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.

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MEDICIN

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