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WELL, GOOD AFTERNOON OR
GOOD 

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MORNING.

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I'M CATHERINE LAW AT THE 

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00:00:16,062 --> 00:00:23,270
NATIONAL CENTER AT NCCIH 

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NATIONAL INSTITUTES OF HEALTH 

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AND ON BEHALF OF HELENE LANGEVIN

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AND DR. DAVID SHURTLEFF I 

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WELCOME YOU TO THE 2023 STEPHEN 

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00:00:34,214 --> 00:00:36,483
E. STRAUS DISTINGUISHED LECTURE 

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IN THE SCIENCE OF COMPLIMENTARY 

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THERAPIES.

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OUR SPEAKER WILL BE DR. AHMED 

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TAWAKOL OF MASSACHUSETTS GENERAL

14
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HOSPITAL AND HARVARD MEDICAL 

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SCHOOL IN MASSACHUSETTS AND THE 

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LINK IS BELOW THE STREAM FOR THE

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FEEDBACK.

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00:01:05,745 --> 00:01:07,347
IF YOU CANNOT FIND THE LINK FOR 

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00:01:07,347 --> 00:01:10,851
SOME REASON YOU CAN E-MAIL YOUR 

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QUESTIONS THE ADDRESS IS NCCIH 

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EVENTS AS ONE WORD AT MAIL DOT 

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NIH GOT GOV.

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DURING THE Q&A WE'LL TRY TO
GET 

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AS MANY QUESTIONS ANSWERED AS WE

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CAN HOWEVER, WE MAY NOT BE ABLE 

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TO GET TO ALL QUESTIONS BUT 

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WE'LL SHARE THEM WITH 

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DR. TAWAKOL AFTER THE EVENT.

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FINALLY THE PRESENTATION IS 

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BEING RECORDED AND WILL BE 

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ARCHIVED IN THE NIH VIDEOCAST 

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SITE FOR FUTURE VIEWING.

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I'D LIKE TO TURN THINGS OVER TO 

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DR. HELENE LANGEVIN, DIRECTOR OF

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NCCIH TO WELCOME OUR SPEAKER AND

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SPEAK A LITTLE BIT ABOUT THE 

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STRAUS LECTURE.

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PLEASE TAKE IT AWAY.

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>> HELLO AND THANK YOU ALL
FOR 

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TAKING TIME TO JOIN US TODAY WE 

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LOOK FORWARD TO THIS LECTURE 

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EACH YEAR AS A VERY SPECIAL TIME

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TO HONOR THE MEMORY AND LEGACY 

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OF DR. STEPHEN E. STRAUS THE 

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CENTER'S FOUNDING DIRECTOR AND 

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LED NCCIH FROM 1989 TO 2006.

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STEVE WAS AN IMMINENT PHYSICIAN 

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RESEARCHER AT NIH AND CHAMPIONED

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EFFORTS TO ESTABLISH THE 

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EFFICACY AND SAFETY OF 

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COMPLIMENTARY AND INTEGRATIVE 

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HEALTH PRACTICES WHILE UPHOLD 

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NIH'S RIGOROUS STANDARDS AND 

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REMEMBERED THROUGHOUT NIH AND 

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VERY MUCH MISSED.

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MRS. BARBARA STRAUSS IS 

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ATTENDING THE LIVE STREAM TODAY 

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AND WE WELCOME HERE AND ALWAYS A

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GREAT SUPPORTER OF THIS EVENT.

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AND I ALSO HAVE SOME ADDITIONAL 

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THANKS TO SHARE.

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MR. BERNARD ORSHER AND 

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MRS. ORSHER MADE THIS POSSIBLE 

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AND WANT TO THANK MARY BITTERMAN

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THE PRESIDENT OF THE BERNARD O 

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RSHER FOUNDATION WHO IS ALSO A 

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WONDERFUL SUPPORTER AND 

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APPRECIATE NIH'S LONG TERM 

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PARTNERSHIP WITH NCCIH ON THE 

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LECTURE SERIES.

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THANK YOU ALL.

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I'M NOW PLEASED TO WELCOME OUR 

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LECTURE YOU ARE, DR. AHMED 

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TAWAKOL WHO WILL SPEAK ON NOVEL 

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INSIGHTS INTO HEART-BRAIN 

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INTERACTIONS AND NEUROBIOLOGICAL

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RESILIENCE.

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WE'RE PLEASED DR. TAWAKOL WOULD 

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SAR HIS THOUGHTS WITH US TODAY 

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ON THIS VERY INTERESTING TOPIC.

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DR. TAWAKOL IS A CARDIOLOGIST 

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WITH A CLINICAL AND RESEARCH 

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00:04:03,523 --> 00:04:05,725
FOCUS ON CARDIOVASCULAR IMAGING.

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HE IS THE DIRECTOR OF NUCLEAR 

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00:04:10,964 --> 00:04:16,469
CARDIOLOGY AND RESEARCH CENTER 

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00:04:16,469 --> 00:04:18,338
AT MASSACHUSETTS GENERAL 

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HOSPITAL AND ASSOCIATE PROFESSOR

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OF MEDICINE AT HARVARD MEDICAL 

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SCHOOL.

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00:04:22,942 --> 00:04:25,979
HE RECEIVED HIS M.D. FROM 

91
00:04:25,979 --> 00:04:28,348
STANFORD AND DID A POST-DOCTORAL

92
00:04:28,348 --> 00:04:30,517
TRAINING IN MEDICINE AND 

93
00:04:30,517 --> 00:04:32,685
CARDIOLOGY AT BRIGHAM AND 

94
00:04:32,685 --> 00:04:35,789
WOMEN'S AND NUCLEAR CARDIOLOGY 

95
00:04:35,789 --> 00:04:37,557
AT THE MASSACHUSETTS GENERAL 

96
00:04:37,557 --> 00:04:37,824
HOSPITAL.

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00:04:37,824 --> 00:04:41,728
THE NIH FUNDERS INCLUDE THE 

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00:04:41,728 --> 00:04:43,997
NHLBI AND THE NATIONAL INSTITUTE

99
00:04:43,997 --> 00:04:46,599
OF ARTHRITIS AND MUSCULOSKELETAL

100
00:04:46,599 --> 00:04:48,401
AND SKIN DISEASES.

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00:04:48,401 --> 00:04:53,139
HIS PIONEERING WORK EXPLORES 

102
00:04:53,139 --> 00:04:53,973
CONNECTIONS ACROSS ORGANS AND 

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00:04:53,973 --> 00:04:57,510
SYSTEMS OF THE BODY RELEVANT TO 

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NCCIH'S INTEREST OF THE WHOLE 

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PERSON AND FOCUSES ON THE EFFECT

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OF STRESS, LIFESTYLE AND 

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RESILIENCE WHICH ARE OTHER AREAS

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00:05:04,217 --> 00:05:05,685
OF FOCUS AT NCCIH.

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00:05:05,685 --> 00:05:07,620
SO WE'RE ALL VERY MUCH LOOKING 

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FORWARD TO HEARING HIS LECTURE.

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SO IT'S MY GREAT PLEASURE TO 

112
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WELCOME DR. AHMED TAWAKOL.

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>> THANK YOU FOR THE KIND 

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INTRODUCTION.

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IT TRULY IS AN HONOR TO GIVE THE

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LECTURE IN THE MEMORY OF 

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DR. STRAUS.

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INDEED HE'S DONE SO MUCH FOR THE

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FIELD AND I'M HONORED TO BE HERE

120
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IN THIS POSITION.

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TODAY I'LL TALK ABOUT 

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PSYCHOSOCIAL STRESS AND HOW IT 

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00:05:46,226 --> 00:05:47,794
LEADS TO DISEASE.

