摘要：We examined whether preemployment influences confounded the association between job strain and atherosclerosis. We assessed biological, familial, and socioeconomic risk factors of coronary heart disease at 12 to 18 years of age and job strain and carotid artery intima-media thickness at 33 to 39 years of age for a cohort of 358 men. Adolescent risk factors predicted adult intima-media thickness but had little effect on the dose–response relation between greater job strain and greater intima-media thickness. Pre-employment influences did not confound the association between job strain and atherosclerosis. According to the job-strain model, 1 , 2 increased stress and health problems are likely when high work demands coincide with low job control (i.e, lack of control over aspects of task performance and the use of skills). In accordance with this hypothesis, several epidemiological studies of adult populations have shown an association between job strain and coronary heart disease (CHD), 3 – 8 but nonsignificant findings also exist. 9 , 10 One of the problems in the evidence of job strain and CHD is that even the best-designed prospective studies have failed to take into account the cumulative effects of early life factors on the development of CHD. 11 Several studies have shown that cholesterol concentration, body mass index, blood pressure, and socioeconomic position in childhood or adolescence predict atherosclerosis and CHD later in life. 12 – 14 Evidence also suggests that early-life risk factors have an effect on stress perceptions in adulthood. 15 , 16 These early influences on both adult CHD risk and stress perception could confound evidence regarding the status of job strain as a risk factor for CHD in adult populations. Indeed, it is unclear whether part of the association between job strain and CHD may be attributable to influences from childhood or adolescence. Using data collected from men participating in the Cardiovascular Risk in Young Finns Study, 17 we prospectively examined whether biological, familial, and socioeconomic risk factors in adolescence contributed to the association between job strain and adult carotid artery intima-media thickness, a marker of atherosclerosis and a valid presymptomatic predictor of CHD. 18 – 20
