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, Volume 83, Issue 11, pp 1448–1457 | Cite as

Stress, psychische Erkrankungen und koronare Herzkrankheit



Es bestehen vielfältige Zusammenhänge zwischen Stress, psychischen Erkrankungen und der koronaren Herzkrankheit (KHK). Akute Stressoren bewirken eine Aktivierung des Hypothalamus-Hypophysen-Nebennierenrinden-Systems und des sympathoadrenalen Systems, chronische Stressoren sind mit längerfristigen funktionellen Änderungen dieser Systeme verbunden. Akute und chronische Stressoren zeigen eine Assoziation mit der Manifestation psychischer Erkrankungen; die beste Evidenz hierfür besteht hinsichtlich der Auslösung depressiver Episoden. Verschiedene psychische Erkrankungen, insbesondere Depression, Angst und Schizophrenie, stellen Risikofaktoren für die Manifestation der KHK dar. Daneben wurden auch akute und/oder chronische Stressoren als Trigger oder Risikofaktoren akuter Koronarsyndrome identifiziert. Therapeutische Anätze zielen auf die Minderung vermehrten Stresserlebens, die Therapie psychischer Erkrankungen sowie auf die Behandlung kardialer Risikofaktoren, die bei Stress und psychischen Erkrankungen gehäuft anzutreffen sind.


Stress Hypothalamus-Hypophysen-Nebennierenrinden-System Sympathoadrenales System Depression Koronare Herzkrankheit 

Stress, mental disorders and coronary heart disease


There are numerous associations between stress, mental disorders and coronary heart disease (CHD). Exposure to an acute stressor leads to activation of the hypothalamus-pituitary-adrenal and sympathoadrenal systems and chronic stressors are associated with sustained functional changes of these systems. Experiencing acute and chronic stress is paralleled by an increased incidence of mental disorders with the most consistent evidence on the triggering of major depressive episodes. Various mental disorders, including depression, anxiety and schizophrenia, are associated with an increased risk of CHD. Furthermore, acute and chronic stressors have been identified as risk factors or triggers of acute coronary syndromes. Thus therapeutic strategies aim at reducing subjective stress experience, therapy of mental disorders and treatment of cardiac risk factors known to be more prevalent in increased stress states and mental disorders.


Stress Hypothalamus-pituitary-adrenal system Sympathoadrenal system Depression Coronary artery disease 



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  1. 1.
    Aboa-Eboule C, Brisson C, Maunsell E et al (2007) Job strain and risk of acute recurrent coronary heart disease events. JAMA 298:1652–1660PubMedCrossRefGoogle Scholar
  2. 2.
    Anda RF, Williamson DF, Escobedo LG et al (1990) Depression and the dynamics of smoking. A national perspective. JAMA 264:1541–1545PubMedCrossRefGoogle Scholar
  3. 3.
    Arrighi JA, Burg M, Cohen IS et al (2000) Myocardial blood-flow response during mental stress in patients with coronary artery disease. Lancet 356:310–311PubMedCrossRefGoogle Scholar
  4. 4.
    Arrighi JA, Burg M, Cohen IS et al (2003) Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease. J Nucl Cardiol 10:267–274PubMedCrossRefGoogle Scholar
  5. 5.
    Baigent C, Keech A, Kearney PM et al (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366:1267–1278PubMedCrossRefGoogle Scholar
  6. 6.
    Barker DJ, Gluckman PD, Godfrey KM et al (1993) Fetal nutrition and cardiovascular disease in adult life. Lancet 341:938–941PubMedCrossRefGoogle Scholar
  7. 7.
    Baumeister H, Hutter N, Bengel J (2011) Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev:CD008012Google Scholar
  8. 8.
    Blumenthal JA, Williams RS, Wallace AG et al (1982) Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction. Psychosom Med 44:519–527PubMedGoogle Scholar
  9. 9.
    Blumenthal JA, Lett HS, Babyak MA et al (2003) Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 362:604–609PubMedCrossRefGoogle Scholar
  10. 10.
    Blumenthal JA, Sherwood A, Babyak MA et al (2005) Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial. JAMA 293:1626–1634PubMedCrossRefGoogle Scholar
  11. 11.
    Boll-Klatt M (2008) Psychokoardiologie in der kardiologischen Rehabilitation inkl. Verhaltensmodifikation. In: Herrmann-Lingen C, Albus C, Titscher G (Hrsg) Psychokardiologie. Deutscher Ärzte-Verlag, Köln, S 237–254Google Scholar
  12. 12.
