Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study.
BACKGROUND
Covert coping with unfair treatment at work--occurring when an employee does not show the "aggressor" that he/she feels unfairly treated--has been found to be associated with cardiovascular risk factors. This study examined whether covert coping also predicts incident coronary heart disease.


METHODS
A prospective cohort study (the WOLF Stockholm study) of workplaces in the Stockholm area, Sweden. The participants were 2755 men with no history of myocardial infarction at baseline screening in 1992-1995. The main outcome measure was hospitalisation due to myocardial infarction or death from ischaemic heart disease until 2003 obtained from national registers (mean follow-up 9.8 ± 0.9 years).


RESULTS
Forty-seven participants had myocardial infarction or died from ischaemic heart disease during follow-up. After adjustment for age, socioeconomic factors, risk behaviours, job strain and biological risk factors at baseline, there was a dose-response relationship between covert coping and risk of incident myocardial infarction or cardiac death (p for trend=0.10). Men who frequently used covert coping had a 2.29 (95% CI 1.00 to 5.29) times higher risk than those who did not use coping. Restricting the analysis to direct coping behaviours only strengthened this association (p for trend=0.02).


CONCLUSIONS
In this study, covert coping is strongly related to increased risk of hard-endpoint cardiovascular disease.
Leineweber
C
C
Stress Research Institute, Stockholm University, Stockholm, Sweden. constanze.leineweber@stressforskning.su.se
Westerlund
H
H
Theorell
T
T
Kivimäki
M
M
Westerholm
P
P
Alfredsson
L
L
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003220:Conflict, Psychological; D006801:Humans; D015994:Incidence; D007398:Interpersonal Relations; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000523:psychology; D016272:Occupational Health; D011287:Prejudice; D011446:Prospective Studies; D011594:Psychometrics; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult