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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.122382v1 98/12/2264    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Väänänen, A. Articles by Jäppinen, P. Search for Related Content PubMed PubMed Citation Articles by Väänänen, A. Articles by Jäppinen, P. Related Collections Epidemiology Occupational Health Cardiovascular Disease Other Environment

Ari Väänänen, PhD, Aki Koskinen, MSc, Matti Joensuu, MA, Mika Kivimäki, PhD, Jussi Vahtera, MD, PhD, Anne Kouvonen, PhD and Paavo Jäppinen, MD, PhD

Ari Väänänen, Aki Koskinen, Matti Joensuu, and Jussi Vahtera are with the Finnish Institute of Occupational Health, Helsinki. Mika Kivimäki is with the University College, London, England. Anne Kouvonen is with the University of Nottingham, Nottingham, England. Paavo Jäppinen is the former vice president of well-being and safety in Stora Enso, Helsinki, Finland.

Correspondence: Requests for reprints should be sent to Ari Väänänen, PhD, Centre of Expertise for Work Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250, Helsinki, Finland (e-mail: ari.vaananen{at}ttl.fi).

Objectives. We examined whether the distinctive components of job control—decision authority, skill discretion, and predictability—were related to subsequent acute myocardial infarction (MI) events in a large population of initially heart disease–free industrial employees.

Methods. We prospectively examined the relation between the components of job control and acute MI among private-sector industrial employees. During an 18-year follow-up, 56 fatal and 316 nonfatal events of acute MI were documented among 7663 employees with no recorded history of cardiovascular disease at baseline (i.e., 1986).

Results. After adjustment for demographics, psychological distress, prevalent medical conditions, lifestyle risk factors, and socioeconomic characteristics, low decision autonomy (P < .53) and skill discretion (P < .10) were not significantly related to subsequent acute MI. By contrast, low predictability at work was associated with elevated risk of acute MI (P = .02). This association was driven by the strong effect of predictability on acute MI among employees aged 45 to 54 years.

Conclusions. Prospective evidence suggests that low predictability at work is an important component of job control, increasing long-term risk of acute MI among middle-aged employees.