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July 4, 1980

Stress and the Major Cardiovascular Disorders

JAMA. 1980;244(1):84. doi:10.1001/jama.1980.03310010064042

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The increasing stress of life in the 20th century is well known to all of us, yet its relationship to cardiovascular disease is at best obscure. Dr Eliot begins with a survey of the causes of stress in the modern age and the physiologic changes it can induce. He proposes a 20th-century "invisible entrapment" syndrome, in which humans are unable to physically act out their fight (increased sympathetic tone) or flight (increased adrenocorticotropic hormone) responses to daily events. This situation often leads to chronic psychological tension and stress.

The book thoroughly reviews the inconclusive literature of the pathophysiologic mechanisms of acute myocardial infarction and sudden coronary death. It supports stressinduced, functional etiologies for both events with intriguing electron micrographs.

The book also supports the Page theory of essential hypertension, in which sporadic, stress-induced elevations of blood pressure eventually cause permanent renovascular changes, resulting in a fixed hypertension that may require