rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2007-3-3-60-67rpcardio-460Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯSTRESS: WHAT WE ACTUALLY KNOW ABOUT THIS RISK FACTOR?СТРЕСС: ЧТО МЫ ЗНАЕМ СЕГОДНЯ ОБ ЭТОМ ФАКТОРЕ РИСКА?ОгановР. Г.OganovR. G.ПогосоваГ. В.PogosovaG. V.Государственный научно-исследовательский центр профилактической медицины Росздрава, МоскваРоссияState Research center of preventive medicine of Roszdrav, MoscowRussian Federation200702012016336067Copyright © Oganov R.G., Pogosova G.V., 20152015Оганов Р.Г., Погосова Г.В.Oganov R.G., Pogosova G.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/460

Results of current studies devoted to relationship between stress and cardiovascular morbidity and mortality were analyzed. The types of stressful reactions are presented: acute and chronic stress as well as models of working stress. Pathophysiological modes of interactions of stress and cardiovascular diseases are presented. Effective methods of stress correction are described. Clinical and prognostic importance of therapy approaches is discussed.

Проанализированы результаты большого числа исследований последних лет, посвященных взаимосвязи стресса с заболеваемостью и смертностью от сердечно-сосудистых заболеваний. Представлены разновидности стрессовых реакций: острый стресс, хронический стресс, а также модели рабочего стресса. Рассмотрены патофизиологические механизмы взаимосвязи стресса с кардиоваскулярной заболеваемостью и смертностью. Приведены наиболее действенные на сегодняшний день методы коррекции повышенного уровня стресса. Обсуждаются их клиническая и прогностическая значимость при лечении ишемической болезни сердца.

стресссердечно-сосудистая заболеваемостьсердечно-сосудистая смертностьstresscardiovascular morbiditycardiovascular mortalityReferencesRahe R.H., Romo M., Benett L., et al. Recent life changes, myocardial infarction and abrupt coronary death. Studies in Helsinki. Arch Intern Med 1974;133:221-8.Rahe R.H., Romo M., Benett L., et al. Recent life changes, myocardial infarction and abrupt coronary death. Studies in Helsinki. Arch Intern Med 1974;133:221-8.Pares C.M., Benjamin B., Fitzgerald R. Broken heart: statistical study of increased mortality among widowers. Brit Med J 1969;1:740-3.Pares C.M., Benjamin B., Fitzgerald R. Broken heart: statistical study of increased mortality among widowers. Brit Med J 1969;1:740-3.Steptoe A. Psychological factors in cardiovascular disorders. London; New York: Academic Press; 1981.Steptoe A. Psychological factors in cardiovascular disorders. London; New York: Academic Press; 1981.Соколов Е.И., Белова Е.В. Эмоции и патология сердца. М.: Медицина, 1983.Соколов Е.И., Белова Е.В. Эмоции и патология сердца. М.: Медицина, 1983.Соломянский В. М., Бурмистров С.А. О роли психической травмы в этиологии гипертонической болезни. Клин мед 1957;35(1):38–40.Соломянский В. М., Бурмистров С.А. О роли психической травмы в этиологии гипертонической болезни. Клин мед 1957;35(1):38–40.Гребенюк Н.И., Козлова З.П., Чернышева А.В. К этиологии и патогенезу гипертонических состояний. Клин мед 1955;33(9):65-7.Гребенюк Н.И., Козлова З.П., Чернышева А.В. К этиологии и патогенезу гипертонических состояний. Клин мед 1955;33(9):65-7.Jenkins C.D., Hurst M.W., Rose R.M., et al. Biomedical and psychosocial predictors of hypertension in air traffic controllers. In: Stress and Anxiety (vol. 9). New York: Hemisphere; 1981.Jenkins C.D., Hurst M.W., Rose R.M., et al. Biomedical and psychosocial predictors of hypertension in air traffic controllers. In: Stress and Anxiety (vol. 9). New York: Hemisphere; 1981.Kagan A.R., Levi L. Health and environment. Psychosocial stimuli. A review. Soc Sci Med 1974;8(5):225-41.Kagan A.R., Levi L. Health and environment. Psychosocial stimuli. A review. Soc Sci Med 