Impact of cinematic viewing on endothelial function

Translational Research of the Acute Effects of Negative Emotions on Vascular Endothelial Health: Findings From a Randomized Controlled Study

BACKGROUND

Provoked anger is associated with an increased risk of cardiovascular disease events. The underlying mechanism linking provoked anger as well as other core negative emotions including anxiety and sadness to cardiovascular disease remain unknown. The study objective was to examine the acute effects of provoked anger, and secondarily, anxiety and sadness on endothelial cell health.

METHODS AND RESULTS

Apparently healthy adult participants (n=280) were randomized to an 8-minute anger recall task, a depressed mood recall task, an anxiety recall task, or an emotionally neutral condition. Pre-/post-assessments of endothelial health including endothelium-dependent vasodilation (reactive hyperemia index), circulating endothelial cell-derived microparticles (CD62E+, CD31+/CD42-, and CD31+/Annexin V+) and circulating bone marrow-derived endothelial progenitor cells (CD34+/CD133+/kinase insert domain receptor+ endothelial progenitor cells and CD34+/kinase insert domain receptor+ endothelial progenitor cells) were measured. There was a group×time interaction for the anger versus neutral condition on the change in reactive hyperemia index score from baseline to 40 minutes (P=0.007) with a mean±SD change in reactive hyperemia index score of 0.20±0.67 and 0.50±0.60 in the anger and neutral conditions, respectively. For the change in reactive hyperemia index score, the anxiety versus neutral condition group by time interaction approached but did not reach statistical significance (P=0.054), and the sadness versus neutral condition group by time interaction was not statistically significant (P=0.160). There were no consistent statistically significant group×time interactions for the anger, anxiety, and sadness versus neutral condition on endothelial cell-derived microparticles and endothelial progenitor cells from baseline to 40 minutes.

CONCLUSIONS

In this randomized controlled experimental study, a brief provocation of anger adversely affected endothelial cell health by impairing endothelium-dependent vasodilation.

Laughter as medicine: A systematic review and meta-analysis of interventional studies evaluating the impact of spontaneous laughter on cortisol levels

OBJECTIVES

Laughter as an expression of humor has been recognized as good medicine for centuries. The health benefits of humor-induced well-being remain unclear and thus we conducted a systematic review and meta-analysis of interventional studies to evaluate the impact of spontaneous laughter on stress response as measured by cortisol levels.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE/PubMed, EMBASE, PsycINFO, Scopus, and Clinicaltrials.gov.

ELIGIBILITY CRITERIA

Interventional studies, which could be either randomized placebo-controlled trials (RCTs) or quasi-experimental studies, conducted in adults that compared any spontaneous laughter intervention to a controlled setting and reported changes in cortisol levels were selected.

DATA EXTRACTION AND SYNTHESIS

We examined the impact of laughter on percentage change in cortisol levels by calculating pooled estimates of the absolute differences between arithmetic means before and after interventions as compared to control using random-effects model.

RESULTS

Eight studies (315 participants; mean age 38.6) met our inclusion criteria; four were RCTs and four were quasi-experiment studies. Five studies evaluated the impact of watching a humor/comedy video, two studies evaluating laughter sessions administered by a trained laughter therapist, and one study evaluating a self-administered laughter program. Pooling these data showed a significant reduction in cortisol levels by 31.9% (95%CI -47.7% to -16.3%) induced by laughter intervention compared to control group with no evidence of publication bias (P = 0.66). Sensitivity analyses demonstrated that even a single laughter session induced a significant reduction of 36.7% in cortisol (95%CI -52.5% to -20.8%). In addition, analyses including the four RCTs reinforced these results by demonstrating a significant reduction in cortisol levels promoted by laughter as compared to the placebo arm [-37.2% (95%CI -56.3% to -18.1%)].

CONCLUSIONS

Current evidence demonstrates that spontaneous laughter is associated with greater reduction in cortisol levels as compared with usual activities, suggesting laughter as a potential adjunctive medical therapy to improve well-being.

TRIAL REGISTRATION

Registration number: CRD42021267972.

