In this issue of The Journal, Gullette et al1 report on the relationship between mental stress and myocardial ischemia among patients with documented coronary artery disease and recent evidence of exercise-induced myocardial ischemia. The risk of silent myocardial ischemia within 1 hour of experiencing negative emotions (tension, sadness, and frustration) was elevated between 2 and 3 times compared with periods when the subjects were not experiencing these emotions. Not surprisingly, episodes of heavy physical activity were associated with a much higher (13-fold) increase in risk of ischemia. Unlike prior studies that evaluated the relationship between laboratory-based mental stress tasks and myocardial ischemia,2-5 this study used innovative methods to evaluate the relationship between reallife stressors and episodes of ischemia in free-living subjects.
See also p 1521.
Gullette et al1 used a case-crossover design6,7 to evaluate the change in risk of an episode of myocardial ischemia associated with
Mittleman MA, Maclure M. Mental Stress During Daily Life Triggers Myocardial Ischemia. JAMA. 1997;277(19):1558–1559. doi:10.1001/jama.1997.03540430070036
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