1974;8(5):225-41.Kalimo R. Stress in work. Conceptual analysis and study of prison personnel. Scand J Work Environ Health 1980;6 Suppl 3:1–124.Kalimo R. Stress in work. Conceptual analysis and study of prison personnel. Scand J Work Environ Health 1980;6 Suppl 3:1–124.Russek H.I., Russek L.G. Is emotional stress an etiologic factor in coronary heart disease? Psychosomatics 1976;17:63-7.Russek H.I., Russek L.G. Is emotional stress an etiologic factor in coronary heart disease? Psychosomatics 1976;17:63-7.Harburg E., Schull W.Y., Erfurt J.C., Schork M.A. A family set method for estimating heredity and stress. A pilot survey of blood pressure among Negroes in high and low stress areas. Detroit, 1966 – 1967. J Chronic Dis 1970;23:69-81.Harburg E., Schull W.Y., Erfurt J.C., Schork M.A. A family set method for estimating heredity and stress. A pilot survey of blood pressure among Negroes in high and low stress areas. Detroit, 1966 – 1967. J Chronic Dis 1970;23:69-81.Rissanen V., Romo M., Siltanen P. Premonitory symptoms and stress factors pre￾ceding sudden death from ischaemic heart disease. Acta Med Scand 1978;204:389-96.Rissanen V., Romo M., Siltanen P. Premonitory symptoms and stress factors pre￾ceding sudden death from ischaemic heart disease. Acta Med Scand 1978;204:389-96.Lazarus R., Folkman S. Stress, appraisal, and coping. Springer, 1984.Lazarus R., Folkman S. Stress, appraisal, and coping. Springer, 1984.Ford D.E., Mead L.A., Chang P.P., et al. Depression is a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med 1998;158:1422-6.Ford D.E., Mead L.A., Chang P.P., et al. Depression is a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med 1998;158:1422-6.Pratt L.A., Ford D.E., Crum R.M., et al. Depression, psychotropic medication, and risk of myocardial infarction: prospective data from Baltimore ECA follow-up. Circulation 1996;94:3123-9.Pratt L.A., Ford D.E., Crum R.M., et al. Depression, psychotropic medication, and risk of myocardial infarction: prospective data from Baltimore ECA follow-up. Circulation 1996;94:3123-9.Anda R., Williamson D., Jones D., et al. Depressed affect, hopelessness, and risk of ischemic heart disease in a cohort of US adults. Epidemiology 1993;4:285-294.Anda R., Williamson D., Jones D., et al. Depressed affect, hopelessness, and risk of ischemic heart disease in a cohort of US adults. Epidemiology 1993;4:285-294.Kubansky L., Kawachi I., Weiss S.T., et al. Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Am Bеhav Med 1998;20:47-58.Kubansky L., Kawachi I., Weiss S.T., et al. Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Am Bеhav Med 1998;20:47-58.Jonas B.S., Franks P., Ingram D.D. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med 1997;6:43-9.Jonas B.S., Franks P., Ingram D.D. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med 1997;6:43-9.Погосова Г.В. Депрессия – новый фактор риска ишемической болезни сердца и предиктор коронарной смерти. Кардиология 2002;42(4):86-90.Погосова Г.В. Депрессия – новый фактор риска ишемической болезни сердца и предиктор коронарной смерти. Кардиология 2002;42(4):86-90.Rozanski A., Blumenthal J.A., Kaplan J. Impact of psychological factors on the patho￾genesis of cardiovascular disease and implications for therapy. Circulation 1999; 99:2192-217.Rozanski A., Blumenthal J.A., Kaplan J. Impact of psychological factors on the patho￾genesis of cardiovascular disease and implications for therapy. Circulation 1999; 99:2192-217.Frasure-Smith N., Lesperance F., Talajic M. The impact of negative emotins on prognosis after myocardial infarction: is it more than depression? Health Psychol 1995;14:388-98.Frasure-Smith N., Lesperance F., Talajic M. The impact of negative emotins on prognosis after myocardial infarction: is it more than depression? Health Psychol 1995;14:388-98.Penninx