Published Online
on August 12, 2002

A more recent version of this article appeared on September 3, 2002

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Submitted on March 26, 2002
Revised on June 17, 2002
Accepted on June 18, 2002

Perceived Mental Stress and Mortality From Cardiovascular Disease Among Japanese Men and Women. The Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study)

Hiroyasu Iso MD^*, Chigusa Date MD, Akio Yamamoto MD, Hideaki Toyoshima MD, Naohito Tanabe MD, Shogo Kikuchi MD, Takaaki Kondo MD, Yoshiyuki Watanabe MD, Yasuhiko Wada MD, Teruo Ishibashi MD, Hiroshi Suzuki MD, Akio Koizumi MD, Yutaka Inaba MD, Akiko Tamakoshi MD, Yoshiyuki Ohno MD, and and JACC Study Group

From the Department of Public Health Medicine (H.I.), Institute of Community Medicine, University of Tsukuba, Ibaraki, Japan; the Department of Public Health (C.D.), Osaka City University Medical School, Osaka, Japan; the Department of Epidemiology (A.Y.), Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan; the Department of Public Health/Health Information Dynamics (H.T., T.K.) and the Department of Preventive Medicine/Biostatistics and Medical Decision Making (A.T., Y.O.), Field of Social Science, Program in Health and Community Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; the Department of Community Preventive Medicine (N.T.), Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan; the Department of Public Health (S.K.), Aichi Medical University, Wakayama, Japan; the Department of Social Medicine and Cultural Sciences (Y. Watanabe), Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan; the Department of Hygiene (Y. Wada), Hyogo College of Medicine, Hyogo, Japan; Asama General Hospital (T.I., H.S.), Saku, Nagano, Japan; the Department of Health and Environmental Sciences (A.K.), Graduate School of Medicine, Kyoto University, Kyoto, Japan; and the Department of Public Health (Y.I.), Juntendo Medical University, Tokyo, Japan.

Background—Perceived mental stress has been associated with risk of coronary heart disease (CHD) in white men, but no prospective data are available for other ethnic groups.

Methods and Results—From 1988 to 1990, a total of 73 424 Japanese (30 180 men and 43 244 women), aged 40 to 79 years, without a history of stroke, CHD, or cancer completed a lifestyle questionnaire including perception of mental stress under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk Sponsored by Monbusho (JACC Study). Systematic surveillance was completed until the end of 1997, with a 580 378 person-year follow-up, and the underlying causes of death were determined according to the International Classification of Diseases, 10th revision. For women, there were 316 with total stroke, 113 with CHD, and 643 with total cardiovascular disease (CVD); for men, there were 341, 168, and 778, respectively. Women who reported high stress had a 2-fold higher age-adjusted risk of mortality from total stroke and CHD and 1.5-fold higher risk of total CVD compared with those who reported low stress. Further adjustment for known cardiovascular risk factors and selected psychological variables did not alter the associations materially. The multivariate relative risk for women who perceived high stress versus low stress was 2.24 (95% CI 1.52 to 3.31, P<0.001) for total stroke, 2.28 (95% CI 1.17 to 4.43, P=0.02) for CHD, and 1.64 (95% CI 1.25 to 2.16, P<0.001) for total CVD. For men, these relations were generally weaker but suggestive of myocardial infarction.

Conclusions—Perceived mental stress was associated with increased mortality from stroke for women and with CHD for men and women.

Key words: stress • mortality • stroke • myocardial infarction • follow-up studies

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