The importance of heart and artery disease as a cause of death and disability is difficult to exaggerate: it causes over half of all deaths in the western world and now accounts for one-quarter of deaths in the entire world. This appalling incidence persists in spite of commendable progress in treatment and prevention, particularly in the last two or three decades. Deaths from coronary disease have decreased by a third in the past twenty years and stroke has decreased by a half in the same period. This remarkable improvement, saving thousands of lives per year, has come about due to changes in life style (low fat diet, control of high blood pressure, less smoking and more exercise) and progress in treatment (more effective drugs, coronary care units, pacemakers, and cardiac surgery). Progress in understanding the pathophysiologic and pharn,acologic mechanisms operative in heart disease have been paramount in the development of more rational and more effective therapy. Dramatic and spectacular surgical treatments have fired the public imagination. Bypass surgery is commonplace and results in complete or considerable relief of symptoms in the majority of patients operated upon.

It has been known or suspected for centuries that there is an association between mind and emotions and the occurrence of heart disease apd sudden death. During the past fifty years this relationship has become identified with the concept of Stress, a notion developed and popularized by Hans Selye. In recent years there has been an upward surge of interest in stress by scientists in several disciplines and by the general public. Although, books, journal articles, seminars and media programs devoted to stress now abound, the definition, manifestations, mechanisms, and management of stress remain uncertain and controversial. In an attempt to clarify the situation an International Symposium on Stress and Heart Disease was held in Winnipeg, Canada, June 26-29, 1984, and the proceedings form the basis of this book and its companion volume "Patho genesis of Stress-Induced Heart Disease". Although most species which have ever existed are now extinct through countless millenia, the human species has successfully adapted to changing conditions ("stressors") such as ice ages, predators and parasites, wars, famine and plague, and now it is coping with rapidly changing social, economic and political circumstances. Such adaptation occurs at all levels of life- at the molecular level within the cell, at the level of the whole cell, in the groups of cells as organs, in the entire organism or individual, and in some cases, in the society in which the individual lives.

A recent comprehensive study of stress and human health by the Institute of Medicine/National Academy of Sciences concludes that individuals who experience any of a wide range of stressful events or situations are at increased risk of developing a physical or mental disorder, including heart disease. Since cardiovascular disease continues to be a leading cause of illness and death, and since the etiology and pathogenesis of several of the commonest forms of heart disease are incompletely known, it is of fundamental impor tance to study the potential role of stress in the genesis of heart disease. Accordingly an International Symposium on Stress and Heart Disease was held in Winnipeg, Canada, June 26-29, 1984 and the proceedings form the basis of this book and its companion volume, "Stress and Heart Disease". The connection between stress (the behavioral sciences) and heart disease (the biomedical sciences) occurs in the mechanisms through which the brain affects or controls the endocrine and the autonomic nervous systems. Initially this linkage appeared to be relatively simple, mainly involving catecholamines and corticosteroids, and communication between nerve cells was thought to be electrical. Now knowledge has increased and concepts have change dramatic ally. Major advances have occurred in biochemical, anatomical, physiological, pharmacological, pathological and behavioral aspects of the neuroendocrine system. The over whelming significance of chemical communication in the nli xviii nervous system has become clear.

The importance of heart and artery disease as a cause of death and disability is difficult to exaggerate: it causes over half of all deaths in the western world and now accounts for one-quarter of deaths in the entire world. This appalling incidence persists in spite of commendable progress in treatment and prevention, particularly in the last two or three decades. Deaths from coronary disease have decreased by a third in the past twenty years and stroke has decreased by a half in the same period. This remarkable improvement, saving thousands of lives per year, has come about due to changes in life style (low fat diet, control of high blood pressure, less smoking and more exercise) and progress in treatment (more effective drugs, coronary care units, pacemakers, and cardiac surgery). Progress in understanding the pathophysiologic and pharn, acologic mechanisms operative in heart disease have been paramount in the development of more rational and more effective therapy. Dramatic and spectacular surgical treatments have fired the public imagination. Bypass surgery is commonplace and results in complete or considerable relief of symptoms in the majority of patients operated upon

A recent comprehensive study of stress and human health by the Institute of Medicine/National Academy of Sciences concludes that individuals who experience any of a wide range of stressful events or situations are at increased risk of developing a physical or mental disorder, including heart disease. Since cardiovascular disease continues to be a leading cause of illness and death, and since the etiology and pathogenesis of several of the commonest forms of heart disease are incompletely known, it is of fundamental impor tance to study the potential role of stress in the genesis of heart disease. Accordingly an International Symposium on Stress and Heart Disease was held in Winnipeg, Canada, June 26-29, 1984 and the proceedings form the basis of this book and its companion volume, "Stress and Heart Disease." The connection between stress (the behavioral sciences) and heart disease (the biomedical sciences) occurs in the mechanisms through which the brain affects or controls the endocrine and the autonomic nervous systems. Initially this linkage appeared to be relatively simple, mainly involving catecholamines and corticosteroids, and communication between nerve cells was thought to be electrical. Now knowledge has increased and concepts have change dramatic ally. Major advances have occurred in biochemical, anatomical, physiological, pharmacological, pathological and behavioral aspects of the neuroendocrine system. The over whelming significance of chemical communication in the nli xviii nervous system has become clear."

It has been known or suspected for centuries that there is an association between mind and emotions and the occurrence of heart disease apd sudden death. During the past fifty years this relationship has become identified with the concept of Stress, a notion developed and popularized by Hans Selye. In recent years there has been an upward surge of interest in stress by scientists in several disciplines and by the general public. Although, books, journal articles, seminars and media programs devoted to stress now abound, the definition, manifestations, mechanisms, and management of stress remain uncertain and controversial. In an attempt to clarify the situation an International Symposium on Stress and Heart Disease was held in Winnipeg, Canada, June 26-29, 1984, and the proceedings form the basis of this book and its companion volume "Patho genesis of Stress-Induced Heart Disease." Although most species which have ever existed are now extinct through countless millenia, the human species has successfully adapted to changing conditions ("stressors") such as ice ages, predators and parasites, wars, famine and plague, and now it is coping with rapidly changing social, economic and political circumstances. Such adaptation occurs at all levels of life- at the molecular level within the cell, at the level of the whole cell, in the groups of cells as organs, in the entire organism or individual, and in some cases, in the society in which the individual lives."