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

(+ inamma5on etc)

Cardiovascular disease in old age

The Age Ladder, by Winter Carl Hansson, Danielsgrden, Bingsj, 1799.

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

Myocardial

No symptoms

Symptoms

infarc7on, stroke, arterial disease

Vascular + autonomic dysfunc7on + inamma7on = 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

Mller 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 nger7ps

Early detec7on of vascular impairment

Occlusion 5 min with blood pressure cu Measure of dila7on acer cu release, larger = healthier Used for risk stra7ca7on 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

Aect 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 rst 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

Time (min)

1,5

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 14.51 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 (=-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?

Benets 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 iden7ed: 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 Whrborg Frida Dangardt Gun Bodehed Berg Reinhard Volkmann Yun Chen Li Ming Gan Stress Research Ins?tute, Stockholm University Aleksander Perski Tres Theorell Torbjrn kerstedt CCARE Sweden, SACER Chris7na Andersson Stefan Einhorn Eva Bojner Horwitz Dan Hasson Camilla Skld Jrgen 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 signicant dierence in the ability to upregulate (enhance) the nega7ve emo7on between the two groups, but burnout pa7ents were signicantly 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 signicant a_er adjus5ng for age, height, BMI-z-score, sex, blood pressure, HDL and smoking.

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