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Doctors Williams and Davidson (1) emphasize that the literature on stress and cardiovascular disease (CVD) is extensive and that the clinical consequences are weighty. I agree. Rather than discuss additional references from this enormous literature, I thought I might reply with an excerpt from Billy Collins’ poem “Picnic, Lightning” (2), a meditation on freak accidents and death.
And we know the message can be delivered from within. The heart, no valentine, decides to quit after lunch, the power shut off like a switch, or a tiny dark ship is unmoored into the flow of the body’s rivers, the brain a monastery, defenseless on the shore.
The pathophysiological links are readily apparent. Our bodies are poised to respond to life’s challenges, and psychological stressors can cast a long shadow on our patients’ prospects for the future, particularly in the context of coronary artery disease. Medicine’s challenge is to devise interventions so that productive lives are not cut short prematurely by the stress-CVD relationship. There has been considerable progress, but more remains to be done.
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