Ramachandruni Srikanth, Handberg Eileen, Sheps David S
Department of Medicine, University of Florida College of Medicine, Gainesville, Florida 32610-0277, USA.
Curr Opin Cardiol. 2004 Sep;19(5):494-9. doi: 10.1097/01.hco.0000132321.24004.25.
Coronary artery disease (CAD) is the leading cause of death in the United States and other developed countries. Along with a number of other factors thought to contribute to the high prevalence of CAD in developed societies (longer life expectancy, obesity, sedentary lifestyles), various psychological and social factors appear to promote the development or worsening of heart disease. It is well recognized that stress can be harmful to the cardiovascular system. The combination of the preexisting vulnerability and the major stressor are believed to result in cardiac arrhythmias and/or plaque rupture leading to death.
Recently, the epidemiologic evidence of a link between stress and CAD is very convincing, yet the biopsychosocial pathway that would explain how stress can lead to disease is less clear. Different types of psychological stress have been found to be associated with increased cardiovascular events. Evidence regarding the efficacy of psychosocial interventions is also presented.
It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing.
冠状动脉疾病（CAD）是美国及其他发达国家的主要死因。除了一些被认为导致发达国家CAD高患病率的其他因素（预期寿命延长、肥胖、久坐不动的生活方式）外，各种心理和社会因素似乎也会促进心脏病的发展或恶化。众所周知，压力对心血管系统有害。先前存在的易感性与主要应激源相结合被认为会导致心律失常和/或斑块破裂，进而导致死亡。
最近，压力与CAD之间存在关联的流行病学证据非常有说服力，但解释压力如何导致疾病的生物心理社会途径尚不清楚。已发现不同类型的心理压力与心血管事件增加有关。还介绍了有关心理社会干预效果的证据。
总体而言，心理和社会因素对CAD发病率和死亡率有影响的证据很有说服力。
