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."

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.