Chapter3-CardiovascularSystemINTRODUCTIONLotharHeinemannandGerdHeuchertCardiovasculardiseases(CVDs)areamongthemostcommoncausesofillnessanddeathintheworkingpopulation,particularlyinindustrializedcountries.Theyarealsoincreasingindevelopingcountries(Wielgosz1993).Intheindustrializedcountries,15to20%ofallworkingpeoplewillsufferfromacardiovasculardisordersometimeduringtheirworkinglivesandthefrequencyclimbssharplywithage.Amongthosebetween45to64yearsofage,morethanathirdofthedeathsamongmenandmorethanaquarterofdeathsamongwomenarecausedbythisgroupofdiseases(seetable3.1).Inrecentyears,CVDshavebecomethemostfrequentcauseofdeathamongpost-menopausalwomen.Table3.1Mortalityfromcardiovasculardiseasesin1991and1990intheagegroups45-54and55-64forselectedcountriesCountryMenWomen45-54Years55-64Years45-54Years55-64YearsRate%Rate%Rate%Rate%Russia**528361,290441623355949Poland**480381,193451343143042Argentina*31740847441313333939Britain**1984266547592026732USA*2123562340832427331Germany**1812959738551821330Italy*1232740430411814825Mexico**1281734623821923024France**102173112230129418Japan**1112728126482211926*1990.**1991.Rate=Deathsper100,000inhabitants.%isfromallcausesofdeathintheagegroup.Becauseoftheircomplexaetiology,onlyaverysmallproportionofthecasesofcardiovasculardiseasearerecognizedasoccupational.Manycountries,however,recognizethatoccupationalexposurescontributetoCVDs(sometimesreferredtoaswork-relateddiseases).Workingconditionsandjobdemandsplayanimportantroleinthemultifactorialprocessthatleadstothesediseases,butascertainingtheroleoftheindividualcausalcomponentsisverydifficult.Thecomponentsinteractinclose,shiftingrelationshipsandoftenthediseaseistriggeredbyacombinationoraccumulationofdifferentcausalfactors,includingthosethatareworkrelated.Thereaderisreferredtothestandardcardiologytextsfordetailsoftheepidemiology,pathophysiology,diagnosisandtreatmentofcardiovasculardiseases.Thischapterwillfocusonthoseaspectsofcardiovasculardiseasethatareparticularlyrelevantintheworkplaceandarelikelytobeinfluencedbyfactorsinthejobandworkenvironment.CARDIOVASCULARMORBIDITYANDMORTALITYINTHEWORKFORCEGottfriedEnderleinandLotharHeinemannInthefollowingarticle,thetermcardiovasculardiseases(CVDs)referstoorganicandfunctionaldisordersoftheheartandcirculatorysystem,includingtheresultantdamagetootherorgansystems,whichareclassifiedundernumbers390to459inthe9threvisionoftheInternationalClassificationofDiseases(ICD)(WorldHealthOrganization(WHO)1975).BasedessentiallyoninternationalstatisticsassembledbytheWHOanddatacollectedinGermany,thearticlediscussestheprevalenceofCVDs,newdiseaserates,andfrequencyofdeaths,morbidityanddisability.DefinitionandPrevalenceintheWorking-AgePopulationCoronaryarterydisease(ICD410-414)resultinginischaemiaofthemyocardiumisprobablythemostsignificantCVDintheworkingpopulation,particularlyinindustrializedcountries.Thisconditionresultsfromaconstrictioninthevascularsystemthatsuppliestheheartmuscle,aproblemcausedprimarilybyarteriosclerosis.Itaffects0.9to1.5%ofworking-agemenand0.5to1.0%ofwomen.Inflammatorydiseases(ICD420-423)mayinvolvetheendocardium,theheartvalves,thepericardiumand/ortheheartmuscle(myocardium)itself.Theyarelesscommoninindustrializedcountries,wheretheirfrequencyiswellbelow0.01%oftheadultpopulation,butareseenmorefrequentlyindevelopingcountries,perhapsreflectingthegreaterprevalenceofnutritionald...
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