Mental stress and myocardial ischemia. Correlates and potential interventions.

In past years, indirect evidence has suggested a link between mental stress and coronary artery disease. Recent research in coronary artery disease patients has confirmed the observation that mental stress is a potent trigger of myocardial ischemia in both the laboratory and the field. The pathophysiologic effects of mental stress appear to operate via alterations in both myocardial oxygen demand and supply. Intense negative emotion, such as hostility, and heightened cardiovascular reactivity are positively associated with this ischemia, suggesting that recognition of these factors may help identify patient subgroups at highest risk. Preliminary studies evaluating pharmacologic intervention suggest that traditional anti-ischemia therapy, such as beta-blockers and vasodilators, can reduce mental-stress-triggered ischemia in coronary artery disease patients. Behavioral and psychosocial interventions, such as reducing environmental stress through social support, altering stress perception through behavioral training, and altering the physiologic reaction to stress through physical training, also show promise as therapeutic options. Further work is needed in this fertile biobehavioral area.