職業促發腦血管及心臟疾病之理論與實務

Work-related Cardiac and Cerebrovascular Diseases: Theory and Practice in Taiwan

腦血管及心臟疾病成因眾多，除了高血壓、糖尿病及高脂血症等慢性疾病外，肥胖、吸菸與缺乏運動等不良健康行為也已被確定。此外職業因素也可能藉由神經及內分泌系統影響心率、血壓、代謝因素和血管內皮健康，而促發腦血管疾病和心臟病的發生。過去的研究指出長時間工作可能會增加心血管疾病的風險（相對風險約為1.1-1.4）。不同國家的研究分別指出職業因素相關的心血管疾病約占全部心血管疾病病因的1%到22%。包括台灣在內的一些國家在某些具體情況下將腦血管和心臟疾病列為可申請法定保險補償的職業病。然而職業性腦血管和心臟病在實務認定上仍是一大挑戰。第一線接觸病患的基層醫師可以藉熟悉最新修訂的診斷指引，在接觸高風險族群時，能提供健康促進、生活方式改變和工作管理的建議，以達到預防疾病及延緩疾病惡化的目的。 Occupational factors have been found to contribute to the development of cardiac and cerebrovascular diseases. Work stress, for example, may affect the nervous and endocrine systems, which in turn affects heart rate, blood pressure, metabolic factors, and endothelium. Previous studies have demonstrated that heavy workload might increase the risk of cardiac and cerebrovascular diseases, and the relative risk was around 1.1 to 1.4. According to studies from different countries, occupational factors contributed to 1% to 22 % of cardiovascular diseases. Several countries have listed cardiac and cerebrovascular diseases among compensable occupational diseases under certain specific conditions, and most cases in Taiwan are attributed to over-work. However, diagnosis of occupational cerebrovascular and heart diseases remains a challenging task. In practice, doctors should keep themselves updated with the latest revision of guidelines set forth by the government for identifying work-related cardiac and cerebrovascular diseases. More importantly, lifestyle modification and workload management should be implemented for disease prevention in high risk groups.