Emotional Stress and Cardiac Disease

BESIDES the well-recognized risk factors leading to atherosclerotic coronary artery disease, such as systemic hypertension, cigarette smoking, elevated serum cholesterol level, and diabetes mellitus, there lurks the amorphous and previously intangible risk factor of emotional stress. Three recent publications summarize the current state of the art regarding emotional stress as a risk factor.1-3It was the consensus of the First National Conference on Emotional Stress and Heart Disease that emotional stress be considered a risk factor equal to other recognized risk factors.1 What is emotional stress? There continues to be debate concerning an exact definition that is acceptable to all investigators. We continue to find useful the so-called fight-or-flight response of Cannon. Although man's response to emotional stress is complex, the majority of cardiovascular responses to emotional stress can be predicted, altered, prevented, and potentially treated by employing this basic concept. In contemporary industrialized society, one is frequently