Acute and chronic psychological stress in coronary disease.
OBJECTIVE
Coronary artery disease (CAD) is the leading cause of death in the United States and other developed countries. Along with a number of other factors thought to contribute to the high prevalence of CAD in developed societies (longer life expectancy, obesity, sedentary lifestyles), various psychological and social factors appear to promote the development or worsening of heart disease. It is well recognized that stress can be harmful to the cardiovascular system. The combination of the preexisting vulnerability and the major stressor are believed to result in cardiac arrhythmias and/or plaque rupture leading to death.


RESULTS
Recently, the epidemiologic evidence of a link between stress and CAD is very convincing, yet the biopsychosocial pathway that would explain how stress can lead to disease is less clear. Different types of psychological stress have been found to be associated with increased cardiovascular events. Evidence regarding the efficacy of psychosocial interventions is also presented.


CONCLUSIONS
It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing.
Ramachandruni
Srikanth
S
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0277, USA.
Handberg
Eileen
E
Sheps
David S
DS
D000208:Acute Disease / Q000523:psychology; D000223:Adaptation, Psychological; D002908:Chronic Disease / Q000523:psychology; D003324:Coronary Artery Disease / Q000209:etiology / Q000523:psychology*; D006801:Humans; D012962:Sociology, Medical; D013315:Stress, Psychological / Q000150:complications*