ABC | Volume 112, Nº3, March 2019

Original Article Ideal Cardiovascular Health and Job Strain: A Cross-Sectional Study from the Amazon Basin Davi Dantas Muniz, 1 Kamile Santos Siqueira, 2 Cristina Toledo Cornell, 3 Miguel Morita Fernandes-Silva, 4 Pascoal Torres Muniz, 1 Odilson Marcos Silvestre 1 Universidade Federal do Acre (UFAC), 1 Rio Branco, AC – Brazil Universidade Federal Fluminense, 2 Niterói, RJ – Brazil Brigham and Womens Hospital - Harvard University, 3 Boston, Massachussets – USA Pontifícia Universidade Católica do Paraná, 4 Curitiba, PR – Brazil Mailing Address: Odilson Marcos Silvestre • Clínica Silvestre Santé - Rua Quintino Bocaiúva, 1108, Postal Code 69900- 785; Rio Branco, AC – Brazil E-mail: odilsonsilvestre@yahoo.com.br Manuscript received March 05, 2018, revised manuscript July 18, 2018, accepted August 08, 2018 DOI: 10.5935/abc.20190005 Abstract Background: Ideal Cardiovascular (CV) Health is characterized by four ideal lifestyle parameters and absence of cardiovascular risk factors. The prevalence of ideal CV health in the Amazon Basin and the influence of job strain on CV health in this setting are uncertain. Objective: To evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. Methods: Job strain was evaluated in 478 employees from an university in the Amazon Basin by a questionnaire that classified participants as passive, active, low or high strain, according to the demand-control model. CV health was evaluated using the American Heart Association 7 health factors (diet, physical activity, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolemia). Participants were classified as having ideal, intermediate or poor CV health. The level of significance was set at p < 0.05. Results: The mean age was 44.3 ± 12 years, 65% were men, and 35% were faculty. No participant fulfilled the criteria for ideal CV health. Intermediate CV health was found in 44 (9%) and poor in 434 (91%) individuals. Considering low strain as a reference group, individuals classified as high strain, active and passive had a non-significant (p > 0.05) increase in the chances of having poor CV health. When adjusting for possible confounders, high job strain was associated with poor BMI (> 30 kg/m 2 ), (OR 2.11, 95%CI 1.06-4.22; p = 0.034) and poor diet (OR 2.31, 95% CI 1.29-4.13; p = 0.005). Conclusion: Job strain was not associated with cardiovascular health, but high job strain was related to obesity and poor diet. Given the high prevalence of poor CV health and lack of participants with ideal CV health, policies focusing on health education and lifestyle interventions are paramount to this population. (Arq Bras Cardiol. 2019; 112(3):260-268) Keywords: Cardiovascular Diseases/epidemiology; Risk Factors; Prevention and Control; Amazonian Ecosystem; Stress,Psychological; Obesity; Eating Disorders. Introduction Cardiovascular diseases (CVD) remain the leading cause of death in both the developed and developing world. 1-3 In order to combat CVD, the American Heart Association (AHA) launched the 2020 impact goal and the Ideal Cardiovascular Health initiative. 4 Ideal Cardiovascular (CV) Health is defined as the presence of both ideal health behaviors (nonsmoking, bodymass index (BMI) <25 kg/m 2 , physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol < 200 mg/dL, untreated blood pressure < 120/80 mmHg, and fasting blood glucose < 100 mg/dL). Subjects in ideal status have a lower incidence of CVD and an increased life expectancy when compared with those in poor status. 4–6 CV health seems to be influenced byworkplace conditions. 7,8 In a study by Karasek et al., 8 high job strain was associated with higher chances of having CV disease. 8 The authors proposed that demand and control at the workplace influence health status. Control is defined as how much leeway in decision making the employee has and how much intellectual skills are required when working. Demand is the intellectual pressure that can be either quantitative, for example, time and velocity to work, or qualitative, defined as conflicts between contradictory demands. 7 Although few studies in this regard have been performed in developed countries, the relationship between job strain and CV health is not completely known in the setting of a developing country. Using the above framework, we hypothesized that ideal CV health has low prevalence in the Amazon Basin. Furthermore, we believe that job strain is associated with a higher prevalence of poor CV health. 260