Behavioural epidemiology and coronary heart disease: some sources of error and an alternative conceptual model

While the quantity of evidence relating behaviour and coronary heart disease is great, the quality is variable. It is possible to discern two broad categories of research error, the methodological and the conceptual, to account for this. The former may be corrected by sufficiently careful study design: the latter may require a complete re-examination of hypotheses. An alternative conceptual model is proposed in which three components (a) a surfeit of adversity in the absence of support, (b) consequent arousal and activation of the cardiovascular system, and (c) the coexistence of one or more of a well documented set of organic risk factors, allow the integrated and systematic testing of hypotheses relating behaviour and coronary heart disease. The authors are presently employing this conceptual model in the investigation of a number of such hypotheses.