Psychosocial factors influencing development and course of coronary heart disease

Background: An important role of psychosocial factors in influencing the development and course of coronary heart disease is increasingly recognized. This article summarizes current evidence with regard to five particularly well established psychosocial constructs. Psychosocial Constructs: These are 1. hostility/overcommitment, 2. depression, vital exhaustion, 3. social support, and a stressful psychosocial work environment, 4. in terms of the demand-control model and 5. in terms of the effort-reward imbalance model. Results of Studies: Selected empirical results from epidemiologic, clinical and experimental studies are described which indicate that the relative risk associated with each one of these factors is of a comparable magnitude for the estimation of future coronary heart disease as established behavioral risk factors such as cigarette smoking or physical exercise. Conclusions: Suggestions concerning a common stress-physiological mechanism underlying chronic socio-emotional stress, as identified by the five constructs, are given. In its final part, the paper briefly discusses practical implications of this new information for the cardiologist's patient-centered work and, most importantly, for improved measures of primary and secondary prevention.