The latest findings from the UK's Whitehall II study found that people who believe stress is affecting their health "a lot or extremely" had double the risk of a heart attack compared to people who didn't believe stress was having a significant effect on their health.
After adjusting for factors such as biological, behavioural or psychological risk factors, they still had a 50 per cent greater risk of suffering or dying from a heart attack, researchers said.
"This current analysis allows us to take account of individual differences in response to stress," said Dr Hermann Nabi, the first author of the study.
Nabi and his colleagues from France, Finland and the UK, followed 7268 men and women for a maximum of 18 years from 1991.
The average age of the civil servants in this analysis was 49.5 and during the 18 years of follow-up there were 352 heart attacks or deaths as a result of heart attack.
Data from the British National Health Service enabled researchers to follow the participants for subsequent years and to see whether or not they had a heart attack or died from it by 2009.
After adjusting for socio-demographic characteristics, civil servants who reported at the beginning of the study that their health had been affected "a lot or extremely" by stress had more than double the risk (2.12 higher) of having a heart attack or dying from it compared with those who reported no effect of stress on their health.
"We found that the association we observed between an individual's perception of the impact of stress on their health and their risk of a heart attack was independent of biological factors, unhealthy behaviours and other psychological factors," researchers said.
The study was published in the European Heart Journal.
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