ABSTRACT
Coronary heart disease (CHD) is the leading cause of death in the USA, accounting for one of every five deaths in this country. The estimated overall prevalence of CHD in the USA is 6.4 per cent, affecting 13 million people, and the prevalence of this disease is similar across most other industrialized countries (American Heart Association, AHA, 2003). The direct and indirect costs of this disease were estimated at $133.2 billion in 2003 (AHA, 2003). CHD is a broad category comprised of a set of conditions resulting from coronary artery disease (CAD), which is the gradual accumulation of plaque in coronary arteries. CAD is a progressive and slow condition that may be asymptomatic for years. Eventual symptoms of CAD can include myocardial ischemia (insufficient oxygen supply to the heart), angina pectoris (chest pain), myocardial infarction (MI; death of heart muscle), and cardiac arrhythmias (Krantz & McCeney, 2002; Smith & Ruiz, 2002). There are a number of wellestablished risk factors associated with the development of CAD and CHD, such as smoking, hypertension, and hyperlipidemia (Kannel, 1979). However, such risk factors have only moderate value in predicting new cases of CHD (Jenkins, 1988), suggesting other variables may play an important role in the development and outcome of this common disease. Thus, research examining other CHD risk factors has increased tremendously, and several psychological variables, including stress, anger, and hostility, have been implicated for their relationship to CHD.
