Integrating into the clinical practice of medicine the recent evidence that psychiatric illness and mental stress contributes to the development of cardiovascular disease has not been a seamless process. The evidence for such a link, in fact, had been slow in materializing. The importance of acute mental stress as a trigger for cardiac catastrophes (acute myocardial infarction, sudden death) and of depressive illness as a cause of coronary heart disease, however, is now firmly established. But the spectre of workplace litigation still does hang over the field, clouding the arguments and polarizing medical opinion. Now that a consensus finally seems to have been reached that mental stress, including in the workplace, is an important cause of coronary heart disease and hypertension, it is hoped that the primary outcome will be the implementation of preventive measures to reduce stress in the workplace, such as worker empowerment to end the very adverse high demand/low job control scenario, rather than a rash of lawsuits. Copyright © 2008 John Wiley & Sons, Ltd.