Subjective Happiness, Frequency of Laughter, and Hypertension: A Cross-Sectional Study Based on the Japan Gerontological Evaluation Study (JAGES)

In recent years, positive psychological factors, such as subjective happiness and laughter, have been reported to be associated with cardiovascular disease. In this study, we examined the relationship of hypertension with subjective happiness and frequency of laughter using the data from the Japan Gerontological Evaluation Study (JAGES). Of the 138,294 respondents, 26,368 responded to a version of the self-administered questionnaire that included a question about the frequency of laughter in the JAGES 2013. In total, 22,503 (10,571 men and 11,932 women) were included in the analysis after excluding those with missing responses regarding a history of hypertension, frequency of laughter, and subjective happiness. The prevalence of hypertension in this study was 10,364 (46.1%). Multivariate logistic regression analysis showed that age, female sex, obesity, infrequent chewing, former and current drinker, seeing three to five friends, and the absence of hobbies were positively associated with hypertension. However, infrequent laughter/high level of subjective happiness, frequent laughter/high level of subjective happiness, being underweight, and current smoker were negatively associated with hypertension. As per the findings of this study, it was determined that subjective happiness was negatively associated with hypertension. Therefore, this study suggests that having more opportunities to feel happiness may be important in preventing hypertension.

Mental Stress and Cardiovascular Health-Part I

Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.

The effectiveness of bench step exercise for ameliorating acute mental stress-induced arterial stiffening

Purpose

This study aimed to evaluate the effectiveness of bench step (BS) exercise for ameliorating arterial stiffening caused by acute mental stress (MS).

Methods

Fifteen young healthy men participated in two randomized trials: rest (RE) and exercise (EX) trials. Following a 5-min MS task (first task), the RE trial participants rested on a chair for 10 min (from 10 to 20 min after task cessation); the EX trial participants performed BS exercise for the same duration. At 40 min after the first task, the participants performed the same task (second task) again. Heart–brachial pulse wave velocity (PWV) (hbPWV), brachial–ankle PWV (baPWV), heart–ankle PWV (haPWV), and the cardio-ankle vascular index (CAVI) were measured simultaneously at 5, 30, and 50 min after the first task.

Results

Both trials caused significant elevations in hbPWV, haPWV, and CAVI at 5 min after the first task; these changes persisted until 30 min after the task in the RE trial, while they were abolished in the EX trial. baPWV significantly increased at 30 min after the task in the RE trial, but not in the EX trial. After the second task (from 30 to 50 min after the first task), none of the parameters significantly increased in the RE trial, although the values remained above baseline levels. In the EX trial, hbPWV, haPWV, and CAVI showed significant elevations.

Conclusion

Our findings suggest that a 10-min BS exercise after acute MS can counteract stress-induced arterial stiffening, but has only a limited effect against subsequent acute MS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00421-022-04962-y.

The Association between Laughter and Functional Dyspepsia in a Young Japanese Population

The potential health benefits of laughter are recognized in relation to several chronic diseases. However, no study has yet investigated the association between laughter and functional dyspepsia (FD). The purpose of this study was to investigate this issue in a young Japanese population.

METHODS

This study was conducted on 8923 Japanese university students. Information on the frequency of laughter and types of laughter-inducing situations, digestive symptoms (Rome III criteria) were obtained through a self-administered, web-based questionnaire.

RESULTS

The percentage of respondents who laughed out loud almost every day was 64.3%. On the other hand, 1.8% of the subjects reported that they rarely laughed. No association was found between the total frequency of laughter and FD. Laughing while talking with family and friends almost every day was significantly inversely associated with FD (adjusted odds ratio (OR): 0.47 (95% confidence interval (CI): 0.28-0.81); p for trend was 0.003). On the other hand, laughing while watching TV or videos and laughing while looking at comics or magazines independently showed a positive correlation with FD (TV or videos: adjusted OR, 1-5 times a week: 1.74 (95% CI: 1.16-2.60); comics or magazines: adjusted OR, 1-5 times a week: 1.78 (95% CI: 1.08-2.81)).

CONCLUSION

In this young Japanese population, no association between laughter frequency and FD was observed although laughing while talking with friends and family was independently and inversely associated with FD.

