Psychosocial Influences on Mortality of Patients With Coronary Heart Disease

Two reports in the current issue ofThe JOURNALbring to its readers fresh evidence of the considerable impact of social and economic factors on the course of coronary heart disease. In the study by Williams et al, 1a group of patients with chest pain and angiographically determined coronary disease showed decreased survival if they had an income of 40 000 or less and were unmarried without a confidant. In the study by Case et al, 2a group of patients surviving myocardial infarction after discharge from the coronary care unit showed increased risk for nonfatal myocardial infarction or cardiac death when they had had less than 12 years of schooling or were living alone. The findings in both studies were independent of a number of clinically important variables including level of ventricular function as determined by ejection fraction. See also pp 515 and 520. Numerous studies in general