Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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The Relationship between Job Stress and hsCRP

직무스트레스와 hsCRP와의 관계

  • Lee, Jong-Heon (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital) ;
  • Chang, Tae-Won (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital) ;
  • Kwon, Young-Jun (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital) ;
  • Kim, Yong-Kyu (Department of Preventive Medicine, Catholic Industrial Medical Center, The Catholic University of Korea) ;
  • Ryu, Sang-Chul (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital) ;
  • Kim, In-Suk (Department of Occupational and Environmental Medicine, Hangang Sacred Hospital)
  • 이종헌 (한림대학교 한강성심병원 산업의학과) ;
  • 장태원 (한림대학교 한강성심병원 산업의학과) ;
  • 권영준 (한림대학교 한강성심병원 산업의학과) ;
  • 김용규 (가톨릭대학교 의과대학 예방의학교실 및 산업의학센터) ;
  • 유상철 (한림대학교 한강성심병원 산업의학과) ;
  • 김인석 (한림대학교 한강성심병원 산업의학과)
  • Published : 2011.09.30
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Abstract

Objectives: We wanted to investigate the relationship between job stress and high-sensitivity C-reactive proteins (hsCRP) with a view to using them as a predictor of future cardiovascular events. Methods : The study subjects were 155 male bank workers. A structured, self-assesment questionnaire was used to analyze the sociodemographic characteristics and job stress of the participants. Seven levels of job stress, as described in the Korean Occupational Stress Scale-Short Form (KOSS-SF), were used to categorized the participants. We included tests for blood pressure, fasting blood sugar, blood lipid level (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides), and hsCRP in our analysis. Multiple logistic regression modeling was used to determine an association between job stress and cardiovascular risk factors including hsCRP. Results : In the multiple logistic regression analyses adjusted for general and job characteristics and cardiovascular risk factors, interpersonal conflict (adjusted OR 1.69, 95% CI=1.11-2.57), job insecurity (adjusted OR 1.94, 95% CI=1.24-3.03) and, occupational climate (adjusted OR 1.89, 95% CI=1.19-3.01) were associated with hsCRP. Conclusion : This study suggests that job stress is associated with hsCRP which is a predictor of future cardiovascular events.

목적: 이 연구는 직무스트레스와 미래의 심혈관계질환발생의 예측인자로서의 hsCRP와의 관계를 알아보고자 하였다. 방법: 일개 대학병원 종합검진센터에 내원한 은행업에 종사하는 남성 근로자 155명을 대상으로 연구대상자의 일반적 특성과 직업적 특성을 구조화된 설문지로 조사하고, 한국인 직무스트레스 측정도구 단축형(KOSS-SF)를 이용하여 직무스트레스를 평가하였다. 심혈관계 위험인자로 과거의 연구에서 논의되었던 혈압(수축기혈압, 이완기혈압), 공복혈당, 혈청 지질 항목(총콜레스테롤, 고밀도콜레스테롤, 저밀도콜레스테롤, 중성지방) 이외에 hsCRP를 측정하였다. 직무스트레스와 hsCRP와의 관계를 알아보기 위하여 hsCRP 측정치를 종속변수로, 영역별 직무스트레스의 수준을 독립변수로 하여 다변량 로지스틱 회귀분석을 실시하였다. 결과: 직무스트레스의 각 하위영역들을 높은 군과 낮은 군으로 나누고, 각 하위영역들의 교차비를 일반적 직업적 특성, 심혈관계 질환의 위험인자로 보정한 결과, 관계갈등(OR 1.69, 95% CI=1.11-2.57), 직무불안정(OR 1.94, 95% CI=1.24-3.03), 직장문화(OR 1.89, 95% CI=1.19-3.01) 영역에서 hsCRP와 유의한 관련성을 보였다 결론: 직무스트레스와 심혈관계 질환 발생의 예측인자로서의 hsCRP사이에는 유의한 관련성이 있는 것으로 나타났다.