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WE HAVE KNOWN THE ATTRIBUTE AND 

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00:05:51,364 --> 00:05:55,835
STRESS IS ON PAR WITH SMOKING, 

126
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DYSLIPIDEMIA AND DIABETES AND 

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LITTLE HAD BEEN KNOWN OF THE 

128
00:06:00,106 --> 00:06:01,174
MECHANISMS THAT TRANSLATES 

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00:06:01,174 --> 00:06:03,643
STRESS TO CARDIOVASCULAR EVENTS.

130
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WE'VE KNOWN SINCE THE INNER 

131
00:06:06,513 --> 00:06:09,616
HEART STUDY, STRESS WHETHER 

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00:06:09,616 --> 00:06:12,152
MEASURED THROUGH 24,000 PATIENTS

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SHOWED 55% INCREASED RISK FOR 

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MYOCARDIAL INFARCTION AFTER 

135
00:06:21,427 --> 00:06:25,064
CONTROLLING FOR RISK FACTORS.

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00:06:25,064 --> 00:06:27,667
WE'VE KNOWN STRESS MAY AFFECT 

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HEART DISEASE RISK, FOR EXAMPLE,

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INACTIVITY, OVER EATING, 

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00:06:33,940 --> 00:06:34,641
HYPERTENSION AND AFTER 

140
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ACCOUNTING FOR ALL THESE WE FIND

141
00:06:37,510 --> 00:06:39,546
THOSE FACTS DON'T EXPLAIN THE 

142
00:06:39,546 --> 00:06:40,113
OBSERVED EXCESS RISK.

143
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WE STARTED TO LEARN QUITE ABOUT 

144
00:06:41,981 --> 00:06:45,852
THE MECHANISMS BY WHICH STRESS 

145
00:06:45,852 --> 00:06:47,787
LEADS TO HEART DISEASE THROUGH 

146
00:06:47,787 --> 00:06:48,988
ANNAL STUDIES.

147
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IN PARTICULAR, STUDIES PUBLISHED

148
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OVER A DECADE AGO SHOWED THAT 

149
00:06:53,393 --> 00:06:56,296
STRESSING MICE, YOU CAN DO SO BY

150
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SHAKING CAGES, CHANGING LITTER 

151
00:06:58,231 --> 00:07:00,200
MATE OR PUTTING A CAT ON A MOUSE

152
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CAGE CAN LEAD TO STIMULATION OF 

153
00:07:02,035 --> 00:07:05,505
THE BONE MARROW AND DOES SO BY 

154
00:07:05,505 --> 00:07:06,940
SYMPATHETIC NERVE GO FROM THE 

155
00:07:06,940 --> 00:07:10,476
BRAIN TO THE BONE MARROW AND 

156
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TRIGGER THE RELEASE OF 

157
00:07:11,611 --> 00:07:13,780
INFLAMMATORY CELLS AND IN THESE 

158
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STUDIES THEY FOUND THOSE 

159
00:07:14,948 --> 00:07:16,716
INFLAMMATORY CELLS CAN GO TO THE

160
00:07:16,716 --> 00:07:18,952
SPLEEN WHERE THEY'RE READY FOR 

161
00:07:18,952 --> 00:07:20,653
THE NEXT INFLAMMATORY INSULT OR 

162
00:07:20,653 --> 00:07:23,456
DIRECTLY TO THE CORONARY 

163
00:07:23,456 --> 00:07:23,723
ARTERIES.

164
00:07:23,723 --> 00:07:25,158
IN CASE THEY MEASURED THE 

165
00:07:25,158 --> 00:07:28,361
ARTERIES IN THE MICE AND FOUND 

166
00:07:28,361 --> 00:07:31,164
THE STRESSED MICE HAVE HIGHER 

167
00:07:31,164 --> 00:07:32,131
ARTERIAL INFLAMMATION.

168
00:07:32,131 --> 00:07:35,168
WE ASKED IF THE SAME PATH OF 

169
00:07:35,168 --> 00:07:37,237
STRESS LEADING STIMULATION OF 

170
00:07:37,237 --> 00:07:42,108
THE BONE MARROW AND SPLEEN 

171
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RESERVOIRS TO ARTERIAL 

172
00:07:44,010 --> 00:07:44,944
INFLAMMATION LEADING TO EVENTS 

173
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WOULD BE SEEN ALSO IN HUMANS.

174
00:07:47,113 --> 00:07:50,116
TO DO SO, WE WONDERED IF 

175
00:07:50,116 --> 00:07:51,084
INTEGRATIVE MULTI-SYSTEM IMAGING

176
00:07:51,084 --> 00:07:52,218
CAN GIVE THOSE INSIGHT.

177
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WHAT DO I MEAN BY THAT?

178
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WE CAN USE PET CT TO IMAGE THE 

179
00:07:58,558 --> 00:08:00,960
BONE MARROW TO IMAGE THE SPLEEN 

180
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AND ALSO LOOK AT ARTERIAL 

181
00:08:04,631 --> 00:08:04,964
INFLAMMATION.

182
00:08:04,964 --> 00:08:06,866
WE AND OTHERS HAVE SHOWN, FOR 

183
00:08:06,866 --> 00:08:08,735
EXAMPLE, THAT YOU CAN MEASURE 

184
00:08:08,735 --> 00:08:10,436
SPLENIC ACTIVITY AND BONE MARROW

185
00:08:10,436 --> 00:08:10,703
ACTIVITY.

186
00:08:10,703 --> 00:08:13,172
HERE YOU CAN SEE A BONE MARROW 

187
00:08:13,172 --> 00:08:15,541
WITH HIGH ACTIVITY AND HERE IS A

188
00:08:15,541 --> 00:08:18,945
BONE MARROW WITH LOW METABOLIC 

189
00:08:18,945 --> 00:08:20,580
ACTIVITY WITH FTG PET.

190
00:08:20,580 --> 00:08:22,715
THAT ACTIVITY ASSOCIATES WITH 

191
00:08:22,715 --> 00:08:24,217
THE BIOMARKERS OF INFLAMMATION 

192
00:08:24,217 --> 00:08:28,154
LIKE CRP AND IL1 BETA AND GENE 

193
00:08:28,154 --> 00:08:29,455
EXPRESSION IN THE CIRCULATING 

194
00:08:29,455 --> 00:08:30,056
CELLS.

195
00:08:30,056 --> 00:08:33,693
MOREOVER, IF WE SIMPLY LOOK AT 

196
00:08:33,693 --> 00:08:35,395
HIGH VERSUS LOW ACTIVITY AND 

197
00:08:35,395 --> 00:08:36,796
FOLLOW PATIENTS OVER TIME WE 

198
00:08:36,796 --> 00:08:38,531
SHOW PATIENTS WITH RELATIVELY 

199
00:08:38,531 --> 00:08:41,701
LOW ACTIVITY, LESS THAN ME 

200
00:08:41,701 --> 00:08:44,771
MEDIAN HAVE FEWER MYOCARDIAL 

201
00:08:44,771 --> 00:08:45,672
INFARCTIONS WITH THOSE WITH 

202
00:08:45,672 --> 00:08:47,340
HIGHER ACTIVITY IN THE BONE 

203
00:08:47,340 --> 00:08:48,041
MARROW.

