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International Journal of Epidemiology 2002;31:1111-1113
© International Epidemiological Association 2002

Reprints and Reflections

Commentary: Stress and the heart, 50 years of progress?

John Macleoda and George Davey Smithb

a Department of Primary Care and General Practice, University of Birmingham, B15 2TT, UK.
b Department of Social Medicine, University of Bristol, BS8 2PR, UK.

The first 150 words of the full text of this article appear below.

Ian Stewart’s essay in the 1950 Christmas edition of the Lancet, on the possible psychosocial origins of coronary heart disease (CHD),1 preceded the publication of Hans Selye’s The Stress of Life by 6 years.2 Selye is still widely credited with inventing (or discovering) ‘modern stress’, although clearly the construct, and a reasonably sophisticated conception of its possible relation to cardiovascular health, already had widespread currency in 1950. Indeed a causal association between heightened ‘stress’ and heart disease was suggested at least as long ago as the 18th century.3

Whether in its observations on medical registrars, Birmingham teenagers, charwomen or other blue-collar workers, Stewart’s essay belongs to an era when doctors were not shy of displaying the assumptions and prejudices of their class. However, it is not epidemiologically naïve. The need for any aetiological explanation of CHD to be congruent with epidemiological understanding is explicitly recognized. In 1950 the epidemiology . . . [Full Text of this Article]


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