B.W., Beekman A.T., Honig A., et al. Depression and cardiac mortality. Arch Gen Psychiatry 2001;58:221-7.Penninx B.W., Beekman A.T., Honig A., et al. Depression and cardiac mortality. Arch Gen Psychiatry 2001;58:221-7.Larson S.L., Owens P.L., Ford D., Eaton W. Depressive disorder, dysthymia, and risk of stroke. Thirteen-year follow-up from the Baltimore epidemiologic catchment area study. Stroke 2001;32(9):1979-83.Larson S.L., Owens P.L., Ford D., Eaton W. Depressive disorder, dysthymia, and risk of stroke. Thirteen-year follow-up from the Baltimore epidemiologic catchment area study. Stroke 2001;32(9):1979-83.Denollet J., Sys S.U., Stroobant N., et al. Personality as independent predictor of longterm mortality in patients with coronary heart disease. Lancet 1996;347:417-21.Denollet J., Sys S.U., Stroobant N., et al. Personality as independent predictor of longterm mortality in patients with coronary heart disease. Lancet 1996;347:417-21.Bush D.E., Ziegelstein R.C., Tayback M., et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 2001;88:337-41.Bush D.E., Ziegelstein R.C., Tayback M., et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 2001;88:337-41.Yusuf S., Hawken S., Ounpu S., et al., on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-control study. Lancet. 2004;364:937-52.Yusuf S., Hawken S., Ounpu S., et al., on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART Study): case-control study. Lancet. 2004;364:937-52.Чазов Е.И. Ишемическая болезнь сердца и возможности повышения эффективности ее лечения. Клинические исследования лекарственных средств в России 2001;(1):2-4.Чазов Е.И. Ишемическая болезнь сердца и возможности повышения эффективности ее лечения. Клинические исследования лекарственных средств в России 2001;(1):2-4.Копина О.С., Суслова С.Ф., Заикин Е.Р. Популяционные исследования психосоциального стресса как фактора риска сердечно-сосудистых заболеваний. Кардиология 1996;36(3):53-6.Копина О.С., Суслова С.Ф., Заикин Е.Р. Популяционные исследования психосоциального стресса как фактора риска сердечно-сосудистых заболеваний. Кардиология 1996;36(3):53-6.Оганов Р.Г., Масленникова Г.Я., Шальнова С.А., и др. Значение сердечно-сосудистых и других неинфекционных заболеваний для здоровья населения России. Профилакт забол укрепл здор 2002;(2):3-7.Оганов Р.Г., Масленникова Г.Я., Шальнова С.А., и др. Значение сердечно-сосудистых и других неинфекционных заболеваний для здоровья населения России. Профилакт забол укрепл здор 2002;(2):3-7.Silver R.C., Holman E.A., McIntosh D.N., et al. Nationwide Longitudinal Study of Psychological Responses to September 11. JAMA 2002;288:1235-44.Silver R.C., Holman E.A., McIntosh D.N., et al. Nationwide Longitudinal Study of Psychological Responses to September 11. JAMA 2002;288:1235-44.Leor J., Poole W.K., Kloner R.A. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996;334:413-9.Leor J., Poole W.K., Kloner R.A. Sudden cardiac death triggered by an earthquake. N Engl J Med 1996;334:413-9.Meisel S.R., Kutz I., Dayan K.I., et al. Effects of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 1991;338:660-1.Meisel S.R., Kutz I., Dayan K.I., et al. Effects of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 1991;338:660-1.Kaprio J., Koskenvuo M., Rita H. Mortality after bereavement: a prospective study of 95647 persons. Am J Public Health 1987;77:283-7.Kaprio J., Koskenvuo M., Rita H. Mortality after bereavement: a prospective study of 95647 persons. Am J Public Health 1987;77:283-7.Nielsen KM, Faergeman O, Larsen ML, Foldspang A. Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons. J Epidemiol Community Health. 2006;60(8):721-8.Nielsen KM, Faergeman O, Larsen ML, Foldspang A. Danish singles have a twofold risk of acute coronary syndrome: data from a cohort of 138 290 persons. J Epidemiol Community Health. 