title: Mastery is associated with cardiovascular disease mortality in men and women at apparently low risk.
abstract: OBJECTIVE
  We examine the prospective relationship between mastery, where limited mastery is defined as the inability to control negative emotions (and perceiving stressful experiences as beyond personal control), and cardiovascular disease (CVD) mortality particularly among individuals at apparently low CVD risk.
  
  
  METHODS
  Prospective population-based study of 19,067 men and women, aged 41-80 years with no previous heart disease or stroke at baseline assessment.
  
  
  METHODS
  Primary outcome measure CVD mortality.
  
  
  RESULTS
  A total of 791 CVD deaths were recorded up to June 2009 during a median 11.3 person-years of follow-up. Limited perceived mastery over life circumstances was associated with an increased risk of CVD mortality, independently of biological, lifestyle, and socioeconomic risk factors (hazard ratio 1.11 per SD decrease in mastery score, 95% confidence interval 1.01-1.21). This association was more pronounced among those participants apparently at low CVD risk (p = .01 for test of interaction according to the number of CVD risk factors at baseline).
  
  
  CONCLUSIONS
  Limited perceived control over life circumstances is associated with an increased risk of CVD mortality, independently of classical cardiovascular risk factors, and particularly among those at apparently low risk. Future attention should be given to this potentially modifiable personal characteristic, through the design of preliminary intervention studies, to reduce cardiovascular risk.
authors.affiliation: Strangeways Research Laboratory, Cambridge, UK. ps404@cam.ac.uk
authors.forename: Paul G
authors.initials: PG
authors.lastname: Surtees
authors.forename: Nicholas W J
authors.initials: NW
authors.lastname: Wainwright
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Bingham
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D012649:Self Concept; D012959:Socioeconomic Factors; D020521:Stroke / Q000150:complications / Q000401:mortality*