Smoking, Stress, and Coronary Heart Disease

Smoking is a major coronary heart disease risk factor that has proven to be very resistant to treatment efforts. For many smokers, environmental stressors, which have also been related to coronary heart disease risk, appear to be strong determinants of smoking behavior and of relapse after cessation. This review focuses on the interrelation between stressors and smoking and on the potential impact of this interrelation on coronary heart disease risk beyond that which is due to stressors or to smoking alone. First, evidence supporting the interrelation between stress and smoking and its relevance to the risk of heart disease is reviewed. Second, mechanisms that may explain why smokers smoke more during stress and why stress may cause relapse are discussed. Finally, new directions in the development of individualized methods to assess, understand, and treat stress-related smoking and relapse are considered.