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Acute and chronic stress long have been suspected as risk factors for coronary artery disease morbidity and mortality. Among the lay public, it is widely believed that acute stress can act as a trigger for myocardial infarction (MI) and sudden cardiac death. Until recently, this view was corroborated primarily by anecdotal and case reports, 2l some epidemiologic and human and animal studies demonstrating physiologic and pathophysiologic effects of mental stress on the cardiovascular 46 Despite this research literature, the cardiology community has regarded the evidence for a causal link between mental stress and the onset of acute cardiovascular events with skepticism.', 29 Doubts about the scientific validity and clinical relevance of this evidence have resulted from difficulties in defining and measuring stress, the multifactorial nature of coronary disease and its onset, and the presence of numerous confounding …