Effects of mental stress in patients with coronary artery disease: Evidence and clinical implications

Both chronic and acute psychosocial stress can be detrimental to the patient with CAD, and preliminary evidence indicates that mental stress testing for ischemia is a predictor of prognosis in these individuals. Moreover, the identification of depression and other psychosocial risk factors for coronary disease progression has led to promising behavioral and psychosocial interventions to aid in the treatment and prevention of coronary disease in high-risk individuals. These data provide a basis for the inclusion of psychosocial treatment components in preventive and cardiac rehabilitation efforts, and suggest that the time may be approaching when evaluation and treatment of psychological stress and depression will be an expected standard of treatment for the patient with CAD. However, additional research is needed to identify the role of mental stress testing in risk assessment in CAD, the most effective types of interventions for particular patients, and the cost-effectiveness of these interventions.