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Abstract It has been well-established that psychological factors can act as risk factors for acute coronary syndromes. While evidences indicate effects of psychological factors on immune system, the role of this system in progression of coronary artery disease (CAD) and its clinical manifestations was confirmed. Thus it seems that the association between psychological factors and CAD is mediated in part by immune system parameters. The purpose of this review is to explain the role of psychoneuroimmunological processes which may contribute to progression of established CAD and show that established CAD is a clinical manifestation of pathophysiological mechanisms accounting for the link between psychological risk factors, immune system factors, and acute coronary syndromes. Psychological risk factors for coronary artery disease can be classified into three categories. Chronic psychological risk factors … may be involved in early disease stages, episodic factors … are considerable for the transition from stable to unstable atherosclerotic plaques, and acute psychological factors may promote myocardial ischemia and plaque rupture. This review describes the role of the psychoneuroimmunological mechanisms for each of three categories of psychological risk factors for acute coronary syndromes. Keywords: Psychoneuroimmunology, Coronary artery disease, Psychological risk factors, Pathogenesis, Mediator.