Stress, smoking, and the cardiovascular system.

Smoking is the most important preventable risk factor for coronary heart disease. Reactivity to psychological stressors is also believed to be cardiopathologic. More recently, evidence has been accumulating that these putative risk factors in combination may be particularly harmful, both because smoking increases in stressful situations and because the cardiovascular effects of smoking combined with those of psychological stress may be greater than those of either alone. This paper reviews the literature on the cardiovascular effects of smoking and psychological stress in the light of epidemiological data and discusses mechanisms by which they may contribute to coronary heart disease.