Association between visual status and the frequency of laughter in older Japanese individuals: the JAGES cross-sectional study

Objective

Although the beneficial effects of laughter are abundantly reported, the physical function that is required as a premise for laughter has not been studied. The aim of this study is to investigate the association between visual status and frequency of laughter in a population-based sample of older adults.

Methods and analysis

We analysed cross-sectional data of community-dwelling independent individuals aged ≥65 years (n=19 452) in Japan. The outcomes were frequency of laughter and number of opportunities to laugh. We used multivariable logistic regression analysis with multiple imputations to investigate the association between visual status and laughter.

Results

The number of participants who laughed almost every day was 8197 (42.1%). After adjusting for individual covariates in the multivariable logistic regression analysis with multiple imputations, visual status was found to be significantly associated with the frequency of laugher and the number of opportunities to laugh (p for trend <0.01). Compare to 'normal vision', while excellent/very good vision was associated with increased frequency and number of opportunities to laugh (ORs: 1.72 and 1.25, respectively), poor vision decreased the frequency and number of opportunities to laugh (ORs: 0.86 and 0.87, respectively).

Conclusions

There is a link between visual impairment and laughter, with poor vision having a negative impact while good vision has a positive effect. Improving vision may lead to laughter promotion.

Association between Laughter and Lifestyle Diseases after the Great East Japan Earthquake: The Fukushima Health Management Survey

We investigated the association between the frequency of laughter and lifestyle diseases after the Great East Japan Earthquake. We included 41,432 participants aged 30-89 years in the Fukushima Health Management Survey in fiscal year 2012 and 2013. Gender-specific, age-adjusted and multivariable odds ratios of lifestyle diseases were calculated using logistic regressions stratified by evacuation status. Those who laugh every day had significantly lower multivariable odds ratios for hypertension (HT), diabetes mellitus (DM) and heart disease (HD) for men, and HT and dyslipidemia (DL) for women compared to those who do not, especially in male evacuees. The multivariable odds ratios (95% confidence intervals) of HT, DM and HD (non-evacuees vs. evacuees) for men were 1.00 (0.89-1.11) vs. 0.85 (0.74-0.96), 0.90 (0.77-1.05) vs. 0.77 (0.64-0.91) and 0.92 (0.76-1.11) vs. 0.79 (0.63-0.99), and HT and DL for women were 0.90 (0.81-1.00) vs. 0.88 (0.78-0.99) and 0.80 (0.70-0.92) vs. 0.72 (0.62-0.83), respectively. The daily frequency of laughter was associated with a lower prevalence of lifestyle disease, especially in evacuees.

Acute mental stress-caused arterial stiffening can be counteracted by brief aerobic exercise

PURPOSE

Acute mental stress (MS) causes an elevation in pulse wave velocity (PWV), an index of arterial stiffness. In contrast, aerobic exercise acutely decreases arterial stiffness, even in the short term. The present study aimed to examine whether acute MS-caused arterial stiffening can be counteracted by brief aerobic exercise.

METHODS

Thirteen young healthy men (mean age, 20 ± 1 years) participated in two randomized experimental visits where they were subjected to acute MS followed by seated rest (RE) or cycling exercise (EX) trials. Following a 5-min MS task, the participants in the RE trial rested on a chair for 10 min (from 10 to 20 min after the cessation of the task), whereas those in the EX trial cycled at 35% of heart rate reserve for the same duration. Heart-brachial PWV (hbPWV), brachial-ankle PWV (baPWV), heart-ankle PWV (haPWV), and the cardio-ankle vascular index (CAVI) were simultaneously measured at baseline and 5, 30, and 45 min after the task.

RESULTS

Both trials caused significant elevations (P < 0.05) in hbPWV, haPWV, and CAVI at 5 min after the task; subsequently, this persisted until 45 min after the task in the RE trial, whereas the elevations in the EX trial were eliminated. In the RE trial, baPWV significantly increased (P < 0.05) at 30 and 45 min after the task, whereas such an increase was not observed in the EX trial.

CONCLUSION

The findings of the present study reveal that brief aerobic exercise counteracts arterial stiffening caused by acute MS.

