By Dr. Paul J. Rosch, M.D., M.A., F.A.C.P.

Here are a half dozen of the numerous mechanisms that link stress to coronary heart disease:

1. For those who still believe in elevated cholesterol, stress has a far greater effect than fatty foods as demonstrated in tax accountants as April 15 approaches, students on the eve of an important exam and several other studies. Stress also contributes to other risk factors such as smoking, hypertension, diabetes and obesity.

2. Stress can cause constriction of the coronary vasculature and increased platelet stickiness and clumping that promote clot formation.

3. Stress increases homocysteine, CRP and fibrinogen, all of which are risk factors or risk markers for coronary heart disease.

4. Stress causes increased deep abdominal fat deposits that contribute to insulin resistance and metabolic syndrome with its varied and sometimes deadly cardiovascular consequences.

5. In addition to Type A behavior, hostility, excessive anger, stressful life events, depression, and anxiety, have all been demonstrated to cause coronary heart disease.

6. It has been proposed that unstable atherosclerotic plaque might actually represent a "microabscess" that resulted from an infection. There is surprising support for this theory, and it is well established that stress can increase susceptibility to infections.