Stress factors in the development of coronary artery disease.

The epidemiologic evidence that stress contributes to cardiovascular disease is reviewed. No one characterization of stress has been associated with all manifestations of cardiovascular disease, yet specific characterizations have been associated with particular manifestations of disease. Type A behavior pattern is a risk factor for coronary artery disease (CAD) and is correlated with the severity and progression of atherosclerosis demonstrated angiographically. Work overload with job dissatisfaction also predisposes to CAD. Socioeconomic disadvantage in a society of urbanization and industrialization increases the risk of hypertension and CAD, while chronic states of anxiety, depression, and helplessness are associated with angina and sudden death. Traumatic life events, especially involving loss of or threat to self-esteem, may precipitate sudden death in patients with preexisting CAD. There is evidence that the mechanism linking the experience of stress and the development of acute coronary events is exposure to sympathetic hyperarousal and a deficit in soothing. Research is needed to determine if work environments can be designed to minimize hyperarousal and provide protective outlets for individuals experiencing such arousal.