Jonathan Sackner Bernstein, MD Cardiologist: The role of stress in cardiovascular risk is very, very poorly defined. I think that it is, there are those that would probably take exception with that statement, but I think that if you look at all of the studies together, you realize that there are a lot more questions than there are answers. If you look closely at some of the studies in animals exposed to different stress ors, you start to see a very, very strong set of data that says that stress plays a role. Figuring that out in people, how to expose people to stress in a controlled way, or how to measure stress is so much more difficult, that I just think it is going to be hard to show a link between stress in humans and cardiovascular disease. Now with that touch of cynicism then I'll give you to the way that the studies can be done and whether the data is definitive or not, I believe from this circumstantial evidence that dealing with stress is a very important part of things. Certainly if you look at stress as it relates to a more extreme or more focused, or a more specific approach, such as people who are very hostile, or very angry, well if stress is leading to hostility and anger, hostility and anger, I think there's a stronger link between them and health risks in general. So, none of these are proven, but I think that if you were to pay attention to the literature as a whole and also look at the experience that many of us has had, stress does seem to play a role, and I think if not on the risk on a cardiovascular event, certainly in the terms of peoples' quality of life. So when I'm interacting with a patient and they want to know did stress play a role in this, I usually tell them, well I would guess it did, but nobody could prove that scientifically. On the other hand, if you don't figure out a way to deal with your stress, if I can't give you some insights or you can't figure it out from some other place, then what I know is that your quality of life won't be as good. And even if that's the way stress plays a role, I think it's worth trying to deal with, figuring out ways to reduce people's stress.