Biobehavioral mechanisms in coronary artery disease. Acute stress.

THIS REPORT is concerned with the implications of acute stress-induced levels of physiologic reactivity of coronary heart disease. Both laboratory-based challenges such as the cold-pressor test, cognitive work, and competitive tasks, and naturalistic stressors such as public speaking, hostile social interaction, and transient work demands are examples of acute stressors that have been linked to physiologic reactivity. Moreover, research has established that levels of physiologic reactivity in response to such challenges appear to be stable at test-retest, thus qualifying as a legitimate individual difference variable. The present report considers the possible pathophysiologic reactivity and other attributes that have been associated with it such as psychological, demographic, and population variables. Similarly, different types of physical and psychological challenges or stressors were examined to determine their effects on different pattems and levels of physiologic reactivity. Also, the interactions of acute stress and various substances such as caffeine, nicotine, and salt intake were examined to determine if the effects on physiologic reactivity were different from those that stress alone or substances ingested alone would engender. Finally, modulators of such reactivity were considered, including the effects of exercise, relaxation therapies, pharmacologic agents, and alcohol. Reactivity and coronary heart disease. A prospective relationship between the challenge-induced physiologic response and incidence of coronary heart disease was suggested by Keys et al.' who showed that the response of diastolic blood pressure to the cold-pressor test was predictive of future clinical manifestations of this disease during the course of a 23 year follow-up study. Recently Perloff et al.2 showed that ambulatory blood pressure responses were better predictors of future morbidity than clinic determinations. Other ambulatory monitoring studies have found similar results in retrospective studies.3'4 Several case-control studies have reported that exaggerated cardiovascular reactions to behavioral challenges characterized coronary