***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims Cortisol is associated with increased cardiovascular morbidity and mortality in patients with chronic heart failure and in the general population . The negative predictive effect of cortisol on survival in non-diabetic patients who have suffered an acute myocardial infa rct ion ( AMI ) has been shown . We aim ed to determine the prognostic significance of cortisol in a general group of AMI patients , as this is not well known . Methods  Plasma cortisol levels  were measured in 955 consecutive patients admitted with AMI . We prospect ively evaluated the relationship between cortisol and major adverse cardiovascular event ( MACE ) , which was a composite of all-cause mortality , and combination all-cause mortality and re-hospitalization for heart failure , in post-AMI patients . Results During the 2-year follow-up , MACE occurred in 261 patients ( 27.3 % ) . Patients with MACE had significantly higher median levels of cortisol than those without ( 609.4 versus 549.4 pmol/ml , P = 0.0073 ) . Log cortisol was independently predictive of MACE after adjusting for covariates with hazard ratio ( 95 % confidence interval ) of 1.55 ( 1.05–2.27 ) , P = 0.027 . Patients in the highest quartile of cortisol had significantly more risk of MACE compared with those in the lowest quartile , with an adjusted hazard ratio ( 95 % confidence interval ) of 1.91(1.16–3.15 ) , P = 0.0120 . Kaplan – Meier survival estimates for MACE were lower in patients with plasma cortisol levels in the highest quartile compared with those in the first three quartiles ( Log rank test & khgr;2 for survival = 10.41 , P = 0.0013 ) . Conclusion This study has shown the prognostic significance of cortisol in 955 post-AMI patients from a single centre AIM Interleukin (IL)-17 pathway is being clinical ly targeted in immune-mediated diseases , most of which are associated with a significant cardiovascular risk . We investigated the relationship between serum levels of IL-17 and the risk of cardiovascular events in patients with acute myocardial infa rct ion . METHODS AND RESULTS We used data from 981 patients enrolled in the prospect i ve , multicentre French registry of Acute ST elevation , or non-ST-elevation Myocardial Infa rct ion ( Fast-MI , NCT00673036 ) . Serum levels of IL-17 were associated with the risk of all-cause death and recurrent MI at 2 years , with levels of IL-17 below the median indicative of a worse outcome . The impact of IL-17 remained significant after adjustment for known cardiovascular risk factors , C-reactive protein , and treatments including statins : hazard ratio ( HR ) = 1.40 ( 1.03 - 1.91 ) ; P = 0.03 . IL-17 inhibited mononuclear cell adhesion to endothelium and reduced endothelial vascular cell adhesion molecule ( VCAM-1 ) expression . Patients with low ( below the median ) IL-17 levels and high ( above the median ) soluble VCAM-1 ( sVCAM-1 ) levels were at particularly increased risk of death and MI : adjusted HR = 2.22 ( 1.32 - 3.75 ) compared with the high IL-17/low sVCAM-1 group ( P = 0.002 ) . CONCLUSIONS Low serum levels of IL-17 are associated with a higher risk of major cardiovascular events in Caucasian patients with acute MI . Our results raise possible concern about the use of inhibitors of the IL-17 pathway in clinical setting s associated with a high cardiovascular risk . CLINICAL TRIALS REGISTRATION NCT00673036 BACKGROUND Justice is a fundamental value in human societies , but its effect on health is poorly described . We examined justice at work as a predictor of  coronary heart disease ( CHD ) .  METHODS Prospect i ve occupational cohort study of 6442 male British civil servants aged 35 to 55 years without prevalent CHD at baseline in phase 1 ( 1985 - 1988 ) . Baseline screening included measurements of conventional risk factors . Perceived justice at work and other work-related psychosocial factors were determined by means of question naire at phases 1 and 2 ( 1989 - 1990 ) . Follow-up for CHD death , first nonfatal myocardial infa rct ion , or definite angina occurring from phase 2 through 1999 was based on medical records ( mean follow-up , 8.7 years ) . RESULTS Cox proportional hazard models adjusted for age and employment grade showed that employees who experienced a high level of justice at work had a lower risk of incident CHD than employees with a low or an intermediate level of justice ( hazard ratio , 0.65 ; 95 % confidence