Dr Lutz's assertion that emotional stress has been overlooked as a major cardiovascular risk factor is not entirely correct. The possibility has been extensively researched during the past two decades.1 For some psychosocial factors, the evidence has been highly suggestive; for others, the evidence is weak or inconsistent. Most sociological concepts have proved rather complex with respect to purported associations with coronary heart disease, including social mobility, status incongruity, occupation, education, marital status, and religious affiliation. Anxiety, depression, irritability, and sleeplessness, which may be taken as signs of emotional drain, have shown some relationship to coronary disease. The major obstacle to research in this area is the vagueness of the entity "emotional stress," defying precise definition and measurement.Symptoms and behavior characterized as "anxiety and neuroticism" have been reported to be related to coronary disease.1 Also, social support systems seem to protect against health hazards associated
Kannel WB. Tranquilizers and Decline in Cardiovascular Mortality-Reply. JAMA. 1982;248(3):306. doi:10.1001/jama.1982.03330030020005
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