204
00:08:48,041 --> 00:08:49,575
LIKEWISE WE CAN LOOK AT THE 

205
00:08:49,575 --> 00:08:51,077
ACTIVITY IN THE ARTERIES AND 

206
00:08:51,077 --> 00:08:54,013
HERE'S EXAMPLES OF AORTIC 

207
00:08:54,013 --> 00:08:56,115
ACTIVITY AND SEE ELEVATED 

208
00:08:56,115 --> 00:08:57,483
ACTIVITY IN THE WALLS OF THE 

209
00:08:57,483 --> 00:09:01,287
AORTA AND HERE IS ACTIVE IN THE 

210
00:09:01,287 --> 00:09:02,522
CAROTID ARTERIES AND HERE'S A 

211
00:09:02,522 --> 00:09:03,656
COMPLEX PLAQUE AND WITHIN THE 

212
00:09:03,656 --> 00:09:05,958
AREA OF THE PLAQUE YOU CAN SEE 

213
00:09:05,958 --> 00:09:07,593
INCREASED METABOLIC ACTIVITY AND

214
00:09:07,593 --> 00:09:09,696
IF YOU LOOK AT IT AT A CROSS 

215
00:09:09,696 --> 00:09:11,297
SECTION HERE AGAIN IS A PLAQUE 

216
00:09:11,297 --> 00:09:13,566
AND THE AREA OF STENOSIS AND 

217
00:09:13,566 --> 00:09:17,036
WHERE THE BLOOD FLOW IS AND 

218
00:09:17,036 --> 00:09:19,605
HERE'S THE INTENSE METABOLIC 

219
00:09:19,605 --> 00:09:20,073
ACTIVITY.

220
00:09:20,073 --> 00:09:21,441
WHEN THIS PERSON WENT FOR 

221
00:09:21,441 --> 00:09:23,876
SURGERY OF THE NARROWED VESSEL 

222
00:09:23,876 --> 00:09:27,980
WE HAVE THE SPECIMEN WHERE WE'RE

223
00:09:27,980 --> 00:09:29,048
ABLE TO SLOW THE MEASURE 

224
00:09:29,048 --> 00:09:30,983
CORRELATED WITH THE DEGREE OF 

225
00:09:30,983 --> 00:09:33,186
ACTIVITY ACROSS THIS GROUP OF 

226
00:09:33,186 --> 00:09:35,188
PATIENTS SO ACROSS OUR PATIENTS 

227
00:09:35,188 --> 00:09:37,523
WE SEE THE MACROPHAGE DENSITY 

228
00:09:37,523 --> 00:09:42,061
AND HISTOLOGY WAS PREDICTIVE OF 

229
00:09:42,061 --> 00:09:43,830
HOW MUCH INFLAMMATION WAS SEEN.

230
00:09:43,830 --> 00:09:46,099
AND IN FACT SEVERAL GROUPS HAVE 

231
00:09:46,099 --> 00:09:49,135
LONG SINCE SHOWN THAT THERE'S A 

232
00:09:49,135 --> 00:09:50,103
CORRELATION FROM WHAT'S SEEN 

233
00:09:50,103 --> 00:10:00,246
HIST

234
00:10:04,784 --> 00:10:05,351
HISTOP

235
00:10:05,351 --> 00:10:07,487
HISTOPATHOLOGICALLY AND IT 

236
00:10:07,487 --> 00:10:07,954
PREDICTS SUBSEQUENT 

237
00:10:07,954 --> 00:10:09,522
CARDIOVASCULAR DISEASE EVENTS.

238
00:10:09,522 --> 00:10:10,523
INDIVIDUALS WITH HIGHER SIGNALS 

239
00:10:10,523 --> 00:10:12,091
TEND TO HAVE MORE EVENTS 

240
00:10:12,091 --> 00:10:15,561
COMPARED TO THOSE WITH LOWER 

241
00:10:15,561 --> 00:10:17,530
IMAGING SIGNALS.

242
00:10:17,530 --> 00:10:19,132
HERE'S A STUDY DIVIDED ACROSS 

243
00:10:19,132 --> 00:10:22,468
THE MEDIAN AND HERE WITH THOSE 

244
00:10:22,468 --> 00:10:26,005
WITH THE HIGHEST IMAGING OF 

245
00:10:26,005 --> 00:10:27,440
ARTERIES ARE HIGHER EVENTS AND 

246
00:10:27,440 --> 00:10:28,374
THAT CAN TELL YOU SOMETHING 

247
00:10:28,374 --> 00:10:29,709
ABOUT SUBSEQUENT EVENTS.

248
00:10:29,709 --> 00:10:31,577
IN FACT, NOW SEVERAL GROUPS AND 

249
00:10:31,577 --> 00:10:34,547
IN FACT THE GUIDELINE 

250
00:10:34,547 --> 00:10:36,716
RECOMMENDATIONS FOR EVALUATING 

251
00:10:36,716 --> 00:10:39,118
INFLAMMATION HAS TRIGGERED THE 

252
00:10:39,118 --> 00:10:42,955
ASSESSMENT OF INFLAMMATION FOR 

253
00:10:42,955 --> 00:10:45,258
AORTITIS AND DEVICE INFECTION 

254
00:10:45,258 --> 00:10:46,626
FOR CLINICAL INDICATIONS AMONG 

255
00:10:46,626 --> 00:10:46,893
OTHERS.

256
00:10:46,893 --> 00:10:48,828
NOW WE HAVE AN OPPORTUNITY TO 

257
00:10:48,828 --> 00:10:50,863
LOOK AT MULTIPLE ORGANS BUT WHAT

258
00:10:50,863 --> 00:10:51,764
ABOUT STRESS?

259
00:10:51,764 --> 00:10:59,138
HOW SHOULD WE MEASURE STRESS?

260
00:10:59,138 --> 00:11:09,182
WE COULD GIVE A PERCEIVED STRESS

261
00:11:09,182 --> 00:11:11,517
TEST AND INVITE YOU TO TAKE THE 

262
00:11:11,517 --> 00:11:14,353
TEST AND WE CAN MEASURE THIS BY 

263
00:11:14,353 --> 00:11:15,388
IMAGING THE BRAIN.

264
00:11:15,388 --> 00:11:17,824
FOR EXAMPLE, WE CAN MEASURE THE 

265
00:11:17,824 --> 00:11:20,126
PREFRONTAL CORTEX OR AMYGDALA, 

266
00:11:20,126 --> 00:11:21,727
TWO AREAS THAT IS HAVE IMPORTANT

267
00:11:21,727 --> 00:11:23,229
ROLES IN THE ASSESSMENT OF 

268
00:11:23,229 --> 00:11:23,463
STRESS.

269
00:11:23,463 --> 00:11:26,699
FOR EXAMPLE, THE PRE-FRONTAL 

270
00:11:26,699 --> 00:11:28,901
CORTEX WILL BE IMPORTANT DURING 

271
00:11:28,901 --> 00:11:30,203
ALERT NON-STRESS CONDITIONS 

272
00:11:30,203 --> 00:11:33,473
WHERE AS THE AMYGDALA TENDS TO 

273
00:11:33,473 --> 00:11:35,741
BE MORE ACTIVE DURING STRESS 

274
00:11:35,741 --> 00:11:36,042
CONDITIONS.

275
00:11:36,042 --> 00:11:37,443
I'LL TELL YOU A LITTLE BIT MORE 

276
00:11:37,443 --> 00:11:38,377
ABOUT THAT.

277
00:11:38,377 --> 00:11:41,314
OVER TIME WITH CHRONIC STRESS 

278
00:11:41,314 --> 00:11:43,449
THE AMYGDALA TENDS TO DEVELOP 

279
00:11:43,449 --> 00:11:47,453
MORE SPINAL DENDRITIC GROWTH.

280
00:11:47,453 --> 00:11:51,224
THE NEURONS BECOME MORE 

281
00:11:51,224 --> 00:11:52,859
ARBORIZED WHEREAS IN STRESSFUL 

282
00:11:52,859 --> 00:11:55,595
CONDITIONS THE CORTEX STARTS TO 

283
00:11:55,595 --> 00:11:58,598
HAVE REVERSIBLE DENDRITIC 

284
00:11:58,598 --> 00:11:59,332
ATROPHY AND BECOMES LESS 

285
00:11:59,332 --> 00:12:02,235
RESPONSIVE OVER TIME.