interval , 0.47 - 0.89 ) . The hazard ratio did not material ly change after additional adjustment for baseline cholesterol concentration , body mass index , hypertension , smoking , alcohol consumption , and physical activity . Although other psychosocial models such as job strain and effort-reward imbalance predicted CHD in these data , the level of justice remained an independent predictor of incident CHD after adjustment for these factors . CONCLUSION Justice at work may have benefits for heart health among employees CONTEXT There is evidence that job strain increases the risk of a first coronary heart disease ( CHD ) event . However , little is known about its association with the risk of recurrent CHD events after a first myocardial infa rct ion ( MI ) . OBJECTIVE To determine whether job strain increases the risk of recurrent CHD events . DESIGN , SETTING , AND PATIENTS Prospect i ve cohort study of 972 men and women aged 35 to 59 years who returned to work after a first MI and were then followed up between February 10 , 1996 , and June 22 , 2005 . Patients were interviewed at baseline ( on average , 6 weeks after their return to work ) , then after 2 and 6 years subsequently . Job strain , a combination of high psychological dem and s and low decision latitude , was evaluated in 4 quadrants : high strain ( high dem and s and low latitude ) , active ( high dem and s and high latitude ) , passive ( low dem and s and low latitude ) , and low strain . A  chronic job strain  variable was constructed based on the first 2 interviews , and patients were divided into those exposed to high strain at both interviews and those unexposed to high strain at 1 or both interviews . The survival analyses were presented separately for 2 periods : before 2.2 years and at 2.2 years and beyond . MAIN OUTCOME MEASURE The outcome was a composite of fatal CHD , nonfatal MI , and unstable angina . RESULTS The outcome was documented in 206 patients . In the unadjusted analysis , chronic job strain was associated with recurrent CHD in the second period after 2.2 years of follow-up ( hazard ratio [ HR ] , 2.20 ; 95 % CI , 1.32 - 3.66 ; respective event rates for patients exposed and unexposed to chronic job strain , 6.18 and 2.81 per 100 person-years ) . Chronic job strain remained an independent predictor of recurrent CHD in a multivariate model adjusted for 26 potentially confounding factors ( HR , 2.00 ; 95 % CI , 1.08 - 3.72 ) . CONCLUSION Chronic  job  strain after a first MI was associated with an increased risk of recurrent CHD Objective : Evidence regarding the status of job strain as a risk factor for coronary heart disease ( CHD ) is mixed , including both results supporting the risk status and null findings . However , previous studies have typically assessed job strain at one point in time only . We examined whether the failure of such measurement to reflect long-term job strain could contribute to false null findings . Methods : Job strain and its components , as stress indicators , were assessed twice ( 3-year time lag ) for 5043 men and 2210 women who were free of apparent CHD at baseline .  Incident CHD after the stress measurement comprised CHD death , a first nonfatal myocardial infa rct ion , or definite angina ( mean follow-up , 10.4 years ) . The data analysis was based on Cox proportional-hazard models adjusted for age , sex , and employment grade and corrected using regression dilution ratios calculated from short-term repeat data in a r and om sub sample . Results : In the total cohort , incidence of new CHD was higher for higher levels of job strain and dem and s. For these stress indicators , the corrected excess CHD risk was 30 % and 29 % higher than the corresponding uncorrected estimates , whereas the corresponding increase for job control was only 13 % . Effects of job strain and work dem and s , but not job control , were stronger for a subgroup , with consistent exposure measurements over time than for the total cohort . Conclusion : This evidence suggests that use of single-time exposure measures may underestimate the status of long-term job strain as a CHD risk factor . CHD = coronary heart disease ; ECG = electrocardiogram BACKGROUND Return to work is an important indicator of recovery after acute cardiac events . This study aim ed to determine rates of work resumption and identify predictors of non-return to work and delayed resumption of work . METHODS 401 currently employed patients