    Boscarino JA (2008) A prospective study of PTSD and early-age heart disease mortality among Vietnam veterans: implications for surveillance and prevention. Psychosom Med 70:668–676PubMedCrossRefGoogle Scholar
  13. 13.
    Brotman DJ, Golden SH, Wittstein IS (2007) The cardiovascular toll of stress. Lancet 370:1089–1100PubMedCrossRefGoogle Scholar
  14. 14.
    Bus BA, Marijnissen RM, Holewijn S et al (2011) Depressive symptom clusters are differentially associated with atherosclerotic disease. Psychol Med 41:1419–1428PubMedCrossRefGoogle Scholar
  15. 15.
    Bush DE, Ziegelstein RC, Tayback M et al (2001) Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 88:337–341PubMedCrossRefGoogle Scholar
  16. 16.
    Carney RM, Freedland KE, Rich MW et al (1993) Ventricular tachycardia and psychiatric depression in patients with coronary artery disease. Am J Med 95:23–28PubMedCrossRefGoogle Scholar
  17. 17.
    Carney RM, Freedland KE, Veith RC et al (1999) Major depression, heart rate, and plasma norepinephrine in patients with coronary heart disease. Biol Psychiatry 45:458–463PubMedCrossRefGoogle Scholar
  18. 18.
    Carney RM, Blumenthal JA, Stein PK et al (2001) Depression, heart rate variability, and acute myocardial infarction. Circulation 104:2024–2028PubMedCrossRefGoogle Scholar
  19. 19.
    Carney RM, Freedland KE, Miller GE et al (2002) Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res 53:897–902PubMedCrossRefGoogle Scholar
  20. 20.
    Carpenter LL, Carvalho JP, Tyrka AR et al (2007) Decreased adrenocorticotropic hormone and cortisol responses to stress in healthy adults reporting significant childhood maltreatment. Biol Psychiatry 62:1080–1087PubMedCrossRefGoogle Scholar
  21. 21.
    Chrousos GP, Gold PW (1992) The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267:1244–1252PubMedCrossRefGoogle Scholar
  22. 22.
    De Hert M, Dekker JM, Wood D et al (2009) Cardiovascular disease and diabetes in people with severe mental illness. Eur Psychiatry 24:412–424CrossRefGoogle Scholar
  23. 23.
    de Kloet E, Joels M, Holsboer F (2005) Stress and the brain: from adaptation to disease. Nat Rev Neurosci 6:463–475CrossRefGoogle Scholar
  24. 24.
    Dedovic K, Renwick R, Mahani NK et al (2005) The Montreal Imaging Stress Task: using functional imaging to investigate the effects of perceiving and processing psychosocial stress in the human brain. J Psychiatry Neurosci 30:319–325PubMedGoogle Scholar
  25. 25.
    Dekker MJ, Koper JW, Aken MO van et al (2008) Salivary cortisol is related to atherosclerosis of carotid arteries. J Clin Endocrinol Metab 93:3741–3747PubMedCrossRefGoogle Scholar
  26. 26.
    Dickerson SS, Kemeny ME (2004) Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull 130:355–391PubMedCrossRefGoogle Scholar
  27. 27.
    Doll R, Peto R, Boreham J et al (2004) Mortality in relation to smoking: 50 years‘ observations on male British doctors. BMJ 328:1519PubMedCrossRefGoogle Scholar
  28. 28.
    Druss BG, Bradford DW, Rosenheck RA et al (2000) Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA 283:506–511PubMedCrossRefGoogle Scholar
  29. 29.
    Epel ES, McEwen B, Seeman T et al (2000) Stress and body shape: stress-induced cortisol secretion is consistently greater among women with central fat. Psychosom Med 62:623–632PubMedGoogle Scholar
  30. 30.
    Farmer ME, Locke BZ, Moscicki EK et al (1988) Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 128:1340–1351PubMedGoogle Scholar
  31. 31.
    Ghiadoni L, Donald AE, Cropley M et al (2000) Mental stress induces transient endothelial dysfunction in humans. Circulation 102:2473–2478PubMedCrossRefGoogle Scholar
  32. 32.
    Glassman AH, O’Connor CM, Califf RM et al (2002) Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 288:701–709PubMedCrossRefGoogle Scholar
  33. 33.
    Glassman AH, Bigger JT, Gaffney M et al (2006) Onset of major depression associated with acute coronary syndromes: relationship of onset, major depressive disorder history, and episode severity to sertraline benefit. Arch Gen Psychiatry 63:283–288PubMedCrossRefGoogle Scholar
  34. 34.
