J Epidemiol Community Health doi:10.1136/jech.2009.088880
  • Research report

Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: Prospective cohort study

  1. Constanze Leineweber1,*,
  2. Hugo Westerlund1,
  3. Töres Theorell1,
  4. Mika Kivimäki2,
  5. Peter Westerholm3,
  6. Lars Alfredsson4
  1. 1 Stockholm University, Sweden;
  2. 2 University College London, United Kingdom;
  3. 3 Uppsala University, Sweden;
  4. 4 Karolinska Institute, Sweden
  1. Correspondence to: Constanze Leineweber, Stress Research Institute, Stockholm University, Stress Research Institute, Stockholm University, Stockholm, 10691, Sweden; constanze.leineweber{at}
  • Received 19 February 2009
  • Accepted 2 September 2009
  • Published Online First 24 November 2009


Objective: 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. We examine whether covert coping also predicts incident coronary heart disease.

Design:Prospective cohort study (the WOLF Stockholm study).

Settings: Workplaces in the Stockholm area, Sweden.

Participants: 2,755 men with no history of myocardial infarction at baseline screening in 1992-1995.

Main outcome measure: Hospitalisation due to myocardial infarction or death from ischemic heart disease until 2003 obtained from national registers (mean follow-up 9.8 ± 0.9 years).

Results: 47 participants had myocardial infarction or died from ischemic heart disease during the follow-up. After adjustment for age, socio-economic 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 no use this 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-end-point cardiovascular disease.