To the Editor.
—The importance of identifying persons at increased risk for developing coronary artery disease is highlighted in the article on evaluating coronary heart disease (CHD) risk by Dr Hoeg.1 The author advocates that examination of an individual patient's risk factors is essential in planning effective treatment. Both nonmodifiable risk factors such as a family history of heart disease and potentially modifiable factors such as cigarette smoking and obesity were described as "established" CHD risk factors. In addition to conventional risk factors, a list of 17 particularly promising proposed CHD risk factors was presented. We were surprised to note that none of the listings or case conceptualizations included psychosocial risk factors that have been shown to play an important role in the progression of coronary artery disease.2 In particular, low levels of social support and economic resources3 and depression4 have been shown to be strongly
Stetson B, Schrodt GR. Expanding and Understanding Risk Factors for Coronary Heart Disease. JAMA. 1997;278(8):635-636. doi:10.1001/jama.1997.03550080045033