And if stress in childhood can lead to heart disease, what about current stresses? Longer work hours, threats of layoffs, collapse in pension funds. A study last year in the Lancered examined more than 11,000 heart attack sufferers from 52 countries. It found that in the year before their heart attacks, patients have been under significantly more stress than some 13,000 healthy control subjects. Those stresses came from work, family, financial trouble, depression and other causes.

Each of these factors individually was associated with increased risk, says Dr. Salim Yosef, professor of medicine at Canada’s McMaster University, and senior investigator on the study. Together they accounted for 30% of overall heart attack risk, but people respond differently to high pressure work situations. Whether it produces heart problems seems to depend on whether you have a sense of control over life, or live at the mercy of circumstances and superiors.

That was the experience of Jano Cano, a roughed Illinois laboratory manager, who suffered his first heart attack in 1996 at the age of 56. In the two years before, his mother and two of his children had suffered serious illnesses, and his job had been changed in a reorganization. “My life seemed completely out of control,” he says, “I had no idea where I would end up.” He ended up in hospital due to a block in his artery. Two months later, he had a triple bypass surgery. A second heart attack when he was 58 left his doctor shaking his head. “There’s nothing more we can do for you,” doctors told him.

23. What does the passage mainly discuss?

24. What do we learn about Jano Cano’s family?

25. What did Jano Cano’s doctors tell him when he had a second heart attack?

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