    Goldstein DS (1997) Stress and science. In: Cameron OG (Hrsg) Adrenergic dysfunction and psychobiology. American Psychiatric Press, Inc., Wahington DC, S 179–236Google Scholar
  35. 35.
    Gotthardt U, Schweiger U, Fahrenberg J et al (1995) Cortisol, ACTH, and cardiovascular response to a cognitive challenge paradigm in aging and depression. Am J Physiol 268:R865–873PubMedGoogle Scholar
  36. 36.
    Graham LN, Smith PA, Stoker JB et al (2002) Time course of sympathetic neural hyperactivity after uncomplicated acute myocardial infarction. Circulation 106:793–797PubMedCrossRefGoogle Scholar
  37. 37.
    Gullette EC, Blumenthal JA, Babyak M et al (1997) Effects of mental stress on myocardial ischemia during daily life. JAMA 277:1521–1526PubMedCrossRefGoogle Scholar
  38. 38.
    Gulliksson M, Burell G, Vessby B et al (2011) Randomized controlled trial of cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM). Arch Intern Med 171:134–140PubMedCrossRefGoogle Scholar
  39. 39.
    Heinrichs M, Baumgartner T, Kirschbaum C et al (2003) Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biol Psychiatry 54:1389–1398PubMedCrossRefGoogle Scholar
  40. 40.
    Hennekens CH (2007) Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. J Clin Psychiatry 68(Suppl 4):4–7PubMedCrossRefGoogle Scholar
  41. 41.
    Holt-Lunstad J, Smith TB, Layton JB (2010) Social relationships and mortality risk: a meta-analytic review. PLoS Med 7:e1000316PubMedCrossRefGoogle Scholar
  42. 42.
    Ilgen MA, Hutchison KE (2005) A history of major depressive disorder and the response to stress. J Affect Disord 86:143–150PubMedCrossRefGoogle Scholar
  43. 43.
    Jiang W, Babyak M, Krantz DS et al (1996) Mental stress—induced myocardial ischemia and cardiac events. JAMA 275:1651–1656PubMedCrossRefGoogle Scholar
  44. 44.
    Jokinen J, Nordstrom P (2009) HPA axis hyperactivity and cardiovascular mortality in mood disorder inpatients. J Affect Disord 116:88–92PubMedCrossRefGoogle Scholar
  45. 45.
    Kajantie E, Feldt K, Raikkonen K et al (2007) Body size at birth predicts hypothalamic-pituitary-adrenal axis response to psychosocial stress at age 60–70 years. J Clin Endocrinol Metab 92:4094–4100PubMedCrossRefGoogle Scholar
  46. 46.
    Kaluza G (2011) Stressbewältigung. Springer Medizin, HeidelbergGoogle Scholar
  47. 47.
    Kendler KS, Karkowski LM, Prescott CA (1999) Causal relationship between stressful life events and the onset of major depression. Am J Psychiatry 156:837–841PubMedGoogle Scholar
  48. 48.
    Kirschbaum C, Prussner JC, Stone AA et al (1995) Persistent high cortisol responses to repeated psychological stress in a subpopulation of healthy men. Psychosom Med 57:468–474PubMedGoogle Scholar
  49. 49.
    Korkeila J, Vahtera J, Korkeila K et al (2010) Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease. Heart 96:298–303PubMedCrossRefGoogle Scholar
  50. 50.
    Kubzansky LD, Koenen KC, Spiro A 3rd et al (2007) Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Arch Gen Psychiatry 64:109–116PubMedCrossRefGoogle Scholar
  51. 51.
    Ladwig K-H, Lederbogen F, Völler H et al (2008) Positionspapier zur Bedeutung psychosozialer Faktoren in der Kardiologie. Kardiologe 4:274–287CrossRefGoogle Scholar
  52. 52.
    Lampert R, Jain D, Burg MM et al (2000) Destabilizing effects of mental stress on ventricular arrhythmias in patients with implantable cardioverter-defibrillators. Circulation 101:158–164PubMedCrossRefGoogle Scholar
  53. 53.
    Lampert R, Joska T, Burg MM et al (2002) Emotional and physical precipitants of ventricular arrhythmia. Circulation 106:1800–1805PubMedCrossRefGoogle Scholar
  54. 54.
    Leor J, Poole WK, Kloner RA (1996) Sudden cardiac death triggered by an earthquake. N Engl J Med 334:413–419PubMedCrossRefGoogle Scholar
  55. 55.