consecutively admitted after acute coronary syndrome or to undergo coronary artery bypass graft surgery were recruited . Patient characteristics , perceptions and occupational outcomes were investigated via interviews and self-report question naires . RESULTS Twenty-three patients were lost to follow-up . Of the 378 completers , 343 ( 90.7 % ) patients resumed work , while 35 ( 9.3 % ) did not . By four months , 309 ( 91.1 % ) patients had returned to work . At 12 months , 302 ( 79.9 % ) of the 378 patients were employed , 32 ( 8.5 % ) unemployed and 20 ( 5.3 % ) retired . The employment status of 24 ( 6.3 % ) patients was unknown . Non-return to work was significantly more likely if patients were not intending to return to work or were uncertain , had a negative perception of health , had a comorbidity other than diabetes and reported financial stress . Significant predictors of delayed return to work were cardiac rehabilitation attendance , longer hospital stay , past angina , having a manual job , physically active work , job dissatisfaction , no confidante and depression . CONCLUSIONS Patients at risk of poor occupational outcomes can be identified early . Strategies to improve vocational rehabilitation require further investigation OBJECTIVE The usual assessment of coronary angiograms by st and ard visual analysis was compared with the assessment by quantitative computer analysis to provide evidence of the consequences of measurement errors attributable to visual assessment in the evaluation of coronary stenoses in clinical trials . METHODS Angiograms obtained in 151 patients enrolled in a double-blind r and omized controlled trial assessing the effect of fish oil supplementation on restenosis were evaluated by both visual and quantitative methods . Proportions of patients with unsuccessful angioplasty and proportions of patients with restenosis according to visual and quantitative methods were compared by st and ard statistical methods . RESULTS Of the 151 patients who were considered successfully dilated by visual interpretation , 32 were not considered successfully dilated by quantitative analysis . With quantitative computer analysis , evaluation of restenosis on the 119 successfully dilated patients documented a protective effect of fish oil against restenosis ( 30.5 % of treated patients versus 48.3 % of control patients , P < 0.05 ) . Visual evaluation of restenosis six months after angioplasty misclassified 10 % of patients in each treatment group and failed to demonstrate a protective effect of fish oil against restenosis . CONCLUSIONS Misclassification by visual assessment of both success and restenosis in the present trial led to underestimating the true effect of fish oil in the prevention of restenosis . Accurate and objective methods , such as quantitative computer analysis , are thus required for evaluating the effects of interventions on coronary arteries Using comparative data from five countries , this study investigates the psychometric properties of the effort-reward imbalance ( ERI ) at work model . In this model , chronic work-related stress is identified as non-reciprocity or imbalance between high efforts spent and low rewards received . Health-adverse effects of this imbalance were documented in several prospect i ve and cross-sectional investigations . The internal consistency , discriminant validity and factorial structure of  ' effort ' , ' reward ' , and ' overcommitment '  scales are evaluated , using confirmatory factor analysis . Moreover , content ( or external ) validity is explored with respect to a measure of self-reported health . Data for the analysis is derived from epidemiologic studies conducted in five European countries : the Somstress Study ( Belgium ; n = 3796 ) , the GAZEL-Cohort Study ( France ; n = 10,174 ) , the WOLF-Norrl and Study ( Sweden ; n = 960 ) , the Whitehall II Study ( UK ; n = 3697 ) and the Public Transport Employees Study ( Germany ; n = 316 ) .  Internal consistency of the scales was satisfactory in all sample s , and the factorial structure of the scales was consistently confirmed ( all goodness of fit measures were > 0.92 ) . Moreover , in 12 of 14 analyses , significantly elevated odds ratios of poor health were observed in employees scoring high on the E 
    Output:
    
Our findings suggest that , in patients with the first CHD , work stress is associated with an increased relative risk of recurrent CHD events by 65 % .