Don'g get mad, get funny

November 14, 2000

One of the best ways to protect yourself against a heart attack is to laugh often and exuberantly - even in situations that many people would find unfunny or irritating - according to a study presented today at the American Heart Association's Scientific Sessions 2000 meeting.

The study is the first to document that laughter and an active sense of humor may help influence heart and artery disease.

Researchers compared the humor responses of 150 patients, who had either suffered heart attacks or had undergone revascularization procedures such as angioplasty, to those of 150 healthy age-matched controls. Results showed that heart patients were 40 percent less likely than their healthy counterparts to laugh in a variety of common situations.

"The old axiom that 'laughter is the best medicine' appears to hold true when it comes to protecting your heart," says Michael Miller, M.D., director of the center for preventive cardiology at the University of Maryland Medical Center, Baltimore.

"We don't know yet if forcing yourself to laugh when you're angry is beneficial, but there may be effective, practical ways for people to lessen their discomfort or hostility to improve their humor response and increase the amount of laughter in their lives," he says. "First, it may be possible to incorporate laughter into daily activities, just as we do with other cardioprotective activities such as exercise, by reading something humorous or watching a funny video. Second, we may be able to find ways to take ourselves less seriously."

All participants in the Baltimore study were asked to answer a series of multiple-choice questions about how much - or how little - they would laugh under certain circumstances during social interactions, surprise situations and daily activities. For example:
(1) If you arrived at a party and found someone else wearing a piece of clothing identical to yours, would you (a) not find it particularly amusing, (b) be amused but not show it outwardly, (c) smile, (d) laugh, (e) laugh heartily? (2) During a day when you have no responsibilities or engagements, and you decide to do something you really enjoy with friends, would your humor response be (a) not much smiling or laughter, (b) smiling occasionally but not laughing aloud, (c) smiling frequently and laughing from time to time, (d) laughing aloud frequently, (e) laughing heartily much of the time?
Each question had five answers and there were 21 questions. A total score was developed by adding the number of positive answers to each question. Total possible score was 105. The lowest was 21. Overall, respondents with a humor score above 50 had a significantly reduced risk of heart disease.

Compared to the control group, individuals with heart disease were less likely to recognize humor or use it as an adaptive mechanism, and they generally showed less ability to laugh, even in positive situations, Miller notes.

"We don't know why laughing protects the heart, but we do know that mental stress is associated with impairment of the endothelium, the protective barrier lining our blood vessels," says Miller, who is also an associate professor of medicine at the University of Maryland School of Medicine. "This can cause a series of inflammatory reactions that lead to fat and cholesterol buildup in the coronary arteries - and ultimately to a heart attack."

The theory that laughter may release some as-yet-unidentified "endothelial protectants" is an attractive hypothesis that will require further study, Miller adds.

Theoretically, he adds, if laughter releases protective chemicals in the body, laughing during anger may counteract potential adverse effects to the endothelium. While stress may be associated with a sense of urgency, anger and hostility, he says, a "hearty" laugh often coincides with a feeling of well being and euphoria.

"Because we know of many more factors that contribute to heart disease than factors that protect against it," Miller says, "the ability to laugh - either naturally or as learned behavior - may have important implications in certain societies such as the United States, where heart disease remains the number one killer."
Other researchers in the study include Adam Clark, M.D., and Alexander Seidler, Ph.D.

American Heart Association

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