Associations of Frequency of Laughter With Risk of All-Cause Mortality and Cardiovascular Disease Incidence in a General Population: Findings From the Yamagata Study

Background

Positive and negative psychological factors are associated with mortality and cardiovascular disease. This study prospectively investigated associations of daily frequency of laughter with mortality and cardiovascular disease in a community-based population.

Methods

This study included 17,152 subjects ≥40 years old who participated in an annual health check in Yamagata Prefecture. Self-reported daily frequency of laughter was grouped into three categories (≥1/week; ≥1/month but <1/week; <1/month). Associations of daily frequency of laughter with increase in all-cause mortality and cardiovascular disease incidence were determined using Cox proportional hazards modeling.

Results

During follow-up (median, 5.4 years), 257 subjects died and 138 subjects experienced cardiovascular events. Kaplan-Meier analysis revealed that all-cause mortality and cardiovascular disease incidence were significantly higher among subjects with a low frequency of laughter (log-rank P < 0.01). Cox proportional hazard model analysis adjusted for age, gender, hypertension, smoking, and alcohol drinking status showed that risk of all-cause mortality was significantly higher in subjects who laughed <1/month than in subjects who laughed ≥1/week (hazard ratio [HR] 1.95; 95% confidence interval [CI], 1.16–3.09). Similarly, risk of cardiovascular events was higher in subjects who laughed ≥1/month but <1/week than in subjects who laughed ≥1/week (HR 1.62; 95% CI, 1.07–2.40).

Conclusion

Daily frequency of laughter represents an independent risk factor for all-cause mortality and cardiovascular disease in a Japanese general population.

Homeostatic effect of laughter on diabetic cardiovascular complications: The myth turned to fact

AIMS

Laughter has been used for centuries to alleviate pain in morbid conditions. It was not until 1976 that scientists thought about laughter as a form of therapy that can modulate hormonal and immunological parameters that affect the outcome of many serious diseases. Moreover, laughter therapy was shown to be beneficial in type 2 diabetes mellitus (T2DM) by delaying the onset of many diabetic complications. Laughter is also described to influence the cardiovascular and endothelial functions and thus may protect against diabetic cardiovascular complications. In this review, we outline the different biochemical, physiological and immunological mechanisms by which laughter may influence the overall state of wellbeing and enhance disease prognosis. We also focus on the biological link between laughter therapy and diabetic cardiovascular complications as well as the underlying mechanisms involved in T2DM.

METHODS

Reviewing all the essential databases for "laughter" and "type 2 diabetes mellitus".

RESULTS

Although laughter therapy is still poorly investigated, recent studies show that laughter may retard the onset of diabetic complications, enhance cardiovascular functions and rectify homeostatic abnormalities associated with T2DM.

CONCLUSIONS

Laughter therapy is effective in delaying diabetic complications and should be used as an adjuvant therapy.

Elevation of Testosterone and Reduction of Transepidermal Water Loss by Viewing a Humorous Film in Elderly Patients with Atopic Dermatitis

The effect of viewing a humorous film on salivary testosterone levels and transepidermal water loss (TEWL) values on the back of the neck in 36 elderly healthy people (36 male, mean 70 years) and 36 elderly patients with atopic dermatitis (AD) (36 male, mean age 70 years) were studied. Salivary testosterone levels were decreased while TEWL values were increased in elderly patients with AD compared to those in elderly healthy people. Viewing a humorous film (The Best Bits of Mr. Bean, Universal studios, 1996) slightly, but significantly (P<0.05), elevated salivary testosterone levels and reduced TEWL values in elderly healthy people, while viewing a control non-humorous film (weather information) failed to do so. Similarly, but more pronouncedly, viewing a humorous film markedly elevated salivary testosterone levels and reduced TEWL values in elderly patients with AD, while viewing a control non-humorous film failed to do so. These finding indicate that viewing a humorous film may be useful in the study of testosterone and TEWL, and treatment for dry skin in elderly people with or without AD.

