A Review in The Lancet reveals the importance of healthy lifestyle choices to reduce stressors related to cardiovascular risk factors. Researchers from John Hopkins Hospital in Baltimore examined records between 1990 to 2006. They observed how stress affects the sympathetic nervous system, impacts physiology, and the effect it has on the cardiovascular system. Lead author, Daniel Brotman, claims "Acute physical stressors such as sugery, trauma, and intense physical exertion are well known triggers of cardiovascular events. Emotional stressors are increasingly recognized as precipitants of such events."

Major life changes connected to phychological or emotional adjustments can increase the chance of cardiac problems. During the month following the 911 attacks, the rise in fear led to two to three times the normal rate of defibrillator firings. Researchers believe that daily fluctuations in stress hormones and endothelial dysfunction account for why people have varying responses to stress and why stress related cardiovascular events are more common in the morning.

From this review, researchers believe that stress is a serious, but potentially modifiable, risk factor for acute and chronic cardiovascular disorders. Doctors should carefully assess symptoms such as chest pain that can arise from negative emotions. Researchers believe that doctors "should help their patients to alleviate unnecssary psychological strain by advising that a healthy lifestyle should include stress reduction, anger management, and treatment of mental illness".