Psychosocial stress-induced heart rate reactivity and atherogenesis: cause or correlation?

The relationship between heart rate reactivity and atherogenesis is examined. Data from empirical studies are presented which support theoretical suggestions that it is the heart rate itself rather than the increase in heart rate following the onset of a stressor which is causally related to the development of arterial atherosclerosis. Several directions for research which will clarify this issue are discussed, with recent developments in the detection of atherosclerosis suggested as forming the basis of more reliable investigation of the effects of cardiac output variables upon arterial atherogenesis.