286
00:12:02,235 --> 00:12:04,604
WE CAN USE IMAGING TO ASSESS 

287
00:12:04,604 --> 00:12:06,072
SOME OF THESE.

288
00:12:06,072 --> 00:12:07,940
FOR EXAMPLE, WE HAVE LONG KNOWN 

289
00:12:07,940 --> 00:12:10,943
THAT INDIVIDUALS WITH GREATER 

290
00:12:10,943 --> 00:12:15,381
AMYGDALA ACTIVITY MEASURED BY 

291
00:12:15,381 --> 00:12:16,549
FUNCTIONAL MRI HAVE GREATER 

292
00:12:16,549 --> 00:12:19,385
BLOOD PRESSURE REACTIVITY AND 

293
00:12:19,385 --> 00:12:23,523
PRODUCE MORE INFLAMMATORY 

294
00:12:23,523 --> 00:12:31,697
CYTOKINES AND MORE ATHEIR  -- 

295
00:12:31,697 --> 00:12:34,367
ATHEROSCLEROSIS AND WE CAN 

296
00:12:34,367 --> 00:12:37,570
MEASURE IN THE AMYGDALA AND IN 

297
00:12:37,570 --> 00:12:40,039
THE PRIMATE MODEL SHOWED THE 

298
00:12:40,039 --> 00:12:41,240
TEMPERAMENT OF THE PRIMATES 

299
00:12:41,240 --> 00:12:44,110
SHOWED WITH THE UPTAKE IN THE 

300
00:12:44,110 --> 00:12:44,744
AMYGD

301
00:12:44,744 --> 00:12:45,011
AMYGDALA.

302
00:12:45,011 --> 00:12:47,146
SO PUTTING THIS TOGETHER, WE CAN

303
00:12:47,146 --> 00:12:49,749
MEASURE THE NEURON BIOLOGY OF 

304
00:12:49,749 --> 00:12:53,386
STRESS USING FGT PET TO LOOK AT 

305
00:12:53,386 --> 00:12:55,454
AMYGDALA ACTIVITY REGULAR TO 

306
00:12:55,454 --> 00:12:56,389
CORTICAL ACTIVITY.

307
00:12:56,389 --> 00:12:58,558
IN THIS CASE THE RATIO OF THE 

308
00:12:58,558 --> 00:13:01,827
ACTIVITY IN THE AMYGDALA DIVIDED

309
00:13:01,827 --> 00:13:04,964
BY THE ACTIVITY IN THE 

310
00:13:04,964 --> 00:13:06,499
PREFRONTAL CORTEX OR TEMPORAL 

311
00:13:06,499 --> 00:13:07,733
LOBE AND LOOK AT NEURAL ACTIVITY

312
00:13:07,733 --> 00:13:09,902
AND ACTIVITY WHERE HEIGHTENED 

313
00:13:09,902 --> 00:13:12,104
ACTIVATION IS SEEN IN THE 

314
00:13:12,104 --> 00:13:13,105
AMYGDALA IN REPRESENTATION TO 

315
00:13:13,105 --> 00:13:16,842
STRESSFUL STIMULI OR SIMPLY 

316
00:13:16,842 --> 00:13:20,346
REDUCED ACTIVITY WITH REGULATORY

317
00:13:20,346 --> 00:13:21,581
TISSUES AND MEASURE TISSUE 

318
00:13:21,581 --> 00:13:25,051
VOLUMES AND THE AMYGDALA SHRINKS

319
00:13:25,051 --> 00:13:26,619
WHEN THERE'S CHRONIC STRESS 

320
00:13:26,619 --> 00:13:29,355
PROBABLY DUE TO LOSS OF COUNTER 

321
00:13:29,355 --> 00:13:32,825
REGULATORY CONNECTIONS AND LOOK 

322
00:13:32,825 --> 00:13:34,560
AT THE TENSER IMAGING OF THE 

323
00:13:34,560 --> 00:13:35,394
AXONS.

324
00:13:35,394 --> 00:13:38,030
HERE'S AN OPPORTUNITY TO USE 

325
00:13:38,030 --> 00:13:42,969
INTEGRATIVE BIO IMAGING WITH PET

326
00:13:42,969 --> 00:13:45,805
CT OR PET MR LOOKING AT RESTING 

327
00:13:45,805 --> 00:13:49,408
NEUROLOGICAL ACTIVITY AND LOOK 

328
00:13:49,408 --> 00:13:52,878
AT FUNCTIONAL MRI, STRUCTURE OF 

329
00:13:52,878 --> 00:13:54,780
THE ATHEROSCLEROSIS OR 

330
00:13:54,780 --> 00:13:56,616
ATHEROSCLEROTIC INFLAMMATION ALL

331
00:13:56,616 --> 00:14:00,353
AT THE SAME TIME.

332
00:14:00,353 --> 00:14:01,954
INDEED WE SAW HIGHER STRESSED 

333
00:14:01,954 --> 00:14:03,823
NEURAL ACTIVITY ASSOCIATES WITH 

334
00:14:03,823 --> 00:14:06,559
A HIGHER RISK OF CARDIOVASCULAR 

335
00:14:06,559 --> 00:14:06,792
DISEASE.

336
00:14:06,792 --> 00:14:09,895
WE DID THIS USING THE IMAGING 

337
00:14:09,895 --> 00:14:14,066
WITH FTC PET GC AND PET MRI 

338
00:14:14,066 --> 00:14:17,269
QUANTIFYING THE ACTIVITY AND 

339
00:14:17,269 --> 00:14:27,747
LOOKED AT THE LEUKO POIETIC 

340
00:14:27,980 --> 00:14:29,315
ACTIVITY AND AFTER EXCLUSIONS WE

341
00:14:29,315 --> 00:14:34,053
HAD A POPULATION OF 2 93 

342
00:14:34,053 --> 00:14:34,987
INDIVIDUALS WITH ADEQUATE 

343
00:14:34,987 --> 00:14:35,454
BASELINE DATA.

344
00:14:35,454 --> 00:14:37,623
WHAT WE FOUND IS THE FOLLOWING.

345
00:14:37,623 --> 00:14:41,827
FIRST, THAT AMYGDALA MEASURED 

346
00:14:41,827 --> 00:14:43,596
NICELY PREDICTED SUBSEQUENT 

347
00:14:43,596 --> 00:14:44,930
CARDIOVASCULAR DISEASE EVENTS 

348
00:14:44,930 --> 00:14:52,171
AND THAT'S AFTER ROBUST 

349
00:14:52,171 --> 00:14:55,408
ADJUSTMENT AND IT WAS STRING

350
00:14:55,408 --> 00:14:56,609
STRINGESTRING

351
00:14:56,609 --> 00:14:57,877
STRINGENTLY ASSOCIATED WITH 

352
00:14:57,877 --> 00:15:00,813
DEFINED EVENTS GOING FROM 

353
00:15:00,813 --> 00:15:04,050
CARDIOVASCULAR DISEASE EVENT TO 

354
00:15:04,050 --> 00:15:10,089
MAJOR ADVERSE CARDIAC EVENTS 

355
00:15:10,089 --> 00:15:11,590
FOUND HIGHER RISK ASSOCIATED 

356
00:15:11,590 --> 00:15:12,625
WITH THE IMAGING SIGNAL.

357
00:15:12,625 --> 00:15:14,360
IF WE LOOKED AT THE TIMING WE 

358
00:15:14,360 --> 00:15:15,261
FOUND SOMETHING INTERESTING.

