Abstract P280: The Association between Perceived Mental Stress and Mortality from Cardiovascular Disease is Modified by Education Level: The JACC Study
Background and Objective: Perceived mental stress has been associated with increased mortality from cardiovascular disease for Japanese men and women (Iso H et al. Circulation 2002), but it is uncertain which subgroup is vulnerable for an adverse effect of mental stress because of the limited number of deaths in 8-year follow-up. We extended the follow-up to 15 years which enable us to conduct the stratified analysis by educational level in order to test our hypothesis that high education individuals are vulnerable for an adverse effect of mental stress.
Design: We examined the above hypothesis in a cohort of 99,449 Japanese (41,656 men and 57,793 women) aged 40 to 79 years, who had no history of stroke, coronary heart disease or cancer at baseline. Perceived mental stress was assessed at baseline by a lifestyle questionnaire administered between 1988 and 1990 under the Japan Collaborative Cohort (JACC) Study, followed up to the end of 2006.
Results: We documented a total of 3,801 (1,963 men and 1,838 women) deaths from total cardiovascular disease (ICD 10th revision, codes 101–199). The multivariable hazard ratio (95%, CI) of mortality from total cardiovascular disease for high versus low perceived mental stress was 1.22 (1.09 to 1.39, P for trend=0.01) in total subjects, 1.15 (0.99–1.34, P for trend=0.05) in men and 1.29 (1.09 to 1.52, P for trend=0.02) in women after adjusting for age, sex, body mass index, smoking status, alcohol intake, sports time, walking time, hours of sleep, and psychological variables, including anger, hurry, self estimation of quick response, hopelessness, sense of joyfulness, being trusted and fulfillment. That association was stronger for persons with higher education (>=12 years) than those with lower education (<12 years). The respective multivariable hazard ratio were 1.69 (1.20–2.38, P for trend<0.01) and 1.18 (1.05–1.34, P for trend=0.02) in total subjects, 1.69 (1.14–2.51, P for trend<0.01) and 1.10 (0.93–1.30, P for trend=0.20) in men, 1.76 (0.84–3.61, P for trend=0.08) and 1.27 (1.07–1.50, P for trend=0.06) in women, although the interaction for mental stress and education did not reached statistical significance.
Conclusion: An adverse effect of perceived mental stress on cardiovascular health was confirmed in the longer-term follow-up and it may be pronounced for higher education group than for lower educational group.
- © 2012 by American Heart Association, Inc.