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Managerial leadership and ischaemic heart disease among employees: the Swedish WOLF study
  1. A Nyberg1,2,
  2. L Alfredsson3,4,
  3. T Theorell2,
  4. H Westerlund2,
  5. J Vahtera5,
  6. M Kivimäki6
  1. 1
    Department of Public Health Sciences, Karolinska Institute, SE–171 77 Stockholm, Sweden
  2. 2
    Stress Research Institute, Stockholm University, Stockholm, Sweden
  3. 3
    Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
  4. 4
    Stockholm Center of Public Health, Karolinska University Hospital, Stockholm, Sweden
  5. 5
    Finnish Institute of Occupational Health, Helsinki, Finland
  6. 6
    Department of Epidemiology and Public Health, University College London, London, UK
  1. Anna Nyberg, Stress Research Institute, Stockholm University, SE – 106 91 Stockholm, Sweden; anna.nyberg{at}


Objective: To investigate the association between managerial leadership and ischaemic heart disease (IHD) among employees.

Methods: Data on 3122 Swedish male employees were drawn from a prospective cohort study (WOLF). Baseline screening was carried out in 1992–1995. Managerial leadership behaviours (consideration for individual employees, provision of clarity in goals and role expectations, supplying information and feedback, ability to carry out changes at work successfully, and promotion of employee participation and control) were rated by subordinates. Records of employee hospital admissions with a diagnosis of acute myocardial infarction or unstable angina and deaths from IHD or cardiac arrest to the end of 2003 were used to ascertain IHD. Cox proportional-hazards analyses were used to calculate hazard ratios for incident IHD per 1 standard deviation increase in standardised leadership score.

Results: 74 incident IHD events occurred during the mean follow-up period of 9.7 years. Higher leadership score was associated with lower IHD risk. The inverse association was stronger the longer the participant had worked in the same workplace (age-adjusted hazard ratio 0.76 (95% CI 0.61 to 0.96) for employment for 1 year, 0.77 (0.61 to 0.97) for 2 years, 0.69 (0.54 to 0.88) for 3 years, and 0.61 (0.47 to 0.80) for 4 years); this association was robust to adjustments for education, social class, income, supervisory status, perceived physical load at work, smoking, physical exercise, BMI, blood pressure, lipids, fibrinogen and diabetes. The dose–response association between perceived leadership behaviours and IHD was also evident in subsidiary analyses with only acute myocardial infarction and cardiac death as the outcome.

Conclusion: If the observed associations were causal then workplace interventions should focus on concrete managerial behaviours in order to prevent IHD in employees.

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  • Funding: AN, TT and HW are financed by a research program grant from the Swedish Council for Working Life and Social Research (FAS, grant no. 2004-2021). MK is supported by the Academy of Finland (projects 117614, 124322 and 124271) and the Finnish Environment Fund. The WOLF study was originally established by the Swedish Council for Working Life and Social Research (FAS grant no. 2001-0163). The study sponsors have not been involved in the research process.

  • Competing interests: None.

  • Ethics approval: The Regional Research Ethics Board in Stockholm, and the ethics committee at Karolinska Institutet, Stockholm, Sweden approved the study (nos. 2006/158-31, 2008/240-32, 92-198 and 03-125).

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