The meta-analysis of Linden et al1 shows evidence that coronary artery disease (CAD) is a psychosomatic condition. They found that the addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality, morbidity, and some biological risk factors. Psychosocial factors as well as biological factors contribute to the pathogenesis of CAD.
Depression, hopelessness, and stress are related to increased morbidity or mortality in patients with CAD. Depression is associated with increased cardiac mortality after myocardial infarction (MI).2 Ventricular tachycardia is higher among patients with CAD and depression than among those with CAD but without depression3; this arrhythmia is the possible link between psychosocial factors and sudden cardiac death. Hopelessness (negative expectancies about oneself and the future), independent of depression and traditional risk factors, is a predictive factor for the incidence of MI.4 There is a causal association between acute mental stress and MI, often silent, in