Lack  of  compassion  in  childhood  and   subesequent  cardiovascular  disease    

vascular  and  autonomic  func7on  as  mediators  of   increased  risk  
 

MD,  PhD  Walter  Osika  
 

The  Science   of  Compassion   Origins,  Measures  and  Interven5ons   July  19-­‐22,  2012  -­‐  Telluride,  Colorado  

Outline  
•  1.  Atherosclerosis  &  myocardial  infarc7on  in  a   life  cycle  perspec7ve   •  2.  Mind-­‐heart  interac7ons  in  children   •  3.  Summary  +  possible  future  studies  

Life  cycle  perspec7ve  of  atherosclerosis:     starts  early,  but  disease  shows  up  late  

Early  vascular  &   autonomic     dysfunc7on    
(+  inflamma5on  etc)  

Cardiovascular   disease  in  old   age  

The  Age  Ladder,  by  Winter  Carl  Hansson,  Danielsgården,  Bingsjö,  1799.    

Development  of  cardiovascular  disease     (nr.1  killer  globally,  WHO  2008)  

Myocardial  

No  symptoms  

Symptoms  

infarc7on,  stroke,   arterial  disease  

Vascular  +  autonomic    dysfunc7on  +  inflamma7on  =  Atherosclerosis  

Children  

Adults  

Aging   Old  age  

Myocardial  infarc7on  linked  to:  
•  •    •  •  •  •  Socioeconomic  disadvantage   Unfairness   Anger   Hos7lity   Depression   Stress  

•  Vascular  &  autonomic                dysfunc7on            Lack  of  compassion?    (Dean  Ornish:  Open  your  heart)            Puzzling:  Low  class  -­‐  more  compassion  towards  others  

Möller  1999,  Rozanski  1999,  Williams  2000,  Hemingway  2001,  Rosengren  2004  Chida  &  Steptoe  2009  

 

Stellar  2012  

Method  1  

Early  detec7on  of  vascular  impairment    
Central   arteries  

Peripheral     arteries  

Similar  processes  in  central  &   peripheral  arteries     Easy  non-­‐invasive  access  to   peripheral  arteries  valuable   when  assessing  interven7ons     Dont  have  to  wait  for  decades   for  outcome    

Early  detec7on  of  vascular  impairment  

Pulse  waves  analyzed,  how  much     increase  acer  occlusion  ?   Small  sensors  on  the  finger7ps    

Early  detec7on  of  vascular  impairment  
Occlusion  5  min   with  blood   pressure  cuff   Measure  of  dila7on   acer  cuff  release,     larger  =  healthier     Used  for  risk     stra7fica7on  in   adults     Worse  in  adult   depression     FDA  approved  

control  

Bonef  et  al  .J  Am  Coll  Cardiol  2004;44:2137–  41  

Method  2  

Autonomic  regula7on  
Mental   stress  

Heart  rate   measurements,   covered  by  the   following  talk  

Vasoconstric7on  

Mental  stress  -­‐  vasoconstric7on  
Non  responder  

Responder:   vasoconstric7ve   response  to  mental   stress    

Vasoconstric7on  during/acer  mental  stress  =  bad  sign,     more  frequent  in  males  
                 

                         Hassan,  Sheps  et  al  2008  

Psychological   distress  related  to   early  markers  of   disease  in  the   young?  

?  

