Research published ahead of print in the Journal of Epidemiology and Community Health reports that men who do not openly express their anger about unfair treatment at work double their risk of having a heart attack or dying from serious heart disease.

"Covert coping" is when an individual does not openly show to the perpetrator that s/he has been unfairly treated. Earlier research has indicated that secretly dealing with unfair treatment at work is associated with risk factors for cardiovascular disease.

Researchers in Sweden based their findings on workplaces in Stockholm participating in the Work, Lipids and Fibrinogen Stockholm (WOLF) study. It included 2,755 male employees who had not had a heart attack at initial screening between 1992 and 1995 when the study began.

Initially, the monitoring incorporated an evaluation of risk factors, such as high cholesterol/blood pressure and lifestyle, and coping responses to unfair treatment or conflict at work.

Questions to participants included whether they used avoidance tactics, such as walking away from the situation or letting things pass without saying anything, and with what frequency. They were also asked if they experienced any physical symptoms as a consequence, such as headache and whether they instead vented their anger at home.

Information on these men was gathered from national registers of hospital treatment and deaths. It included whether any of them subsequently had a heart attack or died as a result of coronary artery (ischemic) heart disease in the period up to 2003.

Up to 2003, 47 men had a heart attack or died from ischemic heart disease.

Physical symptoms and the venting of anger at home were not associated with increased risks.

Factors likely to influence the results were considered, including job strain and biological factors. Results indicated that men who persistently failed to openly express their anger were more than twice as likely to have a heart attack or die of serious heart disease as those who did show their anger.

In addition, those who occasionally or frequently walked away from conflict, rather than letting things pass without saying anything, had three times the risk of having a heart attack or dying from ischemic heart disease.

The authors say: "The evidence suggests that while coping mechanisms depend on individual preference, they are also dictated by the level of job control."
Individuals with little job control are more likely to repress their anger.

But this was accounted for in this study. This suggests that low job control did not explain the increased risk.

"Covert coping with unfair treatment at work and risk of incident myocardial infarction and cardiac death among men: prospective cohort study"
C Leineweber, H Westerlund, T Theorell, M Kivima¨ki, P Westerholm, L Alfredsson
doi:10.1136/jech.2009.088880
Journal of Epidemiology and Community Health

Stephanie Brunner (B.A.)