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Don't worry, be happy: how positive emotions can help protect the heart
A session tomorrow looks at the evidence for laughter, music and job stress (less of it) in enhancing cardiovascular health
Topics:
Cardiovascular Disease Prevention - Risk Assessment and Management
Date: 27 Aug 2011
 Couch potatoes the world over can sit back and smile at the research of Michael Miller, who suggests that you can derive as much cardiovascular benefit from watching your favourite comedy programme as going for a run.
“We’re not talking about a simple chuckle,” says Miller, “but mirthful laughter - which is more of a deep belly laugh that brings tears to your eyes and makes you almost feel as though you’ve almost had a workout.” Miller, from the University of Maryland, Baltimore, believes that laughter needs to last for about 15 seconds.
Laughter, he will tell the symposium, exerts its beneficial effects through the release of endorphins by the brain, which activate receptors on the endothelium which in turn lead to the release of nitric oxide. “Nitric oxide dilates blood vessels, reduces inflammation, cholesterol deposition and clotting,” says Miller.
In their first study Miller and colleagues gave questionnaires to 150 patients who had suffered an MI and to 150 age-matched controls and found that those who had heart disease had a 40% reduction in their ability to find humour in different situations (Int J Cardiol 2001; 80: 87-8). “It’s hard to judge whether patients originally had less humour or whether their illness had made them less humorous,” he says.
In the second study the same group looked at laughter as an active player and studied the impact that positive emotions had on vascular reactivity (Heart 2006; 92: 261-262). With ultrasound they measured the diameter of the brachial artery in 20 non-smoking healthy men and women who on one day watched clips of comedy films, while on another day watched the stressful opening sequence of Saving Private Ryan. The results showed that blood flow was enhanced by 22% in those watching the funny film, but decreased by 35% in those watching the stressful film. “The magnitude of the effects we saw were similar to the effects of exercise or taking a statin,” says Miller, who now believes that a study is needed which looks at the long-term effects of laughter on cardiovascular health.
The ideal study, he says, would involve randomising people who have had an MI to either standard of care or standard of care plus a programme of positive emotions on a regular basis. Unfortunately, funding for such a study has proved impossible to find.
In the meantime, Miller prescribes humour for all his patients. “The number one thing is not to take yourself too seriously,” he says, adding somewhat disappointingly that probably the best thing you could do for your heart would be to run on a treadmill while watching a humorous film.
Study finds stress at work associated with ‘excess CHD’
Psychosocial job strain has been shown to be an independent risk factor for cardiovascular disease, Tea Lallukka will tell the symposium tomorrow.
While specific physical and chemical occupational hazards with a direct impact on cardiovascular pathology have been identified, a far larger proportion of the workforce in modern economies is exposed to mental and emotional demands at work.
“Stressful experiences at work seem to be elicited by a lack of reciprocity between efforts spent at work and rewards received in return,” says Lallukka, a social epidemiologist at the University of Helsinki. Those rewards might include money, promotion prospects, job security, and self-esteem, together with low job control to meet the demands imposed by a “24 hour society” requiring work to be done at any time and place.
Indeed, a systematic review and meta-analysis of 14 prospective cohort studies by Mika Kivimäki, which included more than 83,000 employees, showed that work stress was associated with a 50% excess of coronary heart disease.
But the association between job strain and cardiovascular disease is not clear cut. Job strain shows some associations with behavioural coronary risk factors, such as physical inactivity, smoking, unhealthy eating habits and heavy drinking, which may each lead to indirect effects of job strain on coronary artery disease.
“It has been hypothesised that employees compensate for high psychosocial job strain and working overtime with such adverse behaviours,” said Lallukka, but the evidence has been mixed.
A review of 46 studies by Johannes Siegrist provided only modest support for the association between job strain and adverse health behaviours. Interventions, said Lallukka, are needed at both the individual level and in the workplace. “It’s important to help stressed employees cope better with their work situations,” she explains, “and also at the organisational level to pay attention to creating opportunities for control over work hours.”
Bach or Beta blockers?
In tomorrow’s symposium Hans-Joachim Trappe, pictured right, an organist and cardiologist from the University of Bochum, Herne, Germany, will explore how listening to classical music has the potential to decrease blood pressure and heart rate.
Some evidence for the effect of music on the cardiovascular system comes from a study by Luciano Bernardi and colleagues from the universities of Milan, Oxford and Pavia who tracked the cardiovascular and respiratory profile of 24 healthy subjects aged 24 to 26 years while they were exposed to various pieces of music (Circulation 2009; 30: 3171-80). Twelve of the subjects were experienced choristers and 12 were age- and sex-matched controls with no musical training.
The study found that music with faster tempos resulted in increased breathing, heart rate and blood pressure, while the slower music caused declines in heart rates; swelling crescendos (gradual volume increases) induced moderate arousal while decrescendos (gradual volume decreases) induced relaxation. Furthermore, they found that specific music phrases (frequently at a rhythm of 6 cycles/minute in famous arias by Verdi) synchronised inherent cardiovascular rhythm.
“Music as therapy would be an option for all since it has been reported that musicians and non-musicians alike showed similar qualitative responses,” said Trappe, who in May made an organ recording for the German Heart Foundation in St Sulpice, Church, Paris.
 Trappe and colleagues are currently undertaking music studies in 36 pigs and 60 healthy human volunteers to see if there are differences in blood pressure, respiration rate and cortisol levels when exposed to Bach, the heavy metal group “Disturbed” and controlled episodes of silence.
“From this study we hope to understand more about why music produces its beneficial effects on blood pressure. If our hypothesis is correct we should see the same effects in animals and humans,” said Trappe, who has found that some subjects listening to heavy metal showed episodes of atrial fibrillation.
“Heavy metal has the potential to be dangerous. It encourages rage, disappointment and aggressive behaviour while causing both heart rate and blood pressure to increase,” he said.
Trappe firmly believes that classical music offers the ideal therapy for patients with hypertension and increased heart rates. He is now planning a prospective study - “Bach or beta blockers” - in which patients with hypertension will be randomised to one or the other and followed with continuous blood pressure monitoring.
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Authors: Janet Fricker, ESC Congress News
For background information or independent comment, contact the ESC Press Office:
Tel: +33 (0)4 92 94 86 27. Fax: +33 (0)4 92 94 77 51. Email: press@escardio.org
References
Don’t worry, be happy
Sunday 28 August 11:00 - 12:30, Lisbon - Zone D, FP# 346 to 352
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