The evolution of pace in popular movies

Movies have changed dramatically over the last 100 years. Several of these changes in popular English-language filmmaking practice are reflected in patterns of film style as distributed over the length of movies. In particular, arrangements of shot durations, motion, and luminance have altered and come to reflect aspects of the narrative form. Narrative form, on the other hand, appears to have been relatively unchanged over that time and is often characterized as having four more or less equal duration parts, sometimes called acts - setup, complication, development, and climax. The altered patterns in film style found here affect a movie's pace: increasing shot durations and decreasing motion in the setup, darkening across the complication and development followed by brightening across the climax, decreasing shot durations and increasing motion during the first part of the climax followed by increasing shot durations and decreasing motion at the end of the climax. Decreasing shot durations mean more cuts; more cuts mean potentially more saccades that drive attention; more motion also captures attention; and brighter and darker images are associated with positive and negative emotions. Coupled with narrative form, all of these may serve to increase the engagement of the movie viewer.

Laughter is the Best Medicine? A Cross-Sectional Study of Cardiovascular Disease Among Older Japanese Adults

Background

We sought to evaluate the associations between frequency of daily laughter with heart disease and stroke among community-dwelling older Japanese women and men.

Methods

We analyzed cross-sectional data in 20 934 individuals (10 206 men and 10 728 women) aged 65 years or older, who participated in the Japan Gerontological Evaluation Study in 2013. In the mail-in survey, participants provided information on daily frequency of laughter, as well as body mass index, demographic and lifestyle factors, and diagnoses of cardiovascular disease, hyperlipidemia, hypertension, and depression.

Results

Even after adjustment for hyperlipidemia, hypertension, depression, body mass index, and other risk factors, the prevalence of heart diseases among those who never or almost never laughed was 1.21 (95% CI, −1.03–1.41) times higher than those who reported laughing every day. The adjusted prevalence ratio for stroke was 1.60 (95% CI, 1.24–2.06).

Conclusions

Daily frequency of laughter is associated with lower prevalence of cardiovascular diseases. The association could not be explained by confounding factors, such as depressive symptoms.

Music decreases aortic stiffness and wave reflections

OBJECTIVE

Music has been related to cardiovascular health and used as adjunct therapy in patients with cardiovascular disease. Aortic stiffness and wave reflections are predictors of cardiovascular risk. We investigated the short-term effect of classical and rock music on arterial stiffness and wave reflections.

METHODS

Twenty healthy individuals (22.5±2.5 years) were studied on three different occasions and listened to a 30-min music track compilation (classical, rock, or no music for the sham procedure).

RESULTS

Both classical and rock music resulted in a decrease of carotid-femoral pulse wave velocity (PWV) immediately after the end of music listening (all p<0.01). Augmentation index (AIx) decreased with either classical or rock music in a more sustained way (nadir by 6.0% and 5.8%, respectively, at time zero post-music listening, all p<0.01). When music preference was taken into consideration, both classical and rock music had a more potent effect on PWV in classical aficionados (by 0.20 m/s, p=0.003 and 0.13 m/s, p=0.015, respectively), whereas there was no effect in rock aficionados (all p=NS). Regarding wave reflections, classical music led to a more potent response in classical aficionados (AIx decrease by 9.45%), whereas rock led to a more potent response to rock aficionados (by 10.7%, all p<0.01).

CONCLUSIONS

Music, both classical and rock, decreases aortic stiffness and wave reflections. Effect on aortic stiffness lasts for as long as music is listened to, while classical music has a sustained effect on wave reflections. These findings may have important implications, extending the spectrum of lifestyle modifications that can ameliorate arterial function.

Effects of a laughter and exercise program on physiological and psychological health among community-dwelling elderly in Japan: randomized controlled trial

AIM

To examine the effects of a once-weekly laughter and exercise program on physical and psychological health among elderly people living in the community. As a regular exercise program can be difficult to maintain, we provided a more enjoyable program to enhance adherence to exercise.

METHODS

A total of 27 individuals aged 60 years or older, without disabilities, were randomly assigned to either an immediate treatment group (n=14) or a delayed treatment group (n=13). The intervention was a 120-min session consisting of laughter and exercise, carried out once a week for 10 consecutive weeks. Measurements taken at baseline, 3 and 6 months included bodyweight, height, body fat, lean mass, bone mineral density, hemoglobin A1c (HbA(1c)), glucose, high-density lipoprotein and low-density lipoprotein cholesterol, and triglycerides, as well as self-rated health and psychological factors.

