from our upcoming report...

Concerning the role of underlying biological processes in cardiovascular
disease, there is continuing uncertainty regarding the processes that contribute
to disease.  Marmot and Mustard argue that there are two: those that cause
thickening of blood vessels and those that cause narrowing and blood clotting.
The presence of environmental stressors may be related to the second process
which is the main cause of coronary heart disease. And whether the second
process occurs appears to be related to whether the person experiences stress.
The  implications of this for preventing disease are potentially profound:

     For example, since the main cause of myocardial ischemia (heart attacks) is
     a thromboembolic event it is difficult to see how changes in cholesterol
     levels in adult males will dramatically change outcomes since there is no
     evidence that cholesterol has a major clinical effect on the thromboembolic
     process.  This may be one of the reasons why risk modifications by trying
     to lower cholesterol levels has not had a dramatic effect on the incidence
     of heart attacks. Coronary Heart Disease from a Population Perspective,
     M.G. Marmot & J.F. Mustard. In Why are Some People Healthy and Others Not?
     The Determinants of Health of Populations, R.G. Evans, M.L. Barer, & T.R.
     Marmor (eds). New York: Aldine de Gruyter, 1994.,p.213

     These and numerous other studies indicate that there are additional
societal factors that provide much better explanations than the traditional risk
factors related to lifestyle of why some people stay healthy and others become
ill. These factors have been named social determinants of health and a solid
body of evidence now exists concerning their importance in determining whether
people become ill or stay healthy. What might some of these social determinants
of health be?