A period of prolonged emotional strain associated with occupational responsibilities preceded the attack in 91 of 100 patients with coronary heart disease. In a comparable series of 100 patients with other diseases, only 20 had undergone this kind of strain. The pattern of insecurity, frustration, and restlessness extended beyond the primary vocation into secondary occupations and leisure activities. Taking 91/20 or 4.6 as a ratio measuring the importance of occupational stress, the author obtains comparable ratios of 2.7 for diet, 2.0 for tobacco, 1.7 for heredity, 1.3 for obesity, and 1.0 for lack of physical exercise as suggesting the relative importance of these factors in causing coronary heart disease in this group of patients.
Russek HI. ROLE OF HEREDITY, DIET, AND EMOTIONAL STRESS IN CORONARY HEART DISEASE. JAMA. 1959;171(5):503–508. doi:10.1001/jama.1959.03010230001001
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