RESULTS

All participants completed the 3-month program. Bone mineral density increased significantly in the immediate treatment group compared with the delayed treatment group during the first 3 months (P<0.001). In addition, HbA(1c) decreased significantly (P=0.001), and self-rated health increased significantly (P=0.012).

CONCLUSIONS

The combination of a laughter and exercise program might have physiological and psychological health benefits for the elderly. Laughter might be an effective strategy to motivate the elderly to participate in physical activity.

Effects of humor and laughter on psychological functioning, quality of life, health status, and pulmonary functioning among patients with chronic obstructive pulmonary disease: a preliminary investigation

OBJECTIVE

Previous research indicates the beneficial effects of humor among healthy adults. Little is known about the physical and psychological effects of sense of humor and laughter among patients with chronic obstructive pulmonary disease (COPD).

METHODS

Patients with COPD (n = 46; mean age ± SD, 66.9 ± 9.9 years) completed assessments of sense of humor, depression, anxiety, quality of life, and recent illness. A subset of patients (n = 22) completed a laughter induction study and were randomly assigned to view either a humorous or a neutral video. Pulmonary function, mood state, and dyspnea were assessed before and after the video.

RESULTS

Sense of humor was associated with fewer symptoms of depression and anxiety and an enhanced quality of life. However, the induction of laughter led to lung hyperinflation.

CONCLUSION

Sense of humor among patients with COPD is associated with positive psychological functioning and enhanced quality of life, but laughing aloud may cause acute deterioration in pulmonary function secondary to worsened hyperinflation.

How mental stress affects endothelial function

Mental stress is an important factor contributing to recognized mechanisms underlying cardiovascular events. Among these, stress-related endothelial dysfunction is an early risk factor that predicts future development of severe cardiovascular disorders. Acute mental stress by a variety of tests impairs endothelial function in humans, although the opposite results have been reported by some investigators. Chronic stress always deteriorates endothelial function in humans and experimental animals. Stress hormones, such as glucocorticoids and pro-inflammatory cytokines, and endothelin-1 liberated in response to mental stress participate in endothelial dysfunction possibly via downregulation of endothelial nitric oxide synthase (eNOS) expression, eNOS inactivation, decreased nitric oxide (NO) actions, and increased NO degradation, together with vasoconstriction counteracting against NO-induced vasodilatation. Catecholamines do not directly affect endothelial function but impair its function when blood pressure elevation by the amines is sustained. Endogenous opioids favorably affect endothelial function, which counteract deteriorating effects of other stress hormones and mediators. Inhibition of cortisol and endothelin-1 production, prevention of pro-inflammatory mediator accumulation, hypnotics, mirthful laughter, humor orientation, and lifestyle modification would contribute to the prevention and treatment for stress-related endothelial dysfunction and future serious cardiovascular disease.

Effect of mirthful laughter on vascular function

In contrast to the well-established scientific evidence linking negative emotional states (e.g., depression, anxiety, or anger) to increased risk for cardiovascular disease, much less is known about the association between positive emotional states (e.g., laughter, happiness) and cardiovascular health. We determined the effects of mirthful laughter, elicited by watching comic movies, on endothelial function and central artery compliance. Seventeen apparently healthy adults (23 to 42 years of age) watched 30 minutes of a comedy or a documentary (control) on separate days (crossover design). Heart rate and blood pressure increased significantly while watching the comedy, whereas no such changes were seen while watching the documentary. Ischemia-induced brachial artery flow-mediated vasodilation (by B-mode ultrasound imaging) increased significantly after watching the comedy (17%) and decreased with watching the documentary (-15%). Carotid arterial compliance (by simultaneous application of ultrasound imaging and applanation tonometry) increased (10%) significantly immediately after watching the comedy and returned to baseline 24 hours after the watching, whereas it did not change significantly throughout the documentary condition. Comedy-induced changes in arterial compliance were significantly associated with baseline flow-mediated dilation (r = 0.63). These results suggest that mirthful laughter elicited by comic movies induces beneficial impact on vascular function.

Divergent effects of joyful and anxiety-provoking music on endothelial vasoreactivity

OBJECTIVE

To evaluate the extent to which music may affect endothelial function. In previous research, a link between music and physiologic parameters such as heart rate and blood pressure has been observed.

