{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:15:54Z","timestamp":1783336554208,"version":"3.54.6"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Job strain is a psychological, physical, and behavioral stress that occurs at the workplace. Job strain is associated with more than double the normal risk of coronary artery disease (CAD). The main aim of this study was to determine the association between job strain and the following parameters: high-sensitivity C-reactive protein (hs-CRP), the albumin urine excretion rate (AUER), and secondary-level testing. Materials and Methods: This study was a descriptive cross-sectional study conducted on patients who underwent cardiological assessment between October 2023 and February 2024 at the Promedicanon Cardiology Center. This study comprised 210 participants, with two groups: 105 chronic coronary syndromes (CCS) patients and 105 no-CCS patients. The baseline characteristics collected were age, gender, education, rural\/urban environment, traditional CAD risk factors, hs-CRP, and AUER. The secondary-level testing included an electrocardiogram (ECG), echocardiography, and enhanced contrast computed tomography (ECCT). Psychological questionnaires comprised the tertiary-level testing, including the PHQ-9 depression questionnaire, and the satisfaction with work scale (SWWS) for job strain (Likert score). Results: The baseline characteristics were all significantly different between the groups (p &lt; 0.05) except for total cholesterol. The hs-CRP level had a mean value of 0.4837 \u00b1 0.19082 in the CCS group; for the no-CCS group, the hs-CRP mean value was 0.2289 \u00b1 0.11009; p-value &lt; 0.001. The AUER had a mean value of 42.770 \u00b1 12.8658 for the CCS group and 26.432 \u00b1 9.7338 for the no-CCS group; p-value &lt; 0.001. For the associations between secondary-level testing and job strain: p &lt; 0.001 for ST depression, negative T-waves, and q-waves; p = 0.415 for atrial fibrillation (AF); p = 0.018 for wall motion studies; p = 0.005 for ECCT. The association between job strain and AF had no statistical significance. The contractility of left ventricle walls and coronary calcification score were associated with job strain, with statistical significance. The p-value was 0.013 for the relationship between depression and the ECCT; for the association between depression and CCS status, the p-value was 0.021. Depression is usually diagnosed in job strain. The association between depression, and coronary calcification, as well as depression and CCS status had statistical significance. Conclusions: Job strain increased the hs-CRP level and AUER in both the CCS and no-CCS patients. The primary and secondary prevention of CHD could also include interventions to reduce job strain.<\/jats:p>","DOI":"10.3390\/medicina60071048","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T07:20:06Z","timestamp":1719386406000},"page":"1048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging"],"prefix":"10.3390","volume":"60","author":[{"given":"Paloma","family":"Moisii","sequence":"first","affiliation":[{"name":"1st Medical Department, \u201cGr.T.Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"\u201cPromedicanon\u201d Cardiology Office, 15 Valea Prisacii, Valea Lupului, 707410 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Jari","sequence":"additional","affiliation":[{"name":"2nd Surgical Department, \u201cGr.T.Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"Radiology and Medical Imaging Clinique, \u201cSf.Spiridon\u201d Emergency Hospital, 1st Independentei Avenue, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra Mara","family":"Ursu","sequence":"additional","affiliation":[{"name":"Radiology and Medical Imaging Clinique, \u201cSf.Spiridon\u201d Emergency Hospital, 1st Independentei Avenue, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6894-673X","authenticated-orcid":false,"given":"Alexandru Gratian","family":"Naum","sequence":"additional","affiliation":[{"name":"2nd Morpho-Functional Department, Biophysics and Medical Physics, \u201cGr.T.Popa\u201d University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania"},{"name":"\u201cNeolife\u201d Medical Center, 52 Carol I Avenue, 700503 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100260","DOI":"10.1016\/j.ahjo.2023.100260","article-title":"ANOCA\/INOCA\/MINOCA: Open artery ischemia","volume":"26","author":"Pepine","year":"2023","journal-title":"Am. Heart J. Plus Cardiol. Res. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wang, L., Shi, W., Li, Y., Ang, Y., Jing, P., Zhang, B., Cao, X., Loerbroks, A., and Zhang, M. (2022). Longitudinal associations of work stress with changes in quality of life among patients after acute coronary syndromes\u2014A hospital based study. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192417018"},{"key":"ref_3","first-page":"e0008073","article-title":"Association between work related stress and coronary heart disease: A review of prospective studies through the job strain, effort-reward balance and organizational justice models","volume":"7","author":"Jaskanval","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1037\/a0036600","article-title":"High job strain is associated with inflammatory markers of disease in young long-haul bus drivers","volume":"19","author":"Tsai","year":"2014","journal-title":"J. Occup. Health Psychol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.bbi.2024.06.002","article-title":"Does physical activity and inflammation mediate the job-stress headache relationship? A sequential mediation analysis in the ELSA-Brasil study","volume":"120","author":"Schytz","year":"2024","journal-title":"Brain Behav. Immun."