359
00:15:15,261 --> 00:15:17,363
THOSE INDIVIDUALS WHO HAD NEAR 

360
00:15:17,363 --> 00:15:18,431
TERM EVENT WITHIN THE FIRST YEAR

361
00:15:18,431 --> 00:15:20,866
HAD THE HIGHEST AMYGDALA SIGNALS

362
00:15:20,866 --> 00:15:23,469
COMPARED TO THOSE WITH LATTER 

363
00:15:23,469 --> 00:15:25,871
EVENTS OR THOSE WHO NEVER 

364
00:15:25,871 --> 00:15:28,174
DEVELOPED AN EVENT.

365
00:15:28,174 --> 00:15:29,575
INTERESTINGLY ALSO, WE FOUND 

366
00:15:29,575 --> 00:15:31,777
CORRELATIONS BETWEEN THE IMAGING

367
00:15:31,777 --> 00:15:33,012
SIGNALS IN THE BRAIN WITH WHAT'S

368
00:15:33,012 --> 00:15:34,613
HAPPENING IN THE ARTERIES AND 

369
00:15:34,613 --> 00:15:36,816
THE BONE MARROW.

370
00:15:36,816 --> 00:15:38,117
INDIVIDUALS WITH SUBSEQUENT 

371
00:15:38,117 --> 00:15:40,486
EVENTS TENDED TO HAVE HIGHER 

372
00:15:40,486 --> 00:15:41,587
AMYGDALA SIGNALS AND HERE'S A 

373
00:15:41,587 --> 00:15:42,488
PERSON WITH THE SUBSEQUENT EVENT

374
00:15:42,488 --> 00:15:45,624
AND THE AMYGDALA WITH A PERSON 

375
00:15:45,624 --> 00:15:48,661
WITH THE SUBSEQUENT EVENT.

376
00:15:48,661 --> 00:15:51,363
THE PERSON WITH THE SUBSEQUENT 

377
00:15:51,363 --> 00:15:53,299
EVENT HAD HIGHER INFLAMMATION 

378
00:15:53,299 --> 00:15:56,035
AND LEUKOPOIETIC ACTIVITY IN THE

379
00:15:56,035 --> 00:15:58,237
BONE MARROW AND FOUND 

380
00:15:58,237 --> 00:16:00,206
CORRELATIONS BETWEEN THE BRAIN 

381
00:16:00,206 --> 00:16:02,074
IMAGE AND ATHEROSCLEROTIC 

382
00:16:02,074 --> 00:16:03,943
ACTIVITY AND BONE MARROW 

383
00:16:03,943 --> 00:16:06,979
ACTIVITY AND NOT WITH SUB 

384
00:16:06,979 --> 00:16:07,313
CUTANEOUS FAT.

385
00:16:07,313 --> 00:16:10,950
WE ALSO FOUND THAT THE AMYGDALA 

386
00:16:10,950 --> 00:16:12,384
ACTIVITY PREDICTED ARTERIAL 

387
00:16:12,384 --> 00:16:14,120
INFLAMMATION THROUGH THE BONE 

388
00:16:14,120 --> 00:16:15,554
MARROW ACTIVITY.

389
00:16:15,554 --> 00:16:18,524
THIS WAS SEEN THROUGH SINGLE 

390
00:16:18,524 --> 00:16:20,426
MEDIATION ANALYSIS.

391
00:16:20,426 --> 00:16:27,767
IN FACT 65% WAS EXPLAINED BY 

392
00:16:27,767 --> 00:16:30,936
CHANGES IN BONE MARROW AND THE 

393
00:16:30,936 --> 00:16:32,471
AMYGDALA AND EVENTS WAS 

394
00:16:32,471 --> 00:16:34,173
EXPLAINED BY CHANGES IN THE 

395
00:16:34,173 --> 00:16:34,974
ARTERIES.

396
00:16:34,974 --> 00:16:37,243
IF WE LOOKED AT SERIAL MEDIATOR 

397
00:16:37,243 --> 00:16:40,846
PATHS THE AMYGDALA ASSOCIATED 

398
00:16:40,846 --> 00:16:41,447
WITH CARDIOVASCULAR DISEASE 

399
00:16:41,447 --> 00:16:46,185
THROUGH BONE AMARROW SUPPORT TH 

400
00:16:46,185 --> 00:16:48,954
PATHS PREDICTED IN MICE AND 

401
00:16:48,954 --> 00:16:52,124
SHOWN A MODEL STRESS THROUGH 

402
00:16:52,124 --> 00:16:56,495
ACTIVATION OF THE AMYGDALA 

403
00:16:56,495 --> 00:16:58,264
INCREASES BONE MARROW AND 

404
00:16:58,264 --> 00:16:59,031
STIMULATION AND LEADS TO 

405
00:16:59,031 --> 00:17:01,167
CARDIOVASCULAR EVENTS.

406
00:17:01,167 --> 00:17:04,770
AND THERE'S BEEN SEVERAL 

407
00:17:04,770 --> 00:17:05,104
FEATURES.

408
00:17:05,104 --> 00:17:10,943
THIS STUDY AND THERE'S AN 

409
00:17:10,943 --> 00:17:15,481
ASSOCIATION BETWEEN AMYGDALA 

410
00:17:15,481 --> 00:17:18,083
ACTIVITY AND THE MORE THERE WERE

411
00:17:18,083 --> 00:17:19,618
HIGHER PLAQUES AND IN THE SAME 

412
00:17:19,618 --> 00:17:21,420
STUDY THE AMYGDALA ACTIVITY LEAD

413
00:17:21,420 --> 00:17:26,091
TO FEATURES THROUGH THE BONE 

414
00:17:26,091 --> 00:17:27,960
MARROW.

415
00:17:27,960 --> 00:17:30,362
THIS SHOWED AN ASSOCIATION 

416
00:17:30,362 --> 00:17:34,166
BETWEEN AMYGDALA AND ACUTE 

417
00:17:34,166 --> 00:17:37,236
MYOCARDIAL INFARCTIONS.

418
00:17:37,236 --> 00:17:38,871
THEY HAD HIGHER AMYGDALA 

419
00:17:38,871 --> 00:17:41,473
ACTIVITY AND THERE WAS A NICE 

420
00:17:41,473 --> 00:17:42,141
ASSOCIATION BETWEEN PERCEIVED 

421
00:17:42,141 --> 00:17:44,977
STRESS AND AMYGDALA ACTIVITY.

422
00:17:44,977 --> 00:17:46,946
MOREOVER, THEY ALSO FOUND 

423
00:17:46,946 --> 00:17:49,148
ASSOCIATIONS BETWEEN THE BRAIN 

424
00:17:49,148 --> 00:17:53,085
IMAGING AND ARTERIAL 

425
00:17:53,085 --> 00:17:54,920
INFLAMMATION AS WELL AS BONE 

426
00:17:54,920 --> 00:17:55,821
MARROW ACTIVITY.

427
00:17:55,821 --> 00:17:57,823
RECENTLY HERE'S A STUDY THAT 

428
00:17:57,823 --> 00:18:00,693
SHOWED AMYGDALA ACTIVITY 

429
00:18:00,693 --> 00:18:03,062
PREDICTS RECURRING EVENTS IN 

430
00:18:03,062 --> 00:18:05,197
PATIENTS COMING IN WITH STROKES 

431
00:18:05,197 --> 00:18:08,167
AND IN FACT THEY FOUND THOSE 

432
00:18:08,167 --> 00:18:10,236
PRESENTING WITH LOWER AMYGDALA 

433
00:18:10,236 --> 00:18:13,005
ACTIVITY TENDED TO HAVE FEWER 

434
00:18:13,005 --> 00:18:14,206
RECURRENT STROKES COMPARED TO 

435
00:18:14,206 --> 00:18:17,643
THOSE WITH HIGHER AMYGDALA 

436
00:18:17,643 --> 00:18:17,910
ACTIVITY.

437
00:18:17,910 --> 00:18:20,079
LIKEWISE THEY FOUND THE SAME 

438
00:18:20,079 --> 00:18:20,412
ASSOCIATIONS.

