ABC | Volume 112, Nº3, March 2019

Original Article Muniz et al Ideal cardiovascular health and job strain Arq Bras Cardiol. 2019; 112(3):260-268 Objective The aim of this study is to evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. Methods The study was performed between 2012 and 2013 in Rio Branco, Brazil. All 759 employees at the Federal University of Acre were invited to participate. Employees received a call or email to setup an appointment with two trained researchers. A total of 478 employees accepted to participate, including 166(35%) faculty professionals and 312(65%) non-faculty staff. A questionnaire was used to collect information regarding demographics, CV behavior and risk factors. Weight, height, waist circumference and blood pressure were measured twice at different appointments. The average of the two measurements was considered the final value. We excluded those subjects who declined to sign an informed consent. Twenty-seven participants with missing data regarding job strain were not included in the comparisons among CV health factors and job strain. This study was approved by the Institutional Review Board at the Federal University of Acre. We used the validated Portuguese-language adapted Job Content Questionnaire based in Robert Karesek theoric model to assess job strain. 9 It is composed of 6 questions to evaluate control, 5 questions to assess demand, and 6 questions to assess social support. Each question was composed of 4 possible answers ranging from 1 (strongly disagree) to 4 (strongly agree). We defined as having high demand those participants with scores above the 50th percentile on the Portuguese-language adapted Job Content Questionnaire; low control when below the 50th percentile; High job strain was defined as the combination of high demand and low control; low job strain as low demand and high control; active as high demand and high control; passive as low demand and low control. This study selected seven health indicators proposed by the AHA as markers of CV health. These seven parameters include four lifestyle variables (smoking, physical activity, diet, and BMI) and three CV risk factors (diabetes, hypercholesterolemia, and high blood pressure). Smoking status was classified as never smoker, former smoker and current smoker. Ideal physical activity was defined by more than 150 minutes/week of moderate intensity exercise, any physical activity lower than 150 minutes/week as intermediate and no physical exercise as poor. BMI was calculated as body weight in kilograms divided by the square of body height in meters (kg/m 2 ). Values lower than 25 were considered ideal, between 25 and 29.9 intermediate, and greater than 30 were considered poor. Diabetes and hypercholesterolemia were self-reported in a questionnaire as yes or no responses. Blood pressure was obtained by trained researchers. High blood pressure was defined as a measured value greater than 140/90 mmHg or self-reported high blood pressure in use of anti-hypertensive medication or not. Systolic blood pressure between 120 and 139 or diastolic blood pressure between 80 and 89 were classified as intermediate. Blood pressure < 120/80 was considered ideal. According to the AHA, an ideal diet pattern was defined as consumption of 4 portions or more of fruits and/or vegetables per day, less than 1 liter of sugar-sweetened beverages per week and more than two 3.5-oz servings per week of fresh fish. We used a food frequency questionnaire previously validated in a Brazilian cohort. 10 Sodium and fiber-rich whole grains consumption couldn’t be accessed by the questionnaire. Individuals were classified as having ideal CV health (ideal lifestyle and absence of CV risk factors), poor (when any of the seven factors was evaluated as poor) or intermediate (participants who did not belong to ideal or poor CV health group). The covariates used for data analysis were age, gender, income, education level and occupation, which were self‑reported in a questionnaire. Income was measured in US dollars and subjects were split in two categories, more or less than $20,000/year. Occupation was classified as teaching and non-teaching staff. We modeled education as a dichotomous variable with subjects classified as college or more or high school or less. Low social support was considered for those participants bellow 50th percentile on the adapted Job Content Questionnaire. Statistical analysis The study was designed to detect a difference in the proportion of poor CV health of 15% between high strain (85%) and low strain (70%). Considering a power set at 0.8, an alpha level of 0.05, we estimated a sample size of at least 121 patients per group and a total of 424 participants. We planned including 478 individuals, allowing for non-respondents or incomplete responses up to 12% of participants. Categorical data was reported as percent frequencies and compared by chi-squared test. Continuous normally distributed variables were displayed as mean and standard deviation, and continuous non-normally distributed variables were displayed as median and 25th and 75th percentiles. Significant pairwise comparisons were adjusted for multiple testing using Bonferroni correction and are shown only for variables in which a significant global difference was detected using one-way ANOVA or Kruskal–Wallis tests. The association between job strain and CV health was assessed using multivariable logistic regression using the low strain group as reference. We also used multivariable logistic regression to assess the association between job strain and CV risk factors. We built two models for analyses; the crude analyses without any covariate and the adjusted analyses, which controlled for age, sex, education, income, and occupation. Exposures included high job strain and also high demand and low control, separately. All statistical analyses were performed with STATA version 13.1 (Stata Corp., College Station, TX, USA). P‑values < 0.05 were considered statistically significant. Results Participants had a mean age of 44.3 ± 12 years, and 65% were men; In terms of job strain, the most prevalent group was low job strain with 144 (32%) individuals. A total of 86 (19%) participants were found to have high job strain, 93 (21%) were considered active, and 128 (28%) were considered to have passive work. Teaching professionals were less likely to 261