Eds Stephen A Stansfeld, Michael G Marmot

BMJ Books, £30, pp 304 

ISBN 0 7279 1277 1

Rating:

Stress, as every lay person knows, can lead to a host of ailments. These range from susceptibility to infections and stomach ulcers, to mental illness and asthma attacks. But it is in the area of preventive cardiology that stress research has yielded the most durable and convincing discoveries.

Stress and the Heart is a timely, highly readable, and authoritative volume, with contributions from the leading investigators in the field. As a mark of progress in this area, the editors and chapter authors generally eschew the term "stress" throughout this impressive book. Instead, the chapters are organised around specific concepts and measurements. These include the demands/control and effort/reward imbalance models of job stress; social support and social networks; and the evidence base linking specific negative emotions such as depression and anxiety to cardiovascular disease outcomes. Whereas previous books have treated stress as yet another "risk factor" for heart diseaseamenable to psychotherapy and fluoxetine (Prozac)the editors of this book clearly have a broader audience and message in mind. With chapters on social class and heart disease (chapter 2) and life course approaches to inequalities in cardiovascular disease (chapter 3), it is clear that this book is not just for clinicians and researchers, but also for policy makers.

Some of the most original sections deal with the so called "indirect" pathways linking stress to heart diseasenamely, the associations between stress and health behaviours, including diet, smoking, and exercise. The authors have done an admirable job of synthesising the frequently contradictory evidence. The chapters on stress and gene-environment interactions, as well as Redford Williams' engaging chapter on brain serotonergic function, map out the next research frontier.

Most of the contributors to this volume are from the International Centre for Health and Society and the Department of Epidemiology and Public Health at University College London, an internationally recognised powerhouse of research on the social determinants of health. Not surprisingly, the empirical evidence cited draws heavily on the renowned Whitehall Studies of British civil servants (www.ucl.ac.uk/epidemiology/white/intro.html). For all the disciplinary diversity represented hereranging from social epidemiology, health psychology, to sociology and psychophysiologythe overall coherence of the book is impressive.

It is surely a sign of a maturing field of research when Redford Williams approvingly notes: "We have moved beyond the `guild' approach in which each group of researchers zealously guarded `their' risk factorwhether it was hostility, social isolation, job strain, depression, or socioeconomic inequalityagainst encroachments from the others, in some kind of zero sum game" (p 97).

Ichiro Kawachi, associate professor of health and social behaviour. 

Harvard School of Public Health, USA