Osika Telluride July 2012. PDF

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

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

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

Early vascular & autonomic dysfunc7on (+ inflamma5on etc)

Cardiovascular disease in old age

Children Old age Adults

No symptoms Symptoms

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

Myocardial infarc7on, stroke, arterial disease

Vascular + autonomic dysfunc7on + inflamma7on = Atherosclerosis

Aging

•  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

Myocardial infarc7on linked to:

Stellar 2012

Method 1

Early detec7on of vascular impairment

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

Central arteries

Peripheral arteries

Small sensors on the finger7ps


Pulse waves analyzed, how much increase acer occlusion ?

Occlusion 5 min with blood pressure cuff

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

control

Measure of dila7on acer cuff release, larger = healthier Used for risk stra7fica7on in adults Worse in adult depression FDA approved


Method 2

Autonomic regula7on Mental stress

Vasoconstric7on

Heart rate measurements, covered by the following talk

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

Hassan, Sheps et al 2008

Mental stress -‐ vasoconstric7on

Responder: vasoconstric7ve response to mental stress

Non responder

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

•  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

Kieling et al. Lancet 2011

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…

ANOVA F=3.94, P=0.022 1.75

1.50

1.25

1.00

0.75

0.50

0.25

0.00

Depression score ANOVA F=3.50, P=0.033 1.75

1.50

1.25

1.00

0.75

0.50

0.25

0.00

Anger score ANOVA F=2.57, P=0.081 1.75

1.50

1.25

1.00

0.75

0.50

0.25

0.00

Anxiety score

Vascular func7on linked to psychological distress, girls (12-‐16 years)

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

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

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A

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Mental stress

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

B

A

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D

Mental stress

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

Challenges:

Measurements of both psychological AND physiological changes

Interven7on costs covered by the school?Community?Health care system?

Winners: Individuals, health care system, society

”Please wait a sec, we are busy prac7sing compassion”

Stephanie Brown

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

CCARE Sweden, SACER •  Chris7na Andersson •  Stefan Einhorn •  Eva Bojner Horwitz •  Dan Hasson •  Camilla Sköld •  Jörgen Herlofsson •  Cecilia Stenfors •  Janne Spetz

Stress Research Ins?tute, Stockholm University •  Aleksander Perski •  Töres Theorell •  Torbjörn Åkerstedt

Clinical Neuroscience, Karolinska Ins?tutet •  Ivanka Savic Berglund •  Maki Kasahara •  Emilia Len7ni •  Fredrik Livheim

Compassion training, pilot study

Vasoconstric7on

Mental stress Autonomic regula7on

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.

4.00

3.50

3.00

2.50

2.00

1.50

1.00

*** Depression score

4.50

4.00

3.50

3.00

2.50

2.00

1.50

***

Anger score 3.90

3.60

3.30

3.00

2.70

2.40

2.10

*** Anxiety score

Boys Girls

4.00

3.00

2.00

1.00

0.00

ns

Disrup7ve behavior score

Boys Girls

4.20

3.90

3.60

3.30

3.00

ns

Self concept

Boys Girls

30

25

20

15

10

5

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SDQ

School study: Girls reported more psychological distress(n=230+)

Osika et al. 2009

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.

High levels of soluble intercellular adhesion molecule-‐1, (insulin resistance and saturated fasy acids are associated with endothelial dysfunc7on in healthy adolescents.

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Osika Telluride July 2012. PDF