To assess the causal relation between acute mental stress and myocardial ischemia, we evaluated cardiac function in selected patients during a series of mental tasks (arithmetic, the Stroop color–word task, simulated public speaking, and reading) and compared the responses with those induced by exercise. Thirty-nine patients with coronary artery disease and 12 controls were studied by radionuclide ventriculography.

▪ Abstract An extensive research literature in the behavioral sciences and medicine suggests that psychological and social factors may play a direct role in organic coronary artery disease (CAD) pathology. However, many in the medical and scientific community regard this evidence with skepticism. This chapter critically examines research on the impact of psychological and psychosocial factors on the development and outcome of coronary heart disease, with particular emphasis on studies employing verifiable outcomes of CAD morbidity or mortality. Five key variables identified as possible psychosocial risk factors for CAD are addressed: acute and chronic stress, hostility, depression, social support, and socioeconomic status. Evidence regarding the efficacy of psychosocial interventions is also presented. It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing. However, continued progress in this area requires multidisciplinary research integrating expertise in cardiology and the behavioral sciences, and more effective efforts to communicate research findings to a biomedical audience.

Mental stress can cause angina in patients with coronary artery disease, but Its effects on coronary vasomotion and blood flow are poorly understood. Because atherosclerosis affects the reactivity of coronary arteries to various stimuli, such as exercise, we postulated that atherosclerosis might also influence the vasomotor response of coronary arteries to mental stress.

It has been assumed that it is beneficial for patients to become active and informed participants in health care. Previous research, however, suggests that individuals differ in their receptiveness to information and self-care in treatment stiuations. This article reports the development and validation of the Krantz Health Opinion Survey, a measure of preferences for different treatment approaches. This measure yields a total score and two relatively independent subscales that measure, respectively, preferences for information and for behavioral involvement (i.e., self-care and active participation) in medical care. Three related studies demonstrated the ability of the subscales or total score to predict with some specificity (a) criterion group membership (clinic users and enrollees in a self-care course), (b) reported use of clinic facilities, and (c) overt behavior (e.g., inquisitiveness, self-diagnosis) in a medical setting. Discriminant validity of the instrument is also established. Theoretical implications of the preference constructs are described in terms of the concept of personal control, and practical implications of the measure are presented.