439
00:18:20,412 --> 00:18:21,814
THOSE WITH HIGHER BONE MARROW 

440
00:18:21,814 --> 00:18:24,483
ACTIVITY WERE LIKELY TO COME 

441
00:18:24,483 --> 00:18:25,918
BACK WITH RECURRENT STROKES.

442
00:18:25,918 --> 00:18:28,220
NOW, I'VE BEEN TALKING ABOUT THE

443
00:18:28,220 --> 00:18:29,688
AMYGDALA AND I GIVE YOU THE 

444
00:18:29,688 --> 00:18:34,393
SHORTENED NAME OF THE A MMYGDAL 

445
00:18:34,393 --> 00:18:37,463
ACTIVITY BUT IT'S ABOUT THE 

446
00:18:37,463 --> 00:18:38,898
AMYGDALA CORTICAL INTERACTIONS.

447
00:18:38,898 --> 00:18:44,103
WE LOOKED AT PATIENTS WITH PTSD 

448
00:18:44,103 --> 00:18:46,505
VERSUS CONTROL EXPOSED TO TRAUMA

449
00:18:46,505 --> 00:18:48,407
BUT DIDN'T DEVELOP PTSD AND 

450
00:18:48,407 --> 00:18:52,077
HEALTHY CONTROL AND WE DID BRAIN

451
00:18:52,077 --> 00:18:55,381
IMAGING AND SHOW THE AVERAGE 

452
00:18:55,381 --> 00:18:57,082
BRAIN IMAGING FEATURES.

453
00:18:57,082 --> 00:19:00,953
HEALTHY CONTROLS HAVE THE 

454
00:19:00,953 --> 00:19:04,456
HIGHEST PREFRONTAL CORTICAL 

455
00:19:04,456 --> 00:19:06,125
ACTIVITY IN RELATION TO THE 

456
00:19:06,125 --> 00:19:07,960
AMYGDALA AND LOOKING ACROSS THE 

457
00:19:07,960 --> 00:19:10,195
GROUP AMYGDALA TO CORTICAL 

458
00:19:10,195 --> 00:19:12,231
ACTIVITY WAS HIGHEST IN PTSD 

459
00:19:12,231 --> 00:19:17,703
FOLLOWED BY THE TRAUMA CONTROL 

460
00:19:17,703 --> 00:19:21,974
AND THE INDIVIDUALS WITH PTSD 

461
00:19:21,974 --> 00:19:24,877
HAD MODEST AMYGDALA ACTIVITY BUT

462
00:19:24,877 --> 00:19:26,612
LOWER PREFRONTAL CORTICAL 

463
00:19:26,612 --> 00:19:27,579
ACTIVITY GIVING THEM THE RATIO 

464
00:19:27,579 --> 00:19:37,890
THAT WAS ELEVATED.

465
00:19:41,026 --> 00:19:43,896
AND WE FOUND PEOPLE WITH PT. IS 

466
00:19:43,896 --> 00:19:47,766
SD HAD POORER AXONAL INTEGRITY 

467
00:19:47,766 --> 00:19:51,136
CONNECTING THE PREFRONTAL CORTEX

468
00:19:51,136 --> 00:19:57,543
RELATIVE TO THE HEALTHY CONTROLS

469
00:19:57,543 --> 00:20:01,380
AND WHEN WE SEE THE CORRELATION 

470
00:20:01,380 --> 00:20:04,450
WE ALSO FOUND THE AXONAL 

471
00:20:04,450 --> 00:20:07,252
INTEGRITY PREDICTED 

472
00:20:07,252 --> 00:20:10,556
ATHEROSCLEROSIS AND AMYGDALA 

473
00:20:10,556 --> 00:20:11,857
ACTIVITY PREDICTED THIS BURDEN.

474
00:20:11,857 --> 00:20:12,691
IT'S IMPORTANT TO RECOGNIZE IT'S

475
00:20:12,691 --> 00:20:14,960
NOT ALL ABOUT THE AMYGDALA BUT 

476
00:20:14,960 --> 00:20:16,929
THE AMYGDALA RELATIVE TO COUNTER

477
00:20:16,929 --> 00:20:27,272
REGULATORY TISSUES.

478
00:20:40,586 --> 00:20:42,855
DOCTORS LOOKED AT THE GENETICS 

479
00:20:42,855 --> 00:20:46,859
OF STRESS AND HAD A POLY GENIC 

480
00:20:46,859 --> 00:20:48,527
RISK STORE AND ASKED IF 

481
00:20:48,527 --> 00:20:49,795
INDIVIDUALS WITH HIGHER 

482
00:20:49,795 --> 00:20:52,998
STRESS-RELATED GENETICS HAD 

483
00:20:52,998 --> 00:20:58,003
GREATER AMYGDULAR ACTIVITY AND 

484
00:20:58,003 --> 00:21:02,174
IF YOU SEPARATE THE SIGNAL GOES 

485
00:21:02,174 --> 00:21:12,451
UP IN THE BRAIN.

486
00:21:14,953 --> 00:21:20,959
AND IN CHRONIC STRESS SHRINKAGE 

487
00:21:20,959 --> 00:21:24,696
IN THE AMYGDALA AND YOU HAVE THE

488
00:21:24,696 --> 00:21:29,635
SHRINKAGE OF THE AMYGDALA AS 

489
00:21:29,635 --> 00:21:34,073
WELL AND THEY FOUND AND THE 

490
00:21:34,073 --> 00:21:34,706
STRESS SENSITIVE GENES AS THE 

491
00:21:34,706 --> 00:21:36,675
SCORES WENT UP THE RISK FOR 

492
00:21:36,675 --> 00:21:37,309
CARDIOVASCULAR DISEASE EVENTS 

493
00:21:37,309 --> 00:21:41,080
ALSO WENT UP WHETHER YOU LOOKED 

494
00:21:41,080 --> 00:21:44,683
AT IS IN THE MASS BRIGHAM BIO 

495
00:21:44,683 --> 00:21:54,893
BANK OR U.K.

496
00:21:59,064 --> 00:22:01,100
AND LESS TO CHANGES IN THE 

497
00:22:01,100 --> 00:22:01,366
BRAIN.

498
00:22:01,366 --> 00:22:03,102
THIS IS AN IMPORTANT MECHANISM 

499
00:22:03,102 --> 00:22:08,107
BY WHY THE FINDINGS ARE LINKED.

500
00:22:08,107 --> 00:22:09,575
ANOTHER ASPECT I WANT TO 

501
00:22:09,575 --> 00:22:11,944
INTRODUCE IS THE ARTERY-BRAIN 

502
00:22:11,944 --> 00:22:12,878
CIRCUIT.

503
00:22:12,878 --> 00:22:13,212
ABC.

504
00:22:13,212 --> 00:22:15,214
AND I'M GOING TO TELL YOU 

505
00:22:15,214 --> 00:22:18,951
SOMETHING ABOUT AN ARTERY 

506
00:22:18,951 --> 00:22:27,493
TERTIARY LYMPHOID ORGAN AND THIS

507
00:22:27,493 --> 00:22:30,496
REPORTED IN NATURE '22 THAT MICE

508
00:22:30,496 --> 00:22:31,363
HAD COLLECTIONS OF INFLAMMATION 

509
00:22:31,363 --> 00:22:33,932
AROUND THE ARTERIES AND THEY 

510
00:22:33,932 --> 00:22:35,634
WERE LINKED TO SYMPATHETIC 

511
00:22:35,634 --> 00:22:38,937
NERVES THAT WENT TO THE DORSAL 

512
00:22:38,937 --> 00:22:43,909
ROOT GANGLION AND TRACE IT BACK 

513
00:22:43,909 --> 00:22:53,352
TO THE CENTRAL AMYGDALA AND 

514
00:22:53,352 --> 00:22:55,754
FOUND THERE WAS A LINK.

