STRESS AND ATHEROSCLEROSIS

Until recently, there has been little evidence substantiating the beli ef that mental stress provokes myocardial infarction and stroke, and a ggravates atherosclerosis. However, recent advances in methodology for demonstrating effects of stress are now beginning to build a foundati on of evidence that supports those beliefs. In monkeys, social stress doubles coronary atherosclerosis, and increases coronary spasm, and tr eatment with oestrogen, which improves endothelial function, reduces c oronary spasm in relation to stress. In human beings, mental stress pr ovokes myocardial ischaemia, and haemodynamic responses to mental stre ss predict progression of left ventricular enlargement, and progressio n of carotid atherosclerosis. These findings suggest that it may not b e safe to withhold treatment of high office pressures in patients with white coat hypertension. There is now some evidence that stress manag ement in the form of individualized cognitive behavioural intervention s reduces blood pressure. Further work is needed to determine whether it is safe to withhold treatment in white-coat syndrome, and whether s tress management can reduce atherosclerosis and ischaemic events.