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Evidence and Clinical Implications

David S. Krantz, PhD; David S. Sheps, MD; Robert M. Carney, PhD; Benjamin H. Natelson, MD

JAMA. 2000;283:1800-1802.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

There is increasing recognition in the medical and scientific communities of the importance of behavioral and psychosocial factors in the prevention, development, and treatment of cardiovascular disorders.¹ The purpose of this article is to review the evidence and mechanisms for the effects of acute and chronic stress in individuals with preexisting coronary artery disease (CAD), and evidence for the efficacy of psychosocial interventions in patients with CAD.

Pathophysiologic Effects of Stress in CAD

The hemodynamic and neuroendocrine responses to stress are characterized by release of catecholamines and corticosteroids, concomitant increases in heart rate, cardiac output, and blood pressure,² and changes in processes relevant to hemostasis and thrombosis.³ In patients with atherosclerosis, these physiological changes may increase vulnerability to clinical events such as myocardial ischemia, coronary thrombosis, and myocardial infarction (MI).^3-4 Stress-induced autonomic nervous system activation might also predispose to clinical . . . [Full Text of this Article]

Acute Stress and Myocardial Ischemia and Infarction

Prognostic Significance of Mental Stress–Induced Ischemia

Chronic Stress and Psychological Traits in CAD

Behavioral Medicine Treatment Approaches for the Cardiac Patient

Summary and Conclusions

Author Affiliations: Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Krantz); Division of Cardiovascular Medicine, University of Florida, Gainesville (Dr Sheps); Department of Psychiatry, Washington University Medical Center, St Louis, Mo (Dr Carney); and the Department of Neurosciences, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark (Dr Natelson).

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