515
00:22:55,754 --> 00:23:01,226
AND THAT WAS AN INTERESTING 

516
00:23:01,226 --> 00:23:11,703
FINDING THEY WERE ABLE TO  

517
00:23:19,912 --> 00:23:20,445
SHRINK THE INFLAMMATION AND 

518
00:23:20,445 --> 00:23:21,780
ADDITIONAL FEATURE I WANT TO 

519
00:23:21,780 --> 00:23:25,450
SHARE WITH YOU IS THE ASPECT OF 

520
00:23:25,450 --> 00:23:25,784
MENTAL STRESS.

521
00:23:25,784 --> 00:23:30,989
I'M A CARD CAN -- CARDIOLOGIST 

522
00:23:30,989 --> 00:23:32,191
AND CONVENTIONAL STRESS TESTING 

523
00:23:32,191 --> 00:23:36,528
IS SOMETHING I DO ON A DAILY 

524
00:23:36,528 --> 00:23:37,396
BASIS.

525
00:23:37,396 --> 00:23:38,297
TO DO THAT WE LOOK FOR 

526
00:23:38,297 --> 00:23:42,935
BLOCKAGES.

527
00:23:42,935 --> 00:23:44,870
EXERCISE INDUCED ISCHEMIA OCCURS

528
00:23:44,870 --> 00:23:47,372
WHEN AS THE BLOCKAGE IN THE 

529
00:23:47,372 --> 00:23:49,408
CORONARIES AND THE HEART DOESN'T

530
00:23:49,408 --> 00:23:50,442
GET ENOUGH BLOOD FLOW WITH 

531
00:23:50,442 --> 00:23:53,378
STRESS AND THERE'S A DEFICIT IN 

532
00:23:53,378 --> 00:23:56,615
BLOOD FLOW ON IMAGING.

533
00:23:56,615 --> 00:24:01,920
WE CAN ALSO INDUCE ISCHEMIA WITH

534
00:24:01,920 --> 00:24:06,925
MENSTRUAL STRESS AND THAT'S 

535
00:24:06,925 --> 00:24:09,228
USUALLY DUE TO THE SMALL VESSELS

536
00:24:09,228 --> 00:24:10,762
AND LEADING TO LESS BLOOD FLOW 

537
00:24:10,762 --> 00:24:11,496
THAN WHAT IS REQUIRED.

538
00:24:11,496 --> 00:24:13,265
IN THE STUDY WHERE THEY FOLLOWED

539
00:24:13,265 --> 00:24:15,434
PATIENTS FOR SEVERAL YEARS AFTER

540
00:24:15,434 --> 00:24:17,803
IMAGING, THEY FOUND THE 

541
00:24:17,803 --> 00:24:22,941
INDIVIDUALS WHO HAVE NO ISCHEMIA

542
00:24:22,941 --> 00:24:33,318
HAD LOWEST EVENT RATE.

543
00:24:34,353 --> 00:24:36,154
AND INDIVIDUALS WITH ISCHEMIA 

544
00:24:36,154 --> 00:24:37,556
DURING MENTAL STRESS HAD A 

545
00:24:37,556 --> 00:24:38,657
HIGHER EVENT RATE.

546
00:24:38,657 --> 00:24:40,425
THAT WAS SURPRISING.

547
00:24:40,425 --> 00:24:42,027
AND FOLKS WHO HAD THE WORSE 

548
00:24:42,027 --> 00:24:43,895
OUTCOMES WERE THE INDIVIDUALS 

549
00:24:43,895 --> 00:24:45,163
WHO HAD THE COMBINATION OF 

550
00:24:45,163 --> 00:24:46,999
MENTAL STRESS AND CONVENTIONAL 

551
00:24:46,999 --> 00:24:48,166
STRESS ISCHEMIA.

552
00:24:48,166 --> 00:24:49,801
I DIDN'T MENTION THE MENTAL 

553
00:24:49,801 --> 00:24:51,870
STRESS ISCHEMIA COULD BE INDUCED

554
00:24:51,870 --> 00:24:55,540
BY SIMPLY ASKING THE PARTICIPANT

555
00:24:55,540 --> 00:24:58,310
TO GIVE A SPEECH OR TO DO MENTAL

556
00:24:58,310 --> 00:25:02,281
MATH AND DURING THIS TEST, THE 

557
00:25:02,281 --> 00:25:05,117
PEOPLE PARTICIPATING IN THE 

558
00:25:05,117 --> 00:25:07,753
STUDY WOULD LOOK UNINTERESTED 

559
00:25:07,753 --> 00:25:09,321
AND IT WOULD INCREASE THE STRESS

560
00:25:09,321 --> 00:25:10,789
PERCEIVED BY THE INDIVIDUAL AND 

561
00:25:10,789 --> 00:25:13,592
TO THE DEGREE TO WHICH THE 

562
00:25:13,592 --> 00:25:16,895
MENTAL STRESS LED TO PROFUSION 

563
00:25:16,895 --> 00:25:17,562
ABNORMALITIES ASSOCIATED WITH 

564
00:25:17,562 --> 00:25:18,530
THE OUTCOMES.

565
00:25:18,530 --> 00:25:19,898
WE'VE BEEN TALKING ABOUT STRESS 

566
00:25:19,898 --> 00:25:21,967
AND ITS IMPACT ON THE PATHWAYS 

567
00:25:21,967 --> 00:25:25,270
AND IN MOST OF THESE CASES WE 

568
00:25:25,270 --> 00:25:26,938
TALK ABOUT THEM INDEPENDENTLY OF

569
00:25:26,938 --> 00:25:28,740
RISK FACTORS.

570
00:25:28,740 --> 00:25:30,142
THAT MEANS THE ASSOCIATION 

571
00:25:30,142 --> 00:25:31,677
BETWEEN MENTAL STRESS OR IN THE 

572
00:25:31,677 --> 00:25:35,747
OTHER STUDIES I WAS SHOWING THE 

573
00:25:35,747 --> 00:25:37,082
STRESS MEASURED IN THE BRAIN AND

574
00:25:37,082 --> 00:25:39,718
CARDIOVASCULAR DISEASE EVENTS, 

575
00:25:39,718 --> 00:25:41,687
WE ADJUST FOR CARDIOVASCULAR 

576
00:25:41,687 --> 00:25:43,088
RISK FACTORS.

577
00:25:43,088 --> 00:25:45,090
HOWEVER, STRESS ALSO ASSOCIATES 

578
00:25:45,090 --> 00:25:46,358
WITH AN INCREASE IN THE 

579
00:25:46,358 --> 00:25:52,297
DEVELOPMENT OF RISK FACTORS.

580
00:25:52,297 --> 00:25:54,232
A GROUP LOOKED AT ANXIETY OR 

581
00:25:54,232 --> 00:25:55,934
DEPRESSION AND SHOWED AN 

582
00:25:55,934 --> 00:25:57,169
INCREASE RISK OF DEVELOPING 

583
00:25:57,169 --> 00:25:59,237
CARDIOVASCULAR DISEASE RISK 

584
00:25:59,237 --> 00:26:00,706
FACTORS AFTER THE DIAGNOSIS OF 

585
00:26:00,706 --> 00:26:03,108
ANXIETY OR DEPRESSION.

586
00:26:03,108 --> 00:26:04,976
AND IS THIS IS EVEN AFTER YOU 

587
00:26:04,976 --> 00:26:07,813
ADJUST FOR AGE, SEX, SMOKING, 

588
00:26:07,813 --> 00:26:10,382
LIFESTYLE FACTORS AND COMBINING 

589
00:26:10,382 --> 00:26:11,583
EVERYTHING THERE'S STILL 

590
00:26:11,583 --> 00:26:13,018
SUBSTANTIAL INCREASED RISK NOT 

591
00:26:13,018 --> 00:26:14,519
ONLY THAT BUT THE TIME TO 

592
00:26:14,519 --> 00:26:15,554
DEVELOP ANY RISK FACTOR IN THE 

593
00:26:15,554 --> 00:26:17,522
FUTURE IS REDUCED.