2006;60(8):721-8.Li J., Hansen D., Mortensen P.B., et al. Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark. Circulation 2002;106:1634-9.Li J., Hansen D., Mortensen P.B., et al. Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark. Circulation 2002;106:1634-9.Witte D.R., Bots M.L., Hoes A.W., et al. Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study. BMJ 2000;321:1552-4.Witte D.R., Bots M.L., Hoes A.W., et al. Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study. BMJ 2000;321:1552-4.Carroll D., Ebrahim S., Tilling K., et al. Admissions for myocardial infarction and World Cup football: database survey. BMJ 2002;325:1439-42.Carroll D., Ebrahim S., Tilling K., et al. Admissions for myocardial infarction and World Cup football: database survey. BMJ 2002;325:1439-42.Kobau R., Safran M.A., Zack M.M., et al. Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995–2000. Health Qual Life Outcomes 2004; 2: 40.Kobau R., Safran M.A., Zack M.M., et al. Sad, blue, or depressed days, health behaviors and health-related quality of life, Behavioral Risk Factor Surveillance System, 1995–2000. Health Qual Life Outcomes 2004; 2: 40.Rahe R.H., Romo M., Bennett L., Siltanen P. Recent life changes, myocardial infarction, and abrupt coronary death. Arch Intern Med 1974;133:221-8.Rahe R.H., Romo M., Bennett L., Siltanen P. Recent life changes, myocardial infarction, and abrupt coronary death. Arch Intern Med 1974;133:221-8.Rasul F., Stansfeld S.A., Hart C.L., et al. Psychological distress, physical illness, and risk of coronary heart disease. J Epidemiol Community Health 2005;59:140 -5.Rasul F., Stansfeld S.A., Hart C.L., et al. Psychological distress, physical illness, and risk of coronary heart disease. J Epidemiol Community Health 2005;59:140 -5.Stansfeld S.A., Fuhrer R., Shipley M., Marmot M.G. Psychological distress as a risk factor for coronary heart disease in the Whitehall II study. Int J Epidemiol 2002;31:248-55.Stansfeld S.A., Fuhrer R., Shipley M., Marmot M.G. Psychological distress as a risk factor for coronary heart disease in the Whitehall II study. Int J Epidemiol 2002;31:248-55.Blom M., Georgiades A., Janszky I., Anhve S. Economical distress is an independent predictor of recurrent events among women with coronary artery disease. ESC Congress 2004, 28 Aug–1 Sept, Munich, Germany. Abstract: 3816. Available from URL: http://cic.escardio.org/AbstractDetails.aspx?id= 15282&eevtid=6Blom M., Georgiades A., Janszky I., Anhve S. Economical distress is an independent predictor of recurrent events among women with coronary artery disease. ESC Congress 2004, 28 Aug–1 Sept, Munich, Germany. Abstract: 3816. Available from URL: http://cic.escardio.org/AbstractDetails.aspx?id= 15282&eevtid=6Ruberman W., Weinblatt E., Goldberg J.D., Chaudhary B.S. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1984;311:552-9.Ruberman W., Weinblatt E., Goldberg J.D., Chaudhary B.S. Psychosocial influences on mortality after myocardial infarction. N Engl J Med 1984;311:552-9.Phillips D.P., Liu G.C., Kwok K., et al. The hound of the Baskervilles effect natural experiment on the influence of psychological stress on timing of death. BMJ 2001;323:1443-6.Phillips D.P., Liu G.C., Kwok K., et al. The hound of the Baskervilles effect natural experiment on the influence of psychological stress on timing of death. BMJ 2001;323:1443-6.Smith G. Scared to death? BMJ 2002;325:1442-3.Smith G. Scared to death? BMJ 2002;325:1442-3.Ostry A.S., Kelly S., Demers P.A., et al. A comparison between the effort-reward imbalance and demand control models. BMC Public Health 2003;3:10.Ostry A.S., Kelly S., Demers P.A., et al. A comparison between the effort-reward imbalance and demand control models. BMC Public Health 2003;3:10.Cheng Y., Kawachi I., Coakley E.H., et al. Association between psychosocial work characteristics and health functioning in American women: prospective study. BMJ 2000;320:1432-6.Cheng Y., Kawachi I., Coakley E.H., et al. Association between psychosocial work characteristics and health functioning in American women: prospective study. BMJ 2000;320:1432-6.Kivimaki M., Leino-Arjas P., Luukkonen R., et al. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002;325:857.Kivimaki M., Leino-Arjas P., Luukkonen R., et al. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002;325:857.Lynch J., Krause N., Kaplan G.A., et al. Work place demands, economic reward, and progression of carotid atherosclerosis. Circulation 1997;96:302-7.Lynch J., Krause N., Kaplan G.A., et al. Work place demands, economic reward, and progression of carotid atherosclerosis. Circulation 1997;96:302-7.Netterstrem B., Kristensen T.S., Sjol A. Psychological job demands increase the risk of ischemic heart disease: a 14-year cohort study of employed Danish men. Eur J Cardiovasc Prev Rehabil 2006;13:414-20.Netterstrem B., Kristensen T.S., Sjol A. Psychological job demands increase the risk of ischemic heart disease: a 14-year cohort study of employed Danish men. Eur J Cardiovasc Prev Rehabil 2006;13:414-20.Steptoe A., Willemsen G. The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort. J Hypertens 2004;22:915-20.Steptoe A., Willemsen G. The influence of low job control on ambulatory blood pressure and perceived stress over the working day in men and women from the Whitehall II cohort. J Hypertens 2004;22:915-20.Sokejima S., Kagamimori S. Working hours as a risk for acute myocardial infarction in Japan: case-control study. BMJ 1998;317:775-80.Sokejima S., Kagamimori S. Working hours as a risk for acute myocardial infarction in Japan: case-control study. BMJ 1998;317:775-80.Gander M., von Kanel R. Myocardial infarction and post-traumatic stress disorder: frequency, outcome, and atherosclerotic mechanisms. Eur J Cardiovasc Prev Rehabil 2006;13:165-72.Gander M., von Kanel R. Myocardial infarction and post-traumatic stress disorder: frequency, outcome, and atherosclerotic mechanisms. Eur J Cardiovasc Prev Rehabil 2006;13:165-72.Lucini D., Norbiato G., Clerici M., Pagani M. Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension 2002;39:184- 8.Lucini D., Norbiato G., Clerici M., Pagani M. Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension 2002;39:184- 8.Bairey Merz C.N., Kop W., Krantz D.S., et al. Cardiovascular stress response and coronary artery disease: evidence of an adverse postmenopausal effect in women. Am Heart J 1998;135(5 Pt 1):881-7.Bairey Merz C.N., Kop W., Krantz D.S., et al. Cardiovascular stress response and coronary artery disease: evidence of an adverse postmenopausal effect in women. Am Heart J 1998;135(5 Pt 1):881-7.Steptoe A., Kunz-Ebrecht S., Owen N., et al. Socioeconomic status and stressrelated Biological responces over the working day. Psychosom Med 2003;65:461-70.Steptoe A., Kunz-Ebrecht S., Owen N., et al. Socioeconomic status and stressrelated Biological responces over the working day. Psychosom Med 2003;65:461-70.Krantz D.S., Helmers K.F., Bairey C.N., et al. Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease. Psychosom Med 1991;53:1-12.Krantz D.S., Helmers K.F., Bairey C.N., et al. Cardiovascular reactivity and mental stress-induced myocardial ischemia in patients with coronary artery disease. Psychosom Med 1991;53:1-12.Sheps DS, McMahon RP, Becker L, et al. Mental stress-induced ischemia and allcause mortality in patients with coronary artery disease: Results from the Psychophysiological Investigations of Myocardial Ischemia study. Circulation 2002;105(15):1780-4.Sheps DS, McMahon RP, Becker L, et al. Mental stress-induced ischemia and allcause mortality in patients with coronary artery disease: Results from the Psychophysiological Investigations of Myocardial Ischemia study. Circulation 2002;105(15):1780-4.Yeung A.C., Vekshein V.I., Krantz D.S., et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991;325:1551-6.Yeung A.C., Vekshein V.I., Krantz D.S., et al. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991;325:1551-6.Ghiadoni L., Donald A.E., Cropley M., et al. Mental stress induces transient endothelial dysfunction in humans. Circulation 2000;102: 2473-8.Ghiadoni L., Donald A.E., Cropley M., et al. Mental stress induces transient endothelial dysfunction in humans. Circulation 2000;102: 2473-8.Spieker L.E., Hurlimann D., Ruschitzka F., et al. Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation 2002;105:2817- 20.Spieker L.E., Hurlimann D., Ruschitzka F., et al. Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation 2002;105:2817- 20.Kiecolt-Glaser J.K., Preacher K.J., MacCallum R.C., et al. Chronic stress and agerelated increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci USA 2003;100:9090-5.Kiecolt-Glaser J.K., Preacher K.J., MacCallum R.C., et al. Chronic stress and agerelated increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci USA 2003;100:9090-5.Hansson A., Madsen-Hardig B., Olsson S.B. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fibrillation: a study based on interviews with 100 patients seeking hospital assistance. BMC Cardiovasc Disord 2004;4:13.Hansson A., Madsen-Hardig B., Olsson S.B. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fibrillation: a study based on interviews with 100 patients seeking hospital assistance. BMC Cardiovasc Disord 2004;4:13.Kowalski M, Steinberg JS, Arshad A, et al. A new pattern of cardiac events emerges following the World Trade Center attack [Abstract 3710]. Circulation 2002;106:II- 755.Kowalski M, Steinberg JS, Arshad A, et al. A new pattern of cardiac events emerges following the World Trade Center attack [Abstract 3710]. Circulation 2002;106:II- 755.Kendler K.S., Kessler R.C., Walters E.E., et al. Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiatry 1995;152:833-42.Kendler K.S., Kessler R.C., Walters E.E., et al. Stressful life events, genetic liability, and onset of an episode of major depression in women. Am J Psychiatry 1995;152:833-42.Айвазян Т.А., Зайцев В.П., Саленко Б.Б., и др. Эффективность психорелаксационной терапии у больных гипертонической болезнью. Кардиология 1988;28(3):31-4.Айвазян Т.А., Зайцев В.П., Саленко Б.Б., и др. Эффективность психорелаксационной терапии у больных гипертонической болезнью. Кардиология 1988;28(3):31-4.Frasure-Smith N., Prince R. The ischemic heart disease life stress monitoring program: impact on mortality. Psychosom Med 1985;47:431-45.Frasure-Smith N., Prince R. The ischemic heart disease life stress monitoring program: impact on mortality. Psychosom Med 1985;47:431-45.Castillo-Richmond A., Schneider R.H., Alexander C.N., et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000;31:568-73.Castillo-Richmond A., Schneider R.H., Alexander C.N., et al. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke 2000;31:568-73.Denollet J., Brutsaert D.L. Reducing emotional distress improves prognosis in coronary heart disease. Circulation 2001;104:2018-23.Denollet J., Brutsaert D.L. Reducing emotional distress improves prognosis in coronary heart disease. Circulation 2001;104:2018-23.van Dixhoorn J., White A. Relaxation therapy for rehabilitation and prevention in ischemic heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2005;12:193-202.van Dixhoorn J., White A. Relaxation therapy for rehabilitation and prevention in ischemic heart disease: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil 2005;12:193-202.

The authors declare that there are no conflicts of interest present.