Editor,—In their recent paper Carrollet al 1 showed that men and women in non-manual occupations exhibited greater diastolic blood pressure and heart rate responses to a mental arithmetic test than did people in manual occupations, a finding that they contrasted with known socioeconomic patterning of cardiovascular disease. They also demonstrated lower systolic blood pressure and heart rate reactivity to the test in women, which they considered more consistent with sex differences in cardiovascular disease. It does indeed seem likely that lower catecholamine and blood pressure reactivity to stress in women is one of the explanations for their lower rates of cardiovascular disease, an effect that has been ascribed largely to the effects of oestrogen.2

However, I suggest that Carroll et al cannot claim to have tested cardiovascular reactivity to stress, but only cardiovascular reactivity to a mental arithmetic test. Presumably the authors' aim was to use a mental arithmetic task to cause feelings of stress among participants, but they provide no information on whether this was indeed the …