MENTAL STRESS AND MYOCARDIAL-ISCHEMIA - CORRELATES AND POTENTIAL INTERVENTIONS

In past years, indirect evidence has suggested a link between mental s tress 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 reac tivity are positively associated with this ischemia, suggesting that r ecognition of these factors may help identify patient subgroups at hig hest risk. Preliminary studies evaluating pharmacologic intervention s uggest that traditional anti-ischemia therapy, such as beta-blockers a nd vasodilators, can reduce mental-stress-triggered ischemia in corona ry artery disease patients. Behavioral and psychosocial interventions, such as reducing environmental stress through social support, alterin g stress perception through behavioral training, and altering the phys iologic reaction to stress through physical training, also show promis e as therapeutic options. Further work is needed in this fertile biobe havioral area.