Behavior, stress, and psychosocial traits as risk factors.

Although psychosocial factors have long been associated with the pathogenesis of heart disease, the independent relation between these variables and coronary heart disease (CHD) is still controversial. However, when experimental, clinical pathological, and epidemiologic studies are taken together, strong evidence is provided that psychosocial and behavioral factors are important in the development and the provocation of clinical CHD manifestations. Heterogeneity in study results is partially due to methodological problems in defining and measuring behavior, stress, and psychosocial traits in population groups as well as in individuals. The difficulties in separating the role of psychosocial factors from the classic risk factors strengthen the importance and need for these factors to be considered in the design of further clinical and epidemiologic studies, not only to explore their independent predictive value but also to study their role in adherence to preventive advice and in the reversibility of risk. In these respects results are presented from a prospective epidemiologic and from a controlled multifactorial intervention study.