Jourd zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA of Psychosomanc Research. Vol. 31, No. 6, pp. 661471. 1987 Printed in Great Bntam @X22-3999/87 $3.00 + M) Pergamon Journals Ltd. zyxwvutsr INVITED REVIEW PERSONALITY, LIFE EVENTS AND CARDIOVASCULAR DISEASE D. G. BYRNE* (Received for publication 23 February 1987) INTRODUCTION THE CONNECTION between the heart and the psyche has featured regularly in the history of medicine. For the physician Galen, the source of the emotions was clearly to be located within the heart. While contemporary research on the biology of the emotions has shifted its focus of attention to the brain, and while the determinants of emotional experience are seen to be fundamentally neurophysiological phenomena, the heart/brain nexus remains very much in evidence, for in the past two decades, a large and persuasive collection of data has come to support the role of behaviour and affect in the regulation of cardiovascular activity [l]. In the light of this evidence, it is not surprising that psychosomatic medicine has always displayed a particular interest in cardiovascular disease, both as a category of illness in its own right and as a vehicle for research into more general and basic mechanisms of psychosomatic influence. The lucid and comprehensive accounts by Selye [2] and Groen [3] have presented much of the early work in the area, the former from the perspective of stress and the latter emphasizing the conjoint roles of personality and the social situation. These accounts paint a picture of broad conceptual and methodological diversity in the various psychosomatic approaches to the explanation of cardiovascular disease. By and large, theories to do with the specific effects of psychodynamic conflicts, exemplified by the works of Dunbar [4] and Alexander [5], no longer attract a great following. Nor do speculations based on the broad effects of macro-social variables such as social class, ethnicity or occupation [6, 71. Two categories of evidence have, however, achieved enduring attention, those relating to the roles of both environmental stress and the Type A (coronary prone) behaviour pattern in the development and precipitation of coro- nary heart disease. A discussion of these areas will form the substance of the present paper. TERMINOLOGY Cardiovascular disease encompasses a wide range of patho-physiological states. Most studies have concerned themselves with one particular sequence of patho- *Department of Psychology, Australian National University, GPO Box 4, Canberra, A.C.T. 2601, Australia. 661