Fifty men with clinically manifest ischemic heart disease (IHD), fifty men with risk indicators of IHD and fifty healthy men were interviewed about experiences of psychological stress in work, family life and education. They were also examined for the presence of hypertension, hyperlipidemia, hyperglycemia, hyperuricemia, obesity, impaired pulmonary function, smoking and alcohol consumption. The relative risk of developing clinical IHD associated with the experience of psychological stress during the five years prior to onset of symptoms was calculated. It was found to be six times greater with than without such experience. This relative risk was not reduced when controlling for conventional risk indicators by means of a multivariate confounder score. When the IHD group was compared to the group with merely risk indicators, the relative risk related to stress was statistically significant, but not when the latter group was compared to the control group. The results indicate that the experience of stress as it is defined in this study may contribute to the development of clinical manifestations of IHD, irrespective of the presence of conventional risk indicators.