Chapter PSYCHOSOCIALRISK FACTORS IN CARDIOVASCULAR DISEASE Carla Favoccia 1 1* , Giada Pietrabissa 2,3 , Gianluca Castelnuovo 2,3 , Gian Mauro Manzoni 4 , Mariella Montano 1 , Gianandrea Bertone 1 , Annamaria Titon 1 , Ferruccio Nibbio 1 and Luca Gondoni 1 1 Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, Verbania, Italy 2 Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, Verbania, Italy 3 Department of Psychology, Catholic University, Milan, Italy 4 Faculty of Psychology, eCampus University, Novedrate, Como, Italy ABSTRACT Introduction: according to the literature, psychosocial factors significantly contribute to both pathogenesis and expression of coronary artery disease (CAD). Depression, anxiety, anger and hostility, social isolation and stressful lifestyle represent the main contributing factors both to higher prevalence of unhealthy behaviors (poor diet, physical inactivity, alcohol use or smoking) and adverse pathophysiological mechanisms, such as neuroendocrine and platelet activation. Material and method: over the past few decades, there has been an increasing interest in investigating the relationship between psychosocial risk factors and cardiovascular disease, leading to a growing pool of clinical and epidemiological data on the subject. Specifically, a large case–control trial, involving 52 countries, has identified nine potentially modifiable risk factors for CAD, among which psychosocial factors have been included and divided into two general categories: chronic stressors and emotional factors. These are believed to exacerbate the development of cardiovascular disease by two mechanisms: 1) encouraging unhealthy behaviors and increasing the noncompliance to treatments; and 2) eliciting physiological responses that may lead to insufficient oxygen delivery to the heart muscle, threatening heart rhythms, more vulnerable plaque, * Carla Favoccia, MD. Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, Verbania, Italy. University of Pavia, c/o Fondazione IRCCS Policlinico S. Matteo, V.le Golgi, 19, 27100 Pavia, Italy. Phone: +3402718198. Email: carla.favoccia@gmail.com.