594
00:26:17,522 --> 00:26:19,691
HERE YOU CAN SEE INDIVIDUALS 

595
00:26:19,691 --> 00:26:21,460
WITHOUT ANXIETY AND DEPRESSION 

596
00:26:21,460 --> 00:26:25,497
DO HAVE A RISK OF DEVELOPING 

597
00:26:25,497 --> 00:26:26,164
STANDARD CARDIOVASCULAR RISK 

598
00:26:26,164 --> 00:26:28,900
FACTOR IT'S JUST THAT IT'S 

599
00:26:28,900 --> 00:26:34,339
ACCELERATED IN INDIVIDUALS WITH 

600
00:26:34,339 --> 00:26:35,240
DEPRESSION AND ANXIETY.

601
00:26:35,240 --> 00:26:37,776
I ALSO WANT TO ADD IN ADDITION 

602
00:26:37,776 --> 00:26:41,446
TO THE INCREASE AND 

603
00:26:41,446 --> 00:26:42,748
ATHEROSCLEROTIC DISEASES THERE'S

604
00:26:42,748 --> 00:26:46,585
AN INCREASE IN THROMBOTIC 

605
00:26:46,585 --> 00:26:46,918
DISEASES.

606
00:26:46,918 --> 00:26:57,562
DOCTORS MEZUE AND RF -- ROSOVSKY

607
00:26:59,664 --> 00:27:05,237
HAVE SHOWN THE INCREASE IN DVT 

608
00:27:05,237 --> 00:27:08,140
FOR THOSE WITH ANXIETY AND 

609
00:27:08,140 --> 00:27:09,808
DEPRESSION VERSUS THOSE WITHOUT.

610
00:27:09,808 --> 00:27:11,743
LOOKING AT THE BRAIN WILL SHOW 

611
00:27:11,743 --> 00:27:16,481
THOSE WITH HIGHER AMYGDALAR 

612
00:27:16,481 --> 00:27:19,618
ACTIVITY HAVE INCREASED RISK.

613
00:27:19,618 --> 00:27:21,953
ANXIETY -- DEPRESSION OR HIGH 

614
00:27:21,953 --> 00:27:24,256
STRESS ACTIVITY WILL EACH 

615
00:27:24,256 --> 00:27:26,558
PREDICT AN INCREASED RISK OF 

616
00:27:26,558 --> 00:27:26,858
THROMBOSIS.

617
00:27:26,858 --> 00:27:28,393
PUTTING THEM TOGETHER I PROPOSE 

618
00:27:28,393 --> 00:27:32,330
THE RATIO OF AMYGDALAR ACTIVITY 

619
00:27:32,330 --> 00:27:34,099
TO PREFRONTAL CORTICAL ACTIVITY 

620
00:27:34,099 --> 00:27:36,668
AND IT'S OFF AND HIGHER 

621
00:27:36,668 --> 00:27:39,671
AMYGDALAR ACTIVITY LEADS TO MORE

622
00:27:39,671 --> 00:27:42,507
HPA ACTIVATION AND MORE 

623
00:27:42,507 --> 00:27:44,342
SYMPATHETIC SYSTEM ACTIVATION.

624
00:27:44,342 --> 00:27:47,813
THESE RESULT IN SEVERAL THINGS 

625
00:27:47,813 --> 00:27:52,517
INCLUDING CORTISOL AND 

626
00:27:52,517 --> 00:27:57,889
EPINEPHRINE AND LEADS TO CHRONIC

627
00:27:57,889 --> 00:28:00,725
INFLAMMATION THROMBOSIS AND 

628
00:28:00,725 --> 00:28:02,828
ATHEROSCLEROTIC AND THE STRESSED

629
00:28:02,828 --> 00:28:06,932
ISCHEMIA ALL OF WHICH COLLUDE TO

630
00:28:06,932 --> 00:28:07,566
INCREASED CARDIOVASCULAR DISEASE

631
00:28:07,566 --> 00:28:09,301
RISK.

632
00:28:09,301 --> 00:28:10,502
SO I'VE BEEN TALKING ABOUT 

633
00:28:10,502 --> 00:28:11,703
CHRONIC STRESSORS AND I WANT TO 

634
00:28:11,703 --> 00:28:15,540
TALK NOW ABOUT THE DIFFERENCE 

635
00:28:15,540 --> 00:28:16,975
BETWEEN THE STRESS AND STRESSOR.

636
00:28:16,975 --> 00:28:22,080
SO STRESSORS ARE WHAT CAUSE 

637
00:28:22,080 --> 00:28:25,951
STRESS AND WE HAVE SEVERAL 

638
00:28:25,951 --> 00:28:29,754
STRESSORS IN LOW SOCIO ECONOMIC 

639
00:28:29,754 --> 00:28:31,857
STATUS AND NOISE AND THEY'RE 

640
00:28:31,857 --> 00:28:33,625
WELL KNOWN TO ASSOCIATE WITH AN 

641
00:28:33,625 --> 00:28:35,827
INCREASED RISK OF CARDIOVASCULAR

642
00:28:35,827 --> 00:28:38,897
DISEASE AND HYPOTHESIZED STRESS 

643
00:28:38,897 --> 00:28:41,366
ASSOCIATED PATHWAYS MEDIATE 

644
00:28:41,366 --> 00:28:43,468
BETWEEN NOISE AND SOCIO ECONOMIC

645
00:28:43,468 --> 00:28:44,035
STATUS AND CARDIOVASCULAR 

646
00:28:44,035 --> 00:28:44,436
DISEASE.

647
00:28:44,436 --> 00:28:47,105
HERE'S AN EXAMPLE OF PRIOR 

648
00:28:47,105 --> 00:28:51,743
STUDDOS THAT SHOW HOW INCOME 

649
00:28:51,743 --> 00:28:52,110
ASSOCIATES.

650
00:28:52,110 --> 00:28:55,914
IF YOU LOOK AT INCOME WHETHER IN

651
00:28:55,914 --> 00:28:58,917
THE 2000 OR 2015, THE EXPECTED 

652
00:28:58,917 --> 00:29:01,786
AGE OF DEATH FOR A 40-YEAR-OLD 

653
00:29:01,786 --> 00:29:03,221
WILL DIFFER DEPENDING ON INCOME 

654
00:29:03,221 --> 00:29:07,893
WHERE THOSE WITH THE LOWEST 

655
00:29:07,893 --> 00:29:11,596
INCOME ARE DIFFERENT THAN HIGHER

656
00:29:11,596 --> 00:29:13,064
INCOME AND THE DIFFERENCES ARE 

657
00:29:13,064 --> 00:29:14,866
INCREASING OVER THE DECADES.

658
00:29:14,866 --> 00:29:16,101
WHAT ABOUT CHANGE IN INCOME?

659
00:29:16,101 --> 00:29:18,036
IN THIS PARTICULAR STUDY THEY 

660
00:29:18,036 --> 00:29:19,070
FOLLOWED PATIENTS FROM THE START

661
00:29:19,070 --> 00:29:22,240
OF THE STUDY THROUGH 25 YEARS 

662
00:29:22,240 --> 00:29:26,778
AND FOUND INDIVIDUALS WHO HAD A 

663
00:29:26,778 --> 00:29:29,781
DROP IN INCOME HAD A HIGHER RATE

664
00:29:29,781 --> 00:29:31,983
COMPARED TO THOSE WHO HAD NO 

665
00:29:