Keywords

References

  1. Kim JR, Urm SH, Chun JH, Jeong SJ, Lee CH, Jeong KW, Choi SS, Pee KT. Relationship between life style, the level of stress and irritable bowel syndrome on 1298 male white collars. Korean J Prev Med 1997;30(4):791-804. (Korean)
  2. Yoon JW, Yi KJ, Kim SY, Oh JG, Lee JT. The relationship between occupational stress and musculoskeletal symptoms in call center employees. Korean J Occup Environ Med 2007;19(4):293-303. (Korean)
  3. Jo MH, Kim KS, Lee SW, Kim TG, Ryu HW, Lee MY, Won YL. The relationship between job stress and musculoskeletal symptoms in migrant workers. Korean J Occup Environ Med 2009;21(4):378-87. (Korean)
  4. Cho J. Job stress and cardiovascular disease. J Korean Acad Fam Med 2002;23(7):841-54. (Korean)
  5. Koh SB, Chang SJ, Park JK, Park JH, Son DK, Hyun SJ, Cha BS. Occupational stress and risk factors for cardiovascular diseases. Korean J Occup Environ Med 2005;17(3):186-98. (Korean)
  6. Hwang CK, Koh SB, Chang SJ, Park CY, Cha BS, Hyun SJ, Park JH, Lee KM, Cha KT, Park WJ, Jhun HJ. Occupational stress in relation to cerebrovascular disease: longitudinal analysis from the NSDSOS project. Korean J Occup Environ Med 2007;19(2):105-14. (Korean)
  7. Tsutsumi A, Kayaba K, Kario K, Ishikawa S. Prospective study on occupational stress and risk of stroke. Arch Intern Med 2009;169(1):56-61. https://doi.org/10.1001/archinternmed.2008.503
  8. Park KC, Lee KJ, Park JB, Min KB, Lee KW. Association between occupational stress and depression, anxiety, and stress symptoms among white-collar male workers in an automotive company. Korean J Occup Environ Med 2008;20(3):215-24. (Korean)
  9. Jung DY, Won JU, Park SG, Chang SJ, Kim HC. Job stress as a risk factor for occupational injuries among employees of small and medium-sized companies. Korean J Occup Environ Med 2010;22(1):37-47. (Korean)
  10. Statistics Korea. Annual Report on the Cause of Death Statistics 2008. Statistics Korea. Daejon. 2009. (Korean)
  11. Ministry of Labor. Statistics of Industrial Accidents and Occupational Disease in 2008. Ministry of Labor. Gwacheon. 2009. (Korean)
  12. Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health 1981;71(7):694-705. https://doi.org/10.2105/AJPH.71.7.694
  13. Karasek RA, Theorell T, Schwartz JE, Schnall PL, Pieper CF, Michela JL. Job characteristics in relation to the prevalence of myocardial infarction in the US Health Examination Survey (HES) and the Health and Nutrition Examination Survey (HANES). Am J Public Health 1988;78(8):910-8. https://doi.org/10.2105/AJPH.78.8.910
  14. Hammar N, Alfredsson L, Johnson JV. Job strain, social support at work and incidence of myocardial infarction. Occup Environ Med 1998;55(8):548-53. https://doi.org/10.1136/oem.55.8.548
  15. Uchiyama S, Kurasawa T, Sekizawa T, Nakatsuka H. Job strain and risk of cardiovascular events in treated hypertensive Japanese workers: hypertension follow-up group study. J Occup Health 2005;47(2):102-11. https://doi.org/10.1539/joh.47.102
  16. Kivimaki M, Head J, Ferrie JE, Brunner E, Marmot MG, Vahtera J, Shipley MJ. Why is evidence on job strain and coronary heart disease mixed? An illustration of measurement challenges in the Whitehall II study. Psychosom Med 2006;68(3):398-401. https://doi.org/10.1097/01.psy.0000221252.84351.e2
  17. Lallukka T, Martikainen P, Reunanen A, Roos E, Sarlio-Lahteenkorva S, Lahelma E. Associations between working conditions and angina pectoris symptoms among employed women. Psychosom Med 2006;68(2):348-54. https://doi.org/10.1097/01.psy.0000204653.92047.0e
  18. Jain D, Burg M, Soufer R, Zaret BL. Prognostic implications of mental stress-induced silent left ventricular dysfunction in patients with stable angina pectoris. Am J Cardiol 1995;76:31-5. https://doi.org/10.1016/S0002-9149(99)80796-6