Psychological   distress  and   heart  disease  in   adults-­‐   established  link  

Mental  health  problems  common  in   the  young  
•  Affect  10-­‐20%  of  children  and  adolescents   worldwide,  account  for  large  por5on  of  global   burden  of  diseases     Kieling  et  al.  Lancet  2011   •  Self-­‐perceived  psychosoma7c  health  in  young   people  (10  to  24  years  of  age)  during  the  years  2005,  2007  to  2010                  via  a  community  website   •  >130  000  answers  in  2005-­‐2010    
Friberg,  Hagquist,  Osika,  in  press  

Results:  
•  High  percentage  responded  they  felt  stressed   very  ocen/ocen;  higher  for  females  (47%)  than   for  males  (29%).   •  Both  sexes  reported  a  slightly  worse  self-­‐ perceived  health  status  in  2010  than  in  2007.   •  Lack  of  self-­‐compassion?        
Friberg,  Hagquist,  Osika,  in  press  

Psychological  and  vascular  func7on  in   children  
  •  Link  between  vascular  func7on  and  psychological   distress    -­‐  already  in  childhood?   •  Vascular  func7on     •  Self  assessed  psychological  health   •  Compassion  scales  in  childhood?  Not  in  swedish…  

Vascular  func7on  linked  to  psychological   distress,  girls  (12-­‐16  years)  
Depression  score  
1.75   1.50   1.25   1.00   0.75   0.50   0.25   0.00  

Anger  score  
1.75   1.50   1.25   1.00   0.75   0.50   0.25   0.00  

Anxiety  score  
1.75   1.50   1.25   1.00   0.75   0.50   0.25   0.00  

ANOVA  F=3.94,  P=0.022  

ANOVA  F=3.50,  P=0.033  

ANOVA  F=2.57,  P=0.081  

More  psychological  distress  –  worse  vascular  func7on  
 

Mental  stress  and  vascular  reac7vity,  same  cohort  
•  Vascular  response  curve:   mental  arithme7c  test   performed  during  the  first   minute.     •  More  pronounced  &   prolonged  constric7on  in  boys  
•  High  cardiovascular  reac5vity  to   stress  is  associated  with  poor   subsequent  cardiovascular  risk   status  

A
PAT response

1,4 1,2 1,0 0,8 0,6 0,4 0,2 0,0 0

Girls, 17-20y Girls, 7-12y

Boys, 17-20 y Boys, 7-12y

Mental stress
0,5

B

Time (min)

1

1,5

2

Values  are  means  ±***  SE.  

***

Chen,  Osika  et  al.  2011    Chida  et  al  2010  

Longitudinal  study  
•  Three-­‐year  follow-­‐up       •  Again:  Psychological  distress  –  self  reported   •  Again:  Vascular  func7on  
•  Adjusted  for  physical  ac5vity,  smoking  and  parental  educa5on   •  162  adolescents  (94  females)  par5cipated  in  both  baseline   (mean  age  14.5±1  years)  and  follow  up    

Chen,  Y.,  Osika  W.,  et  al.  Impact  of  psychological  health  on  the  endothelial  func7on   and  the  HPA-­‐axis  ac7vity  in  healthy  adolescents.  Submised  

Results:  
•  Long-­‐term  nega7ve  emo7on  determinant  for   changes  in  vascular  func7on  over  three  years   in  male  adolescents  (β=-­‐0.299,  p=0.03)  
•  Females  had  increased  psychosoma5c  complaints,   males  reported  increased  depression  

Chen,  Y.,  Osika  W.,  et  al.  Impact  of  psychological  health  on  the  endothelial  func7on   and  the  HPA-­‐axis  ac7vity  in  healthy  adolescents.  Submised  

Preven7on  in  the   young   Compassion  training?  

Benefits”   direct  and  in   the  long  run   Winners:   Individuals,   health  care   system,  society   ”Please  wait  a  sec,   we  are  busy   prac7sing   compassion”   Stephanie  Brown  

Challenges:   Measurements  of  both   psychological  AND   physiological  changes   Interven7on  costs   covered  by  the  school? Community?Health   care  system?  

Summary  
Several  lack-­‐of  compassion  situa7ons  iden7fied:   •  Anger  &  depression:  Myocardial  infarc7on   •  Special  case:  low  socioeconomic  class  increased  risk  of   disease,  but  show  more  compassion  towards  others   •  Psychological  distress  and  vascular  impairment  associated       already  in  the  young   •  Develop  measures  of  compassion  in  the  young?   •  Physical  exercise  –  beser  compassion  capacity?   •  Customize  interven7on  studies  in  the  young,  based  on   physiology  +  psychology  pre-­‐tes7ng?    