    Lesperance F, Frasure-Smith N, Juneau M et al (2000) Depression and 1-year prognosis in unstable angina. Arch Intern Med 160:1354–1360PubMedCrossRefGoogle Scholar
  56. 56.
    Lesperance F, Frasure-Smith N, Talajic M et al (2002) Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 105:1049–1053PubMedCrossRefGoogle Scholar
  57. 57.
    Li J, Hansen D, Mortensen PB et al (2002) Myocardial infarction in parents who lost a child: a nationwide prospective cohort study in Denmark. Circulation 106:1634–1639PubMedCrossRefGoogle Scholar
  58. 58.
    Linden W, Phillips MJ, Leclerc J (2007) Psychological treatment of cardiac patients: a meta-analysis. Eur Heart J 28:2972–2984PubMedCrossRefGoogle Scholar
  59. 59.
    Liu D, Diorio J, Tannenbaum B et al (1997) Maternal care, hippocampal glucocorticoid receptors, and hypothalamic-pituitary-adrenal responses to stress. Science 277:1659–1662PubMedCrossRefGoogle Scholar
  60. 60.
    McCaffery JM, Frasure-Smith N, Dube MP et al (2006) Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosom Med 68:187–200PubMedCrossRefGoogle Scholar
  61. 61.
    McEwen BS, Stellar E (1993) Stress and the individual. Mechanisms leading to disease. Arch Intern Med 153:2093–2101PubMedCrossRefGoogle Scholar
  62. 62.
    Meisel SR, Kutz I, Dayan KI et al (1991) Effect of Iraqi missile war on incidence of acute myocardial infarction and sudden death in Israeli civilians. Lancet 338:660–661PubMedCrossRefGoogle Scholar
  63. 63.
    Miller GE, Stetler CA, Carney RM et al (2002) Clinical depression and inflammatory risk markers for coronary heart disease. Am J Cardiol 90:1279–1283PubMedCrossRefGoogle Scholar
  64. 64.
    Mittleman MA, Maclure M, Sherwood JB et al (1995) Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 92:1720–1725PubMedCrossRefGoogle Scholar
  65. 65.
    Nabel EG, Braunwald E (2012) A tale of coronary artery disease and myocardial infarction. N Engl J Med 366:54–63PubMedCrossRefGoogle Scholar
  66. 66.
    Neigh GN, Gillespie CF, Nemeroff CB (2009) The neurobiological toll of child abuse and neglect. Trauma Violence Abuse 10:389–410PubMedCrossRefGoogle Scholar
  67. 67.
    O’Connor CM, Jiang W, Kuchibhatla M et al (2010) Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol 56:692–699CrossRefGoogle Scholar
  68. 68.
    Ong L, Linden W, Young S (2004) Stress management: what is it? J Psychosom Res 56:133–137PubMedCrossRefGoogle Scholar
  69. 69.
    Orth-Gomer K, Schneiderman N, Wang HX et al (2009) Stress reduction prolongs life in women with coronary disease: the Stockholm Women’s Intervention Trial for Coronary Heart Disease (SWITCHD). Circ Cardiovasc Qual Outcomes 2:25–32PubMedCrossRefGoogle Scholar
  70. 70.
    Otte C, Marmar CR, Pipkin SS et al (2004) Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: The Heart and Soul Study. Biol Psychiatry 56:241–247PubMedCrossRefGoogle Scholar
  71. 71.
    Parkes CM, Benjamin B, Fitzgerald RG (1969) Broken heart: a statistical study of increased mortality among widowers. Br Med J 1:740–743PubMedCrossRefGoogle Scholar
  72. 72.
    Raikkonen K, Keltikangas-Jarvinen L, Adlercreutz H et al (1996) Psychosocial stress and the insulin resistance syndrome. Metabolism 45:1533–1538PubMedCrossRefGoogle Scholar
  73. 73.
    Ray WA, Meredith S, Thapa PB et al (2004) Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther 75:234–241PubMedCrossRefGoogle Scholar
  74. 74.
    Rifkin L, Lewis S, Jones P et al (1994) Low birth weight and schizophrenia. Br J Psychiatry 165:357–362PubMedCrossRefGoogle Scholar
  75. 75.
    Roest AM, Martens EJ, Jonge P de et al (2010) Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 56:38–46PubMedCrossRefGoogle Scholar
  76. 76.
    Rosengren A, Hawken S, Ounpuu S et al (2004) Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 364:953–962PubMedCrossRefGoogle Scholar
  77. 77.