  19. Frimerman A, Miller HI, Laniado S, keren G. Changes in hemostatic function at times of cyclic variation in occupational stress. Am J Cardiolology 1997;79:72-5. https://doi.org/10.1016/S0002-9149(96)00680-7
  20. Harlan WR, Manolio TA. Factors Associated with thrombosis and thrombolysis. In: Eliott P(eds) Coronary heart disease epidemiology. Oxford University Press. Oxpord. 1992, pp 120-1.
  21. Ishizaki M, Tsuritani I, Noborisaka Y, Yamada Y, Tabata M, Nakagawa H. Relationship between job stress and plasma fibrinolytic activity in male Japanese workers. Int Arch Occup Environ Health 1996;68:315-20. https://doi.org/10.1007/BF00409416
  22. Chang SJ, Koh SB, Kang D, Kim SA, Kang MG, Lee CG, Chung JJ, Cho JJ, Son M, Chae CH, Kim JW, Kim JI, Kim HS, Roh SC, Park JB, Woo JM, Kim SY, Kim JY, Ha M, Park J, Rhee KY, Kim HR, Kong JO, Kim IA, Kim JS, Park JH, Huyun SJ, Son DK. Developing an occupational stress scale for korean employees. Korean J Occup Environ Med 2005;17(4):297-317. (Korean)
  23. Chang SJ, Koh SB, Choi HR, Woo JM, Cha BS, Park JK, Chen YH, Chung HK. Job stress, heart rate variability and metabolic syndrome. Korean J Occup Environ Med 2004;16(1):70-81. (Korean)
  24. Cho JJ, Kim JY, Byun JS. Occupational stress on risk factors for cardiovascular disease and metabolic syndrome. Korean J Occup Environ Med 2006;18(3):209-20. (Korean)
  25. Ridker PM. C-reactive protein and the prediction of car-diovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007;49:2129-38. https://doi.org/10.1016/j.jacc.2007.02.052
  26. Torres JL, Ridker PM. Clinical use of high-sensitivity C-reactive protein for the prediction of adverse cardiovascular events. Curr Opin Cardiol 2003;18:471-8. https://doi.org/10.1097/00001573-200311000-00008
  27. Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, IL 6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286:327-34. https://doi.org/10.1001/jama.286.3.327
  28. Laaksonen DE, Niskanen L, Nyyssonen K, Punnonen K, Tuomainen TP, Valkonen VP, Salonen R, Salonen JT. C-reactive protein and the development of the metabolic syndrome and diabetes in middle-aged men. Diabetologia 2004;47:1403-10.
  29. Tice JA, Browner W, Tracy RP, et al. The relation of Creactive protein levels to total and cardiovascular mortality in older U.S. women. Am J Med 2003;114:199-205. https://doi.org/10.1016/S0002-9343(02)01497-3
  30. Chang SJ. Standardization of job stress measurement scale for Korean employee. OSHRI, Korea Occupational Safety and Health Agency. Incheon. Korea 2004. pp 17-41, p 130. (Korean)
  31. WHO Expert Consultation. Appropriate body-mass index for asian populations and its implications for policy and intervention strategies. Lancet 2004;363(9403):157-63. https://doi.org/10.1016/S0140-6736(03)15268-3
  32. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA 2003;289:2560-71. https://doi.org/10.1001/jama.289.19.2560
  33. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl 1):S62-9.
  34. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation 2002;106(25):3143-421.
  35. Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for health care professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499-511. https://doi.org/10.1161/01.CIR.0000052939.59093.45
  36. Peters ML, Godaert GL, Ballieux RE, Brosschot JF, Sweep FC, Swinkels LM,van Vliet M, Heijnen CJ. Immune responses to experimental stress: effects of mental effort and uncontrollability. Psychosom Med 1999;61:513-24.
  37. Yudkin JS, Kumari M, Humphries SE, Mohamed-Ali V. Inflammation, obesity, stress and coronary heart disease: is interleukin-6 the link? Atherosclerosis 1999;148:209-14.
  38. Friedman BH, Thayer JF. Anxiety and autonomic flexibility: a cardiovascular approach. Biol Psychiatry 1998;47:243-63. https://doi.org/10.1016/S0301-0511(97)00027-6