Compassion  training,  vascular  respons    

1. Harassment  

2. Harassment  

Thanks  for  listening  
Sahlgrens  Academy,   Gothenburg  University   •  Peter  Friberg   •  Peter  Währborg   •  Frida  Dangardt   •  Gun  Bodehed  Berg   •  Reinhard  Volkmann   •  Yun  Chen     •  Li  Ming  Gan   Stress  Research  Ins?tute,   Stockholm  University   •  Aleksander  Perski   •  Töres  Theorell   •  Torbjörn  Åkerstedt   CCARE  Sweden,  SACER   •  Chris7na  Andersson   •  Stefan  Einhorn   •  Eva  Bojner  Horwitz   •  Dan  Hasson   •  Camilla  Sköld   •  Jörgen  Herlofsson   •  Cecilia  Stenfors   •  Janne  Spetz  
Clinical  Neuroscience,     Karolinska  Ins?tutet   •  Ivanka  Savic  Berglund   •  Maki  Kasahara   •  Emilia  Len7ni   •  Fredrik  Livheim  

Compassion  training,  pilot  study  

Mental   stress  

Autonomic  regula7on  

Vasoconstric7on  

a  group  of  pa7ents  who  had  been  diagnosed  as  “burnout”       (of  work-­‐related  chronic  stress)  on:      1)  emo7onal  reac7vity  to  nega7ve  visual  s7muli,    2)  regula7on  of  the  nega7ve  emo7on,  and    3)  the  func5onal  and  structural  brain  networks      There  was  no  significant  difference  in  the  ability  to  upregulate  (enhance)     the  nega7ve  emo7on  between  the  two  groups,    but  burnout  pa7ents  were  significantly  less  able  to  downregulate  (suppress)    their  nega7ve  emo7on.      

School  study:  Girls  reported  more  psychological   distress(n=230+)  
Depression  score  
4.00   3.50   3.00   2.50   2.00   1.50   1.00   Disrup7ve  behavior  score   4.00   3.00   2.00   1.00   3.00   0.00  

Anger  score  
4.50   4.00   3.50   3.00   2.50   2.00   1.50   Self  concept   3.90   3.60   3.30   3.00   2.70   2.40   2.10  

Anxiety  score  

***  

***  

***  

SDQ  
30   25   20  

ns  

4.20   3.90   3.60   3.30  

ns  

***  

15   10   5  

Girls  

Boys  

Girls  

Boys  

Girls  

Osika  et  al.  2009    

Boys  

High  levels  of  soluble  intercellular  adhesion   molecule-­‐1,  (insulin  resistance  and  saturated   fasy  acids  are  associated  with  endothelial   dysfunc7on  in  healthy  adolescents.  
ICAM-­‐1  mediates  the  adhesion  of  lymphocytes,  monocytes,   eosinophils,  and  basophils  to  vascular  endothelium.  It  also   func7ons  in  leukocyte-­‐endothelial  cell  signal  transduc7on,   and  it  may  play  a  role  in  the  development  of  atherosclerosis.   The  RHI  was  inversely  associated  with  plasma  ICAM-­‐1   (p=0.0003),  HOMA  index  for  insulin  resistance  (HOMA-­‐IR,   p=0.001)  and  saturated  fasy  acids  of  plasma  phospholipids   (SFA,  p=0.001).    

The  associa5ons  remained  significant  a_er  adjus5ng  for  age,  height,  BMI-­‐z-­‐score,   sex,  blood  pressure,  HDL  and  smoking.    

In  healthy  adolescents  impaired  endothelial  func7on  is   significantly  associated  with  high  level  of  soluble  ICAM-­‐1,   HOMA-­‐IR  and  SFA.  

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