    Rozanski A, Bairey CN, Krantz DS et al (1988) Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N Engl J Med 318:1005–1012PubMedCrossRefGoogle Scholar
  78. 78.
    Sapolsky RM (1996) Stress, glucocorticoids, and damage to the nervous system: the current state of confusion. Stress 1:1–19PubMedCrossRefGoogle Scholar
  79. 79.
    Seals DR, Chase PB (1989) Influence of physical training on heart rate variability and baroreflex circulatory control. J Appl Physiol 66:1886–1895PubMedCrossRefGoogle Scholar
  80. 80.
    Seeman TE, Singer BH, Rowe JW et al (1997) Price of adaptation—allostatic load and its health consequences. MacArthur studies of successful aging. Arch Intern Med 157:2259–2268PubMedCrossRefGoogle Scholar
  81. 81.
    Seyle H (1974) Stress without distress. New American Library, New YorkGoogle Scholar
  82. 82.
    Steinberg JS, Arshad A, Kowalski M et al (2004) Increased incidence of life-threatening ventricular arrhythmias in implantable defibrillator patients after the World Trade Center attack. J Am Coll Cardiol 44:1261–1264PubMedCrossRefGoogle Scholar
  83. 83.
    Stetler C, Miller GE (2011) Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosom Med 73:114–126PubMedCrossRefGoogle Scholar
  84. 84.
    Strohle A, Holsboer F (2003) Stress responsive neurohormones in depression and anxiety. Pharmacopsychiatry 36(Suppl 3):S207–S214PubMedGoogle Scholar
  85. 85.
    Szyf M (2012) The early-life social environment and DNA methylation. Clin Genet 81:341–349PubMedCrossRefGoogle Scholar
  86. 86.
    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology (1996) Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Eur Heart J 17:354–381CrossRefGoogle Scholar
  87. 87.
    Thompson C, Syddall H, Rodin I et al (2001) Birth weight and the risk of depressive disorder in late life. Br J Psychiatry 179:450–455PubMedCrossRefGoogle Scholar
  88. 88.
    Tiihonen J, Lonnqvist J, Wahlbeck K et al (2009) 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 374:620–627PubMedCrossRefGoogle Scholar
  89. 89.
    Tofler GH, Stone PH, Maclure M et al (1990) Analysis of possible triggers of acute myocardial infarction (the MILIS study). Am J Cardiol 66:22–27PubMedCrossRefGoogle Scholar
  90. 90.
    Troxler RG, Sprague EA, Albanese RA et al (1977) The association of elevated plasma cortisol and early atherosclerosis as demonstrated by coronary angiography. Atherosclerosis 26:151–162PubMedCrossRefGoogle Scholar
  91. 91.
    Ulrich-Lai YM, Herman JP (2009) Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci 10:397–409PubMedCrossRefGoogle Scholar
  92. 92.
    von Kanel R, Dimsdale JE (2003) Fibrin D-dimer: a marker of psychosocial distress and its implications for research in stress-related coronary artery disease. Clin Cardiol 26:164–168CrossRefGoogle Scholar
  93. 93.
    Weber-Hamann B, Hentschel F, Kniest A et al (2002) Hypercortisolemic depression is associated with increased intra-abdominal fat. Psychosom Med 64:274–277PubMedGoogle Scholar
  94. 94.
    Weber-Hamann B, Kopf D, Lederbogen F et al (2005) Activity of the hypothalamus-pituitary-adrenal system and oral glucose tolerance in depressed patients. Neuroendocrinology 81:200–204PubMedCrossRefGoogle Scholar
  95. 95.
    Whalley B, Rees K, Davies P et al (2011) Psychological interventions for coronary heart disease. Cochrane Database Syst Rev:CD002902Google Scholar
  96. 96.
    Wulsin LR, Singal BM (2003) Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 65:201–210PubMedCrossRefGoogle Scholar
  97. 97.
    Yehuda R, Kahana B, Binder-Brynes K et al (1995) Low urinary cortisol excretion in Holocaust survivors with posttraumatic stress disorder. Am J Psychiatry 152:982–986PubMedGoogle Scholar
  98. 98.
    Yeung AC, Vekshtein VI, Krantz DS et al (1991) The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 325:1551–1556PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische GesundheitUniversität Heidelberg, Medizinische Fakultät MannheimMannheimDeutschland
  2. 2.Klinik für Psychiatrie und PsychotherapieCharité – Universitätsmedizin Berlin, Campus Charité MitteBerlinDeutschland

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