Abstract
The association between the amount of standing at work and the progression of carotid intima media thickness (IMT) was studied among 584 active working men participating in the Kuopio Ischemic Heart Disease Risk Factor Study. Ultrasound measurements of atherosclerotic changes in the carotid arteries were performed at the beginning of the study and after 4 years. Analyses of changes in IMT included adjustments for risk factors and stratification by base-line levels of atherosclerosis and prevalent ischemic heart disease (IHD). Significant relationships were found between the amount of standing at work and atherosclerotic progression. After adjustment for the heaviness of the work, psychosocial job factors, income, and biological and behavioral risk factors, the mean change in maximum IMT for those standing not at all, a little, a lot, and very much was 0.24, 0.25, 0.28, and 0.33 mm, respectively. For men with IHD the respective changes were 0.08, 0.15, 0.37, and 0.75 mm -- a 9-fold difference between the no-exposure and high-exposure group. For the men with carotid stenosis, the respective difference was 3-fold. These findings provide the first empirical support in a population study for the role of hemodynamic factors in the progression of atherosclerosis induced by long-term standing. Men with carotid stenosis or IHD appear especially vulnerable to the adverse effects associated with standing at work. Reducing the duration of standing at work should be considered both in the occupational rehabilitation of such patients and in the primary prevention of atherosclerosis.
Highlights
Base-line information on other physical and psychosocial workplace characteristics, socioeconomic status, prevalent disease, and biological and behavioral atherosclerotic risk factors have been used to adjust for known risk factors and to stratify the analyses by both prevalent ischemic heart disease and the extent of atherosclerosisat the time of the base-line measurements
Information on the progression of carotid atherosclerosis and covariates was available for 982 men
The progression of carotid atherosclerosis was calculated as the arithmetic difference between the base-line and 4-year follow-up values for maximum intima media thickness (IMT)
Summary
Ultrasound measurements of atherosclerotic changes in the carotid arteries were performed at the beginning of the study and after 4 years. The development of ultrasound measurements of atherosclerotic changes in the carotid arteries allows us to look at the relationship between work characteristics and the progression of atherosclerosis in earlier, asymptomatic stages before selection effects occur (10,ll). Standing leads to a redist~ibutionof circulating blood into Increasing amounts of circulating catecholamines have the extremities [22] This hydrostatic or venous pooling been linked to increased lipid absorption into the arterial walls, increasing levels of clotting factors, and increases in heart rate and systolic blood pressure [30,31,32]. This study tested the hypothesis that long-term standing at work is associated with an accelerated progression of atherosclerosis in common carotid arteries of middleaged men. Ultrasound measurements of atherosclerotic changes in the carotid arteries at base line and after 4 years in the Kuopio Ischemic Heart Disease Risk Factor Study enabled us to study this problem prospectively in a population sample. Base-line information on other physical and psychosocial workplace characteristics, socioeconomic status, prevalent disease, and biological and behavioral atherosclerotic risk factors have been used to adjust for known risk factors and to stratify the analyses by both prevalent ischemic heart disease and the extent of atherosclerosisat the time of the base-line measurements
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