title: Perceived control as a predictor of cardiovascular disease mortality in Poland. The HAPIEE study.
abstract: BACKGROUND
  Neither the development in methods of treatment of coronary heart disease nor the changes in exposure to main cardiovascular disease (CVD) risk factors do not fully explain the trends in CVD mortality in Poland. An influence of psychosocial factors is considered. The aims of the study were: (1) to assess the relationship between perceived control and the prevalence of classic CVD risk factors; (2) to assess the relationship between perceived control and the risk of death from all causes and from CVD.
  
  
  METHODS
  A cohort study with 5-year follow-up was conducted. Random sample of 10,728 permanent residents of Krakow aged 45-69 was examined. Perceived control was measured using a standard 11-item scale. The studied group was divided into four subgroups of people with very high, high, moderate, and low perceived control according to quartile values. Data on deaths and causes were obtained from the local register, death certificates and participants' families. An independent effect of perceived control on CVD mortality was assessed using Cox proportional hazards models.
  
  
  RESULTS
  Low perceived control was strongly associated with a higher CVD mortality, independently of age, education, marital status, history of CVD, hypertension, hypercholesterolemia, smoking, body mass index, physical activity or diabetes in both men and women (HR 2.68, 95% CI 1.36-5.31 and HR 5.18, 95% CI 1.17-22.96, respectively). After adjustment for age, both in men and women, the highest risk of death from all causes was observed in persons with low perceived control. Further adjustment for covariates attenuated the relationship.
  
  
  CONCLUSIONS
  Perceived control is a strong independent predictor of CVD mortality and may be considered a CVD risk factor in the Polish urban population.
authors.affiliation: Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian Univer sity Medical College, Krakow, Poland. mkozela@cm-uj.krakow.pl.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kozela
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Doryńska
authors.forename: Urszula
authors.initials: U
authors.lastname: Stepaniak
authors.forename: Krystyna
authors.initials: K
authors.lastname: Szafraniec
authors.forename: Roman
authors.initials: R
authors.lastname: Topór-Mądry
authors.forename: Witosława
authors.initials: W
authors.lastname: Misiowiec
authors.forename: Martin
authors.initials: M
authors.lastname: Bobak
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pająk
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010465:Perception; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D000068356:Self-Control; D011795:Surveys and Questionnaires; D013997:Time Factors