INTRODUCTION Scientists have long puzzled over the fact that manyheart attacks occur in persons apparently free of riskfactors such as high blood pressure, smoking, andhigh cholesterol. What, they ask, accounts for theseheart attacks?

The answer, according to some, may lie not merely in physiology but in behavior. In the last 30 years orso, a small group of scientists has held steadfastly tothe hypothesis that the way people think, feel, and act as they cope with the daily stresses of life canhave a profound—and sometimes deadly—effect on their hearts. Through thousands of interviews with heart attack patients, these researchers have dis-cerned common traits, behavioral responses, andstress reactions that appear to be associated with in-creased risk for heart disease. By following individ-uals with evidence of such patterns, they have been able to amass enough evidence to support the ideathat stress and how we react to it plays an important,albeit controversial, role in the risk factor profile.