METHODS

Randomized four-phase crossover and counterbalanced trial in ten healthy, nonsmoking volunteers (70% male; mean age, 35.6 years) that included self-selections of music evoking joy or provoking anxiety. Two additional phases included watching video clips to induce laughter and listening to audio tapes to promote relaxation. To minimize emotional desensitization, subjects were asked to refrain from using self-selected tapes and images for at least 2 weeks before the assigned study phase. Endothelial function was assessed by brachial artery flow-mediated dilation (FMD) and measured as percent diameter change after an overnight fast. After baseline FMD measurements, subjects were randomized to a 30-minute phase of the testing stimulus followed by poststudy FMD; they returned a minimum of 1 week later for the subsequent task. A total of 160 FMD measurements were obtained.

RESULTS

Compared with baseline, music that evoked joy was associated with increases in mean upper arm FMD (2.7% absolute increase; p < .001), whereas reductions in FMD were observed after listening to music that elicited anxiety (0.6% absolute decrease; p = .005 difference between joyful and anxiety-provoking music). Self-selected joyful music was associated with increased FMD to a magnitude previously observed with aerobic activity or statin therapy.

CONCLUSION

Listening to joyful music may be an adjunctive life-style intervention for the promotion of vascular health.

The effect of mirthful laughter on the human cardiovascular system

It has become increasingly recognized and more widely acknowledged during the past several decades, that a complex relationship exists between behavior associated with emotion and the human cardiovascular (CV) system. Early studies focused on the interplay between negative emotions and elevated CV risk, an effect that has in large part been attributed to increased adrenergic activity. Thus, a variety of adverse CV effects ranging from sudden cardiac death triggered by natural disasters such as earthquakes to transient myocardial stunning resulting from heightened sympathetic overload have been identified in response to acute emotional distress. In fact, the biologic interplay between emotion and CV health has been greatly enhanced through studies of the vascular endothelium. As the largest organ in humans, the inner blood vessel lining serves as a conduit for the transfer of blood cells, lipids and various nutrients across the lumen to neighboring tissues. Healthy endothelial cells secrete vasoactive chemicals, most notably endothelial-derived relaxing factor or nitric oxide (NO), that effects smooth muscle relaxation and vessel dilation via a cyclic guanosine monophosphate (cGMP) dependent protein kinase signaling pathway. In addition, endothelial derived NO may reduce vascular inflammation by attenuating or inhibiting leukocyte adhesion and subendothelial transmigration as well as decreasing platelet activation via cGMP mediated pathways. Taken together, studying the endothelium provides an exceptional opportunity to advance our understanding of the potentially important interrelationship between emotions and the vasculature. Premised on the identification of physiological and biochemical correlates, the former was demonstrated after intracoronary administration of acetylcholine yielded paradoxical endothelial vasoconstriction in response to mental stress exercises. More recently, the brachial artery reactivity test (BART) has permitted endothelial function to be assessed in a non-invasive manner. In addition to traditional CV risk factors, exposure to negative emotions including mental stress and depression have been associated with reduced endothelial vasoreactivity as measured by BART. Whether mirthful laughter has the opposite effect garnered consideration following the discovery that mu3 opiate receptors were expressed in the vascular endothelium. Because mirthful laughter induces the release of beta-endorphins which in turn have high affinity for mu3 opiate receptors, we hypothesize that such positive emotions lead to the direct release of NO and associated biological consequences. Indeed, our studies have demonstrated opposing effects on endothelial vasoreactivity between those previously established (e.g., mental stress induced by negative visual and/or auditory stimuli) and those induced after mirthful laughter, thereby providing a potential mechanistic link between positive emotions and beneficial effects on the vasculature. This article reviews the relevant physiology and comments on the potentially wider clinical implications in the integration of this process to improve vascular health.

Divergent effects of laughter and mental stress on arterial stiffness and central hemodynamics

OBJECTIVE

To investigate the effect of laughter and mental stress on arterial stiffness and central hemodynamics. Arterial stiffness and wave reflections are independent predictors of cardiovascular risk. Chronic psychological stress is an independent risk factor for cardiovascular events, whereas acute stress deteriorates vascular function.

