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Psychosocial factors in the aetiology of coronary heart disease
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  1. A STEPTOE
  1. Department of Psychology
  2. St George’s Hospital Medical School
  3. University of London, London SW17 0RE, UK

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    The role of psychosocial factors in the cause of coronary heart disease (CHD) has been investigated with increasing confidence over recent years, due to a number of developments. Large scale prospective studies of psychosocial factors assessed with standardised measures and using all the rigour of modern multivariate epidemiology have begun to produce results. These have been accompanied by greater sophistication in the identification of the physiological mechanisms through which emotions, behaviour, and the social environment influence disease processes. Distinctive factors may be associated with the long term progression of CHD and with the triggering of cardiac events in vulnerable individuals. Animal studies have also come of age, with older stress paradigms being replaced by observations on more relevant phenomena such as social isolation and social disruption.1This brief summary describes some of the main themes that are emerging in psychosocial research, and their relevance to current clinical practice.

    The work environment

    Psychosocial factors include both psychological characteristics such as personality, and life experiences such as acute traumatic events and long term stressors. Stressful working conditions are important in that they may induce sustained changes in neuroendocrine and autonomic activity, increasing atherogenesis. Several studies have shown that jobs characterised by high demands coupled with low control are particularly problematic, and are associated with an increased risk of CHD.2 Data from the Whitehall II study of British civil servants indicate that low job control predicts …

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