  39. Hayano J, Sakakibara Y, Yamada M. Decreased magnitude of heart rate spectral components in coronary artery disease: its relation to angiographic severity. Circulation 1990;81:1217-24. https://doi.org/10.1161/01.CIR.81.4.1217
  40. Brunner EJ, Marmot MG, Nanchahal K, Shipley MJ, Stansfeld SA, Juneia M, Alberti KGM. Social inequality in coronary risk; central obesity and the metabolic syndrome. Evidence from the Whithehall II study. Diabetoiogia 1997;40:1341-9.
  41. Weixian X, Yiming Z, Lijun G, Yanhong G, Wei G. Job stress and coronary heart disease: A case-control study using a chinese population. J Occup Health 2009;51:107-13. https://doi.org/10.1539/joh.L8060
  42. Hintsa T, Kivima M, Elovainio M, Vahtera J, Hintsanen M, Viikari JSA, Raitakari OT, Keltikangas- Jarvinen L. Is the association between job strain and carotid intima-media thickness attributable to preemployment environmental and dispositional factors? The Cardiovascular Risk in Young Finns Study. Occup Environ Med 2008;65:676-82. https://doi.org/10.1136/oem.2007.037622
  43. Marcel K, Patrick D, Susana S, Michele D, Charles B, Guy D, Marco F, Irene H, Isacssong IO, Ostergreng PO, Inaki P, Edwin P, Monique R, Anika R, Giancarlo C, Lars W. Job stress and major coronary events: results from the Job Stress, Absenteeism and Coronary Heart Disease in Europe study. Eur J Cardiovasc Prev Rehabil 2006;13:695-704. https://doi.org/10.1097/01.hjr.0000221865.19415.e9
  44. Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999;340:115-26. https://doi.org/10.1056/NEJM199901143400207
  45. Zhou X, Stemme S, Hansson GK. Evidence for a local immune response in atherosclerosis: CD4T cells infiltrate lesions of apolipoprotein-E-deficient mice. Am J Pathol 1996;149:359-66.
  46. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJ. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995;333:1301-7. https://doi.org/10.1056/NEJM199511163332001
  47. Jabs WJ, Theissing E, Nitschke M, et al. Local generation of C-reactive protein in diseased coronary artery venous bypass grafts and normal vascular tissue. Circulation. 2003;108:1428-31. https://doi.org/10.1161/01.CIR.0000092184.43176.91
  48. Szmitko PE, Wang CH, Weisel RD, et al. New markers of inflammation and endothelial cell activation: Part I. Circulation. 2003;108:1917-23. https://doi.org/10.1161/01.CIR.0000089190.95415.9F
  49. Paffen E, DeMaseri MP. C-reactive protein in atherosclerosis: a usal factor? Cardiovasc Res 2006;71:30-9. https://doi.org/10.1016/j.cardiores.2006.03.004
  50. Paul MR. The Time for Cardiovascular Inflammation Reduction Trials Has Arrived How Low to Go for hsCRP? Arterioscler Thromb Vasc Biol 2008;28;1222-324. https://doi.org/10.1161/ATVBAHA.108.168989
  51. Libby P, Ridker PM. Inflmmation and atherosclerosis: role of C-reactive protein in risk assessment. Am J Med 2004;116(Suppl 6A):9S-16S.
  52. Pepys MB, Hirschfield GM. C-reactive protein and atherothrombosis. Ital Heart J 2001;2:196-9.
  53. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557-65. https://doi.org/10.1056/NEJMoa021993
  54. Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K. Physiological correlates of burnout among women. J Psychosom Res 2003;55(4):309-16. https://doi.org/10.1016/S0022-3999(02)00633-5
  55. Poanta L, Craciun A, Dumitrascu DL. Professional stress and inflammatory markers in physicians. Rom J Intern Med 2010;48(1):57-63.
  56. Kade E, Kade G, Wierzbicki P, Prokopiuk M, Geras G, Wan′kowicz Z. Coping style with stress against chosen biochemical risk factors of atherosclerosis in potentially health men. Pol Arch Med Wewn 2001;106(5):999-1005.
  57. Shivpuri S, Gallo LC, Crouse JR, Allison MA. The association between chronic stress type and C-reactive protein in the multi-ethnic study of atherosclerosis: does gender make a difference? J Behav Med 2011;19[Epub ahead of print].