tories of allostatic load. It is, in fact, such early precursors that are believed to initiate the cumulative physiological wear and tear that the concept of allostatic load is intended to capture. Investigations along these lines will require increased assessment of co-occurring components of physiological risk (e.g., function of the cardiovascular system, the HPA axis, sympathetic nervous system function, metabolic risk, immune function) early in life as well as their long-term sequelae in later life comorbidity.

RECOMMENDATIONS

A basic research initiative throughout NIH should focus on predisease pathways. Such an initiative would, of necessity, emphasize the unfolding interactions between environmental influences and gene expression over time. It should include the following topics:

  • identification of early markers of predisease states;

  • examination of their genetic and environmental origins through animal and human studies;

  • identification of behavioral risk factors in the exacerbation or amelioration of predisease pathways;

  • prioritization of experimental and longitudinal research to chart these trajectories across the life span;

  • focus on the mechanisms by which genetic influences, early life experiences, and behavioral and psychosocial risk factors across the life span interact, leading to accumulating physiological risk for a broad range of disease outcomes.

REFERENCES

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Amkraut A , Solomon GF. 1977 “From the symbolic stimulus to the pathophysiologic response: Immune mechanisms” in Lipowski ZJ , Lipsitt DR , Whybrow PC. (eds.). Psychosomatic Medicine: Current Trends and Clinical Applications ( New York Oxford University Press ).

Ballard M , Cummings EM , Larkin K. 1993 “Emotional and cardiovascular responses to adults' angry behavior and to challenging tasks in children of hypertensive and normotensive parents” Child Development 64 : 500-515 .

Beitner-Johnston D , Guitart X , Nestler EJ. 1992 “Neurofilament proteins and the mesolimic dopamine system: Common regulation by chronic morphine and chronic cocaine in the rat ventral tegmental area” Journal of Neuroscience 12 : 2165-2175 .

Blumenthal JA , Emery CF , Walsh MA , Cox DR , Kuhn CM , Williams RB , Williams RS. 1988 “Exercise training in healthy type A middle-aged men: Effects of behavioral and cardiovascular responses” Psychosomatic Medicine 50 : 418-433 .

Booth-Kewley S , Friedman HS. 1987 “Psychological predictors of heart disease: A quantitative review” Psychological Bulletin 101 : 343-362 .



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