"Stress" and coronary heart disease: psychosocial risk factors

Stephen J Bunker, David M Colquhoun, Murray D Esler, Ian B Hickie, David Hunt, V Michael Jelinek, Brian F Oldenburg, Hedley G Peach, Denise Ruth, Christopher C Tennant and Andrew M Tonkin
Med J Aust 2003; 178 (6): 272-276.


  • An Expert Working Group of the National Heart Foundation of Australia undertook a review of systematic reviews of the evidence relating to major psychosocial risk factors to assess whether there are independent associations between any of the factors and the development and progression of coronary heart disease (CHD), or the occurrence of acute cardiac events.

  • The expert group concluded that (i) there is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of CHD; and (ii) there is no strong or consistent evidence for a causal association between chronic life events, work-related stressors (job control, demands and strain), Type A behaviour patterns, hostility, anxiety disorders or panic disorders and CHD.

  • The increased risk contributed by these psychosocial factors is of similar order to the more conventional CHD risk factors such as smoking, dyslipidaemia and hypertension.

  • The identified psychosocial risk factors should be taken into account during individual CHD risk assessment and management, and have implications for public health policy and research.

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  • Stephen J Bunker1
  • David M Colquhoun3
  • Murray D Esler4
  • Ian B Hickie5
  • David Hunt6
  • V Michael Jelinek7
  • Brian F Oldenburg8
  • Hedley G Peach9
  • Denise Ruth10
  • Christopher C Tennant11
  • Andrew M Tonkin2

  • 1 National Heart Foundation, West Melbourne, VIC.
  • 2 University of Queensland, Brisbane, QLD.
  • 3 Monash University, Melbourne, VIC.
  • 4 beyondblue: the national depression initiative, Melbourne, VIC.
  • 5 Royal Melbourne Hospital, Parkville, VIC.
  • 6 St Vincent's Hospital, Melbourne, VIC.
  • 7 School of Public Health, Queensland University of Technology, Kelvin Grove, QLD.
  • 8 Ballarat Health Services, Ballarat, VIC.
  • 9 University of Melbourne, Melbourne, VIC.
  • 10 University of Sydney, Sydney, NSW.



This project was supported by the National Heart Foundation of Australia and by a grant from beyondblue: the national depression initiative.

Competing interests:

None identified.

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