 36.5% | 9 | 17.0% | 28 | 26.7% | p < 0.001 ** |
3 | 10 | 19.2% | 11 | 20.8% | 21 | 20.0% | |
4 | 4 | 7.7% | 16 | 30.2% | 20 | 19.0% | |
5 | 3 | 5.8% | 11 | 20.8% | 14 | 13.3% | |
Total | 52 | 100.0% | 53 | 100.0% | 105 | 100.0% | |
Likert score | q-waves | Total | Pearson Chi-Square Test | ||||
Absent | Present | ||||||
n | % | n | % | n | % | ||
1 | 6 | 11.3% | 16 | 30.8% | 22 | 21.0% | Chi2 = 19.928 |
2 | 9 | 17.0% | 19 | 36.5% | 28 | 26.7% | p < 0.001 ** |
3 | 11 | 20.8% | 10 | 19.2% | 21 | 20.0% | |
4 | 16 | 30.2% | 4 | 7.7% | 20 | 19.0% | |
5 | 11 | 20.8% | 3 | 5.8% | 14 | 13.3% | |
Total | 53 | 100.0% | 52 | 100.0% | 105 | 100.0% | |
Likert score | AF | Total | Pearson Chi-Square Test | ||||
Absent | Present | ||||||
n | % | n | % | n | % | ||
1 | 17 | 18.3% | 5 | 41.7% | 22 | 21.0% | Chi2 = 3.935 |
2 | 25 | 26.9% | 3 | 25.0% | 28 | 26.7% | p = 0.415 |
3 | 19 | 20.4% | 2 | 16.7% | 21 | 20.0% | |
4 | 19 | 20.4% | 1 | 8.3% | 20 | 19.0% | |
5 | 13 | 14.0% | 1 | 8.3% | 14 | 13.3% | |
Total | 93 | 100.0% | 12 | 100.0% | 105 | 100.0% |
Likert Score | Total | Pearson Chi-Square Test | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Normokinesia | Hypokinesia | Akinesia | Dyskinesia | ||||||||
n | % | n | % | n | % | n | % | n | % | ||
1 | 1 | 6.3% | 5 | 12.5% | 6 | 30.0% | 10 | 34.5% | 22 | 21.0% | Chi2 = 24.391 |
2 | 3 | 18.8% | 7 | 17.5% | 8 | 40.0% | 10 | 34.5% | 28 | 26.7% | p = 0.018 * |
3 | 4 | 25.0% | 8 | 20.0% | 3 | 15.0% | 6 | 20.7% | 21 | 20.0% | |
4 | 6 | 37.5% | 10 | 25.0% | 2 | 10.0% | 2 | 6.9% | 20 | 19.0% | |
5 | 2 | 12.5% | 10 | 25.0% | 1 | 5.0% | 1 | 3.4% | 14 | 13.3% | |
Total | 16 | 100.0% | 40 | 100.0% | 20 | 100.0% | 29 | 100.0% | 105 | 100.0% |
Likert Score | Total | Pearson Chi-Square Test | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Extensive Calcification | Moderate Calcification | Mild Calcification | Minimal Calcification | ||||||||
n | % | n | % | n | % | n | % | n | % | ||
1 | 14 | 29.8% | 5 | 25.0% | 2 | 8.7% | 1 | 6.7% | 22 | 21.0% | Chi2 = 28.050 |
2 | 18 | 38.3% | 6 | 30.0% | 2 | 8.7% | 2 | 13.3% | 28 | 26.7% | p = 0.005 ** |
3 | 9 | 19.1% | 4 | 20.0% | 5 | 21.7% | 3 | 20.0% | 21 | 20.0% | |
4 | 5 | 10.6% | 3 | 15.0% | 7 | 30.4% | 5 | 33.3% | 20 | 19.0% | |
5 | 1 | 2.1% | 2 | 10.0% | 7 | 30.4% | 4 | 26.7% | 14 | 13.3% | |
Total | 47 | 100.0% | 20 | 100.0% | 23 | 100.0% | 15 | 100.0% | 105 | 100.0% |
Depression Severity | Total | Pearson Chi-Square Test | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Extensive Calcification | Moderate Calcification | Mild Calcification | Minimal Calcification | ||||||||
n | % | n | % | n | % | n | % | n | % | ||
Mild | 3 | 6.4% | 3 | 15.0% | 5 | 21.7% | 6 | 40% | 17 | 16.2% | Chi2 = 20.917 |
Moderate | 9 | 19.1% | 2 | 10.0% | 5 | 21.7% | 6 | 40% | 22 | 20.9% | p = 0.013 * |
Moderate–severe | 14 | 29.8% | 7 | 35.0% | 6 | 26.1% | 2 | 13.3% | 29 | 27.6% | |
Severe | 21 | 44.7% | 8 | 40.0% | 7 | 30.4% | 1 | 6.7% | 37 | 35.3% | |
Total | 47 | 100.0% | 20 | 100.0% | 23 | 100.0% | 15 | 100.0% | 105 | 100.0% |
Statistical Significance of the Association | |||||
---|---|---|---|---|---|
ST depression | negative T-waves | q-waves | AF | Echo | ECCT |
Job strain | |||||
(Ls) | |||||
** | ** | ** | no | * | ** |
Sample | Total | Pearson Chi-Square Test | ||||||
---|---|---|---|---|---|---|---|---|
CCS | no-CCS | |||||||
DS | N | % | n | % | n | % | ||
Mild | 17 | 16.2% | 39 | 37.1% | 56 | 26.7% | Chi2 = 26.482 | |
Moderate | 22 | 20.9% | 37 | 35.2% | 59 | 28% | p = 0.021 * | |
MS | 29 | 27.6% | 17 | 16.2% | 46 | 21.9% | ||
Severe | 37 | 35.3% | 12 | 11.5% | 49 | 23.3% | ||
Total | 105 | 100.0% | 105 | 100% | 210 | 100% |
Sample | Total | Pearson Chi-Square Test | ||||||
---|---|---|---|---|---|---|---|---|
CCS | no-CCS | |||||||
Likert score | N | % | n | % | N | % | ||
1 | 22 | 21.0% | 13 | 12.4% | 35 | 16.7% | Chi2 = 5.007 | |
2 | 28 | 26.7% | 24 | 22.9% | 52 | 24.8% | p = 0.287 | |
3 | 21 | 20.0% | 25 | 23.8% | 46 | 21.9% | ||
4 | 20 | 19.0% | 30 | 28.6% | 50 | 23.8% | ||
5 | 14 | 13.3% | 13 | 12.4% | 27 | 12.9% | ||
Total | 105 | 100.0% | 105 | 100.0% | 210 | 100.0% |
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Moisii, P.; Jari, I.; Ursu, A.M.; Naum, A.G. The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging. Medicina 2024, 60, 1048. https://doi.org/10.3390/medicina60071048
Moisii P, Jari I, Ursu AM, Naum AG. The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging. Medicina. 2024; 60(7):1048. https://doi.org/10.3390/medicina60071048
Chicago/Turabian StyleMoisii, Paloma, Irina Jari, Andra Mara Ursu, and Alexandru Gratian Naum. 2024. "The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging" Medicina 60, no. 7: 1048. https://doi.org/10.3390/medicina60071048