METHODS

Eighteen healthy individuals were studied on three occasions, according to a randomized, single-blind, crossover, sham procedure-controlled design. The effects of viewing a 30-minute segment of two films inducing laughter or stress were assessed. Carotid-femoral pulse wave velocity was used as an index of arterial stiffness; augmentation index was used as a measure of wave reflections.

RESULTS

Laughter decreased pulse wave velocity (by 0.30 m/sec, p = .01), and augmentation index (by 2.72%, p = .05). Conversely, stress increased pulse wave velocity (by 0.29 m/sec, p = .05) and augmentation index (by 5.1%, p = .005). Laughter decreased cortisol levels by 1.67 microg/dl (p = .02), soluble P-selectin by 26 ng/ml (p = .02) and marginally von Willebrand factor (by 2.4%, p = .07) and increased total oxidative status (by 61 micromol/L, p < .001). Stress decreased interleukin-6 (by 0.11 pg/ml, p = .04) and increased total oxidative status (by 44 micromol/L, p = .007). Soluble CD40 ligand and fibrinogen remained unchanged.

CONCLUSIONS

Positive (laughter) and negative (stress) behavioral interventions have divergent acute effects on arterial stiffness and wave reflections. These findings have important clinical implications extending the spectrum of lifestyle modifications that can ameliorate arterial function.

NO netting, health and stress – Studying wellness from a net perspective

On the nature of wellness, stress, netting and the radical gas nitric oxide (NO). The multi-complex role of NO resulted in its discoverers receiving a Nobel award, its presence everywhere and volatility makes it a suitable candidate to be a main signal in an instantaneous communication network. Such network, with the capacity of tight physiological monitoring, enables assets distributions in the body. A model is presented suggesting that an inter-cellular communication network coordinates the various bodily functions. Radical gases like nitric oxide (NO) are signals in this net and its usability affects health and indicates wellness. From this netting point of view, stress is the sense of flow interruption or blockage of the information stream. Such flow interruption affects also physiological functions and can explain the association between stress and many ailments. It is suggested that netting is a prerequisite route of wellness, enabling bodily unconscious managerial decisions. This vital diffusive network is extremely labile and potentially could contain the interplay of consciousness and unconsciousness effected by activities such as yoga or guided imagery. Vast data from studies on NO signals, health and the relaxation/stress processes have already been accumulated. Integration of these data supports this novel look of an NO network as a coordinator. Interactions between stress and health are discussed in net perspective and include basic concepts of some integrative health approaches. Studying the nature of such communication network and of NO may suggest new ways to reduce stress and approach wellness.

Spousal caregivers of patients with Alzheimer's disease show longitudinal increases in plasma level of tissue-type plasminogen activator antigen

OBJECTIVE

To determine if caregivers of spouses with Alzheimer's disease demonstrate greater increase in tissue plasminogen activator (t-PA) antigen relative to noncaregiving controls. Caring for a spouse with Alzheimer's disease has been associated with increased mortality and reduced time to developing cardiovascular disease (CVD), possibly due to impaired fibrinolysis resulting from chronic stress.

METHODS

Annual in-home assessments of plasma t-PA antigen were collected from 165 participants (112 caregivers and 53 noncaregivers) enrolled in the University of California, San Diego Alzheimer caregiver study. Participants were married, living with their spouses, at least 55 years of age, and free of serious medical conditions (e.g., cancer). Caregivers provided in-home care for their spouse with Alzheimer's disease at the time of enrollment. Exclusion criteria included taking anticoagulant medication or evidenced severe hypertension (>200/120 mm Hg). Mixed (random effects) regression was used to assess slopes for t-PA antigen over the study period at the same time controlling for medical and demographic characteristics associated with t-PA antigen.

RESULTS

Caregivers demonstrated significantly greater increases in t-PA antigen over the 5-year study period compared with noncaregiving controls (p = .02), even when controlling for body mass index, mean blood pressure, age, gender, and use of CVD medication.

CONCLUSIONS

The accelerated rate of developing a prothrombotic environment including elevated t-PA antigen may provide one mechanism by which caregiving is associated with greater morbidity and mortality and the development of CVD.