In this study, the role of psychological make-up was assessed as a risk factor in the etiology of vasospasm in variant angina (VA) using the Cornell Medical Index (CMI). Study subjects consisted of 15 patients with VA; 32 with effort angina or old myocardial infarction having no vasospasm (EA + OMI); and 34 healthy men. For a neurosis discriminative diagram, the areas I and II were judged as normal and the areas III and IV were judged compatible with a neurotic disorder. Correlation of serum lipid levels with psychological factors was attempted. 1. Among the VA patients, 46.7% belonged to the areas III and IV, as compared to 18% of the patients with EA + OMI, and 2.6% of the healthy subjects. 2. Seventy-three percent of the VA group showed anxiety states indicating a correlation with a psychological disorder. 3. A majority of the VA patients had a variety of psychological symptoms unrelated to myocardial ischemia. 4. Total cholesterol, triglycerides, LDL cholesterol, serum uric acid and the atherogenic index were all lower in the VA group than in the EA + OMI group. 5. In the EA + OMI group, triglycerides, serum uric acid and the atherogenic index were higher in the psychological group than in the non-psychological group. However, total cholesterol, LDL cholesterol and HDL cholesterol were lower in the former than in the latter group. It was concluded that an anxiety state constitutes a contributing background for developing VA and it was speculated that such an anxiety state may lead to an exaggerated secretion of stress hormones, resulting in vasospasm of the coronary arteries.