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To the Editor: In their observational study, Dr Orth-Gomér and colleagues¹ reported an association between psychosocial adversity and poorer cardiovascular health. They found that among women with a history of coronary heart disease (CHD), the chances of a recurrent coronary event (cardiac death, recurrent symptoms, or a revascularization procedure) were 3 times higher in those who reported severe marital stress. If this relationship is causal, then it may be mediated through the psychoneuroendocrine mechanisms that the authors invoke and may even suggest that "specific preventive measures be tailored to the needs of women with CHD." The health policy implications of this latter conclusion are substantial. It is therefore important to consider alternative explanations for these intriguing findings.

First, it is well recognized that reporting bias (resulting from a tendency to overreport both marital stress and cardiac symptoms) can result in problems of interpretation of this relationship.² It would be interesting . . . [Full Text of this Article]

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