Data published within the last decade have revealed important influences of stress and psychological factors on the development and course of CHD, ranging from experimental data demonstrating cardiovascular consequences of stress (Steptoe and Kivimaki 2012) to life stress as a noteworthy risk factor for myocardial infarction (Yusuf et al. 2004).

Despite the growing body of evidence, stress and psychological factors are not included in a recent review focusing on risk factors for cardiovascular incidence (Berry et al. 2012). This absence may be in part explained by the lack of a clear definition of stress and clear guidelines on how to assess and record psychological factors in the general population as well as in patients with CHD.

Therefore, international boards working on this important topic should join and publish guidelines for the assessment of stress and psychological factors (i.e., considering the inclusion of technical developments like remote online assessments). This might help to gather important data in routine care as well as to collect important information about these risk factors.

From a behavioral approach, research focusing on stress and psychological factors should include moderating variables such as diet and physical activity. Different long-term patterns and acute effects of these behaviors seem to be connected to cardiovascular reactivity which might be a key determinant of cardiovascular disease.

From a psychological point of view, it is important to note that providing information alone about healthy lifestyle or strategies to reduce stress does not lead to desired changes in behavior (Soureti et al. 2012). Health psychological intervention strategies based on sound theories like self-determination theory or health action process approach including individual goal setting and implementation strategies seem to be effective in changing behavior (Platter et al. 2012) and might help to prevent future cardiac incidents (Ornish 1990; Ornish et al. 1998). Limiting aspects are that CBT programs are time consuming and rarely available outside university cities. Research has shown important developments in web-based health-behavior change programs (Civljak et al. 2010), and trials bringing more knowledge about web-based CBT approaches in cardiovascular prevention and treatment of CHD might help to implement best practice approaches within routine care. Lieber et al. (2012), for example, report on encouraging results regarding the effects of a 12-week, web-based, and self-directed lifestyle intervention for women.

Research has shown considerable gender-specific differences indicating that women are more sensitive with regard to psychosocial risk factors. Focus on research and development of gender-specific prevention strategies and treatment options is becoming more important (Hallman et al. 2001).

Overall, psychosocial factors have been shown to be primary risk factors. A variety of intervention strategies exist to improve and foster a healthy lifestyle to tackle CHD as the lifestyle disease of the twenty-first century.