There is a definite association between “covert coping” in the face of unfair treatment in the workplace. Men who tend to walk away from conflict at work could be setting themselves up for a myocardial infarction and cardiac death.

In a prospective study of Swedish workers, those who used “covert coping” techniques when they felt they had been unfairly treated were more likely to have an MI or die of ischemic heart disease. Constanze Leineweber, PhD, of Stockholm University in Sweden, and colleagues in the Journal of Epidemiology and Community Health, expanded on research indicating that covert coping – or walking away from a conflict and dealing with the anger “indirectly and introvertly” – increases cardiovascular risk factors. They cautioned that the study didn’t pin down a causal relationship between covert coping and cardiovascular disease. Instead, they said, it raises “an interesting hypothesis, which needs to be confirmed or refuted by future studies.” The researchers analyzed data from a long-running prospective cohort study in Stockholm, the Work, Lipids, and Fibrinogen study, dubbed WOLF for short.

Covert coping was measured by questionnaire, in which the participant was asked about how he or she dealt with unfair treatment from either a boss or a fellow worker. The questionnaire did not measure whether or not the participant experienced unfair treatment at work nor how often covert coping mechanisms were used.

The participants were asked whether they sometimes, often, seldom, or never:

Let things pass without saying anything
Walk away
Feel bad — developing a headache, for instance
Get into a bad temper at home

The results yielded a covert coping score that could range from 8 to 32; the researchers stratified covert coping as low if the score was 8 through 14, medium if it was 15 through 18, and high if it was 19 or more.

They also categorized immediate responses – to the first two options – as low, medium, or high.

Compared with those who had low covert coping scores, the researchers found:

When the unfair treatment came from a boss, those who sometimes or often walked away were three times as likely to have an MI or ischemic death. (The hazard ratio was 3.05, with a 95% confidence interval from 1.23 to 7.58.).

Letting things pass showed a nonsignificant trend to more cardiovascular outcomes for those who did so more often. When the unfair treatment came from a co-worker, the pattern was similar, except that those who said they seldom walked away also had a significant risk for cardiovascular outcomes. The hazard ratio for those who seldom walked away was 4.08, compared with 4.45 for those who said they did so sometimes or often. Both ratios were statistically significant. Neither of the delayed reactions had any association with cardiovascular outcomes – feeling bad or becoming ill-tempered at home – either for unfair treatment from a boss or a co-worker.

Future research, Leineweber and colleagues said, should look at “whether interventions designed to reduce covert coping would alter risk of myocardial infarction and cardiac death.”