Mental Stress During Daily Life Triggers Myocardial Ischemia

In this issue ofThe Journal, Gullette et al1report on the relationship between mental stress and myocardial ischemia among patients with documented coronary artery disease and recent evidence of exercise-induced myocardial ischemia. The risk of silent myocardial ischemia within 1 hour of experiencing negative emotions (tension, sadness, and frustration) was elevated between 2 and 3 times compared with periods when the subjects were not experiencing these emotions. Not surprisingly, episodes of heavy physical activity were associated with a much higher (13-fold) increase in risk of ischemia. Unlike prior studies that evaluated the relationship between laboratory-based mental stress tasks and myocardial ischemia,2-5this study used innovative methods to evaluate the relationship between reallife stressors and episodes of ischemia in free-living subjects. See also p 1521. Gullette et al1used a case-crossover design6,7to evaluate the change in risk of an episode of myocardial ischemia associated with