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Della Corte, V., Todaro, F., Cataldi, M., and Tuttolomondo, A. (2023). Atherosclerosis and Its Related Laboratory Biomarkers. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242115546"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.jacc.2021.07.016","article-title":"High-sensitivity C-Reactive Protein modifies the cardiovascular risk of lipoprotein(a): Multi-ethnic Ssudy of atherosclerosis","volume":"78","author":"Zhang","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","first-page":"263","article-title":"High sensitivity C reactive protein (hsCRP)and its implications in cardiovascular outcomes","volume":"27","author":"Denegri","year":"2021","journal-title":"Curr. Farm. Des."},{"key":"ref_9","first-page":"194","article-title":"The link between microalbuminuria, endothelial dysfunction and cardiovascular disease in diabetes","volume":"13","author":"Naidoo","year":"2002","journal-title":"Cardiovasc. J S. Afr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e040890","DOI":"10.1136\/bmjopen-2020-040890","article-title":"Urinary albumin-to-creatinine ratio levels are associated with subclinical atherosclerosis and predict CVD events and all-cause deaths: A prospective analysis","volume":"11","author":"Liu","year":"2021","journal-title":"BMJ Open"},{"key":"ref_11","first-page":"29","article-title":"Association between shift work and microalbuminuria: Data from KNHANES (2012\u20132014)","volume":"21","author":"Kang","year":"2017","journal-title":"Ann. Occup. Environ. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1161\/01.HYP.38.1.71","article-title":"Perceived job stress but not individual cardiovascular reactivity to stress is related to higher blood pressure at work","volume":"38","author":"Fauvel","year":"2001","journal-title":"AHA J. Hypertens."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1503\/cmaj.121735","article-title":"Associations of job strain and lifestyle risk factors with risk of coronary artery disease: A meta-analysis of individual participant data","volume":"185","author":"Kivimaki","year":"2013","journal-title":"CMAJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/PSY.0b013e3182860d63","article-title":"Job strain-associated inflammatory burden and long-term risk of coronary events: Findings from the MONICA\/KORA Augsburg case-cohort study","volume":"75","author":"Emeny","year":"2013","journal-title":"Psychosom. Med."},{"key":"ref_15","first-page":"e009700","article-title":"Psychosocial Stressors at Work and Coronary Heart Disease Risk in Men and Women: 18-Year Prospective Cohort Study of Combined Exposures","volume":"16","author":"Trudel","year":"2023","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2147\/VHRM.S7457","article-title":"Using noncontrast cardiac CT and coronary artery calcification measurements for cardiovascular risk assessment and management in asymptomatic adults","volume":"9","author":"Rumberger","year":"2010","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1037\/h0079854","article-title":"The satisfaction scale: Canadian-French validation of the Satisfaction with Life Scale","volume":"21","author":"Blais","year":"1989","journal-title":"Can. J. Behav. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rodgers, J.L., Jones, J., Bolleddu, S.I., Vanthenapalli, S., Rodgers, L.E., Shah, K., Karia, K., and Panguluri, S.K. (2019). Cardiovascular Risks Associated with Gender and Aging. J. Cardiovasc. Dev. Dis., 6.","DOI":"10.3390\/jcdd6020019"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1055\/s-0042-1751234","article-title":"Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly","volume":"31","author":"Fadah","year":"2022","journal-title":"Int. J. Angiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/j.jacc.2017.12.068","article-title":"Coronary Artery Disease in Patients \u226580 Years of Age","volume":"71","author":"Madhavan","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e017780","DOI":"10.1161\/JAHA.120.017780","article-title":"Associations of job strain, stresfull life events and social strain with coronary heart disease in the Women\u2019s health initiative observational study","volume":"10","author":"Wang","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1016\/S0140-6736(21)00684-X","article-title":"The Lancet women and cardiovascular disease Commission: Reducing the global burden by 2030","volume":"397","author":"Vogel","year":"2021","journal-title":"Lancet"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101985","DOI":"10.1016\/j.jaccas.2023.101985","article-title":"Gender Disparity in Cardiovascular Disease in the Era of Precision Medicine","volume":"23","author":"Hosseini","year":"2023","journal-title":"JACC Case Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e015334","DOI":"10.1161\/JAHA.119.015334","article-title":"Increasing mortality from premature coronary artery disease in women in the rural United States","volume":"9","author":"Bossard","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_28","unstructured":"Martinho, M., and Martinho, M. (2023, January 22). Women more likely to die after heart attack than men. Proceedings of the Heart Failure, Congress of European Society of Cardiology, Topics Heart Failure, Prague, Czech Republic."},{"key":"ref_29","first-page":"100698","article-title":"Clinical determinants of ischemic heart disease in Eastern Europe","volume":"33","author":"Cenko","year":"2023","journal-title":"Lancet"},{"key":"ref_30","unstructured":"Brown, J.C., Gerhardt, T.E., and Kwon, E. (2024). Risk factors for coronary artery disease. StatPearls, Stat Pearls Publishing."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e222687","DOI":"10.1001\/jamanetworkopen.2022.2687","article-title":"Association of the Interaction Between Familial Hypercholesterolemia Variants and Adherence to a Healthy Lifestyle with Risk of Coronary Artery Disease","volume":"5","author":"Fahed","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.amjmed.2021.11.011","article-title":"Association of Low-Density Lipoprotein Testing After an Atherosclerotic Cardiovascular Event with Subsequent Statin Adherence and Intensification","volume":"135","author":"Rana","year":"2022","journal-title":"Am. J. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.numecd.2022.10.001","article-title":"LDL-cholesterol control in the primary prevention of cardiovascular diseases: An expert opinion for clinicians and health professionals","volume":"33","author":"Poli","year":"2023","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_34","first-page":"212","article-title":"Systemic inflammation and high sensitivity C reactive protein and atherosclerotic plaque progression","volume":"17","author":"Bienstock","year":"2024","journal-title":"Cardiovasc. Imaging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1080\/07853890701749225","article-title":"The connection between C-reactive protein and atherosclerosis","volume":"40","author":"Singh","year":"2008","journal-title":"Ann. Med."},{"key":"ref_36","first-page":"e30225","article-title":"Role of High-Sensitivity C-reactive Protein (Hs-CRP) in Non-communicable Diseases: A Review","volume":"14","author":"Banait","year":"2022","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1161\/01.CIR.0000052939.59093.45","article-title":"Markers of inflammation and cardiovascular disease: Application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association","volume":"107","author":"Pearson","year":"2003","journal-title":"Circulation"},{"key":"ref_38","first-page":"64","article-title":"Microalbuminuria, endothelial dysfunction and cardiovascular risk","volume":"26","year":"2000","journal-title":"Diabetes Metab."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e030131","DOI":"10.1161\/JAHA.123.030131","article-title":"Albuminuria-an underappreciated risk factor for cardiovascular disease","volume":"13","author":"Barzilay","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1093\/eurjpc\/zwaa095","article-title":"Association between albuminuria, incident cardiovascular events, and mortality in persons without hypertension, diabetes, and cardiovascular disease","volume":"29","author":"Nowak","year":"2022","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4103\/hm.hm_35_22","article-title":"Depression Symptom Patterns as Predictors of Metabolic Syndrome and Cardiac Events in Symptomatic Women with Suspected Myocardial Ischemia: The Women\u2019s Ischemia Syndrome Evaluation (WISE and WISE-CVD) Projects","volume":"6","author":"Virzi","year":"2022","journal-title":"Heart Mind"},{"key":"ref_42","first-page":"e20149","article-title":"Coronary Artery Calcium Score\u2014A Reliable Indicator of Coronary Artery Disease?","volume":"3","author":"Shreya","year":"2021","journal-title":"Cureus"},{"key":"ref_43","first-page":"775","article-title":"Pathophysiological mechanisms linking depression and atherosclerosis: An overview","volume":"26","author":"Pizzi","year":"2012","journal-title":"J. Biol. Regul. Homeost. Agents"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e032698","DOI":"10.1161\/JAHA.123.032698","article-title":"Translational Research of the Acute Effects of Negative Emotions on Vascular Endothelial Health: Findings From a Randomized Controlled Study","volume":"13","author":"Shimbo","year":"2024","journal-title":"J. Am. Heart Assoc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1097\/00149831-200308000-00005","article-title":"Type D personality, cardiac events and impaired quality of life: A review","volume":"10","author":"Pedersen","year":"2003","journal-title":"Eur. J. Prev. Cardiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1048\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:04:53Z","timestamp":1760108693000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/7\/1048"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,26]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["medicina60071048"],"URL":"https:\/\/doi.org\/10.3390\/medicina60071048","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,26]]}}}