Mental stress during daily life triggers myocardial ischemia.

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Abstract
In this issue ofThe Journal, Gullette et al1report on the relationship between mental stress and myocardial ischemia among patients with documented coronary artery disease and recent evidence of exercise-induced myocardial ischemia. The risk of silent myocardial ischemia within 1 hour of experiencing negative emotions (tension, sadness, and frustration) was elevated between 2 and 3 times compared with periods when the subjects were not experiencing these emotions. Not surprisingly, episodes of heavy physical activity were associated with a much higher (13-fold) increase in risk of ischemia. Unlike prior studies that evaluated the relationship between laboratory-based mental stress tasks and myocardial ischemia,2-5this study used innovative methods to evaluate the relationship between reallife stressors and episodes of ischemia in free-living subjects. See also p 1521. Gullette et al1used a case-crossover design6,7to evaluate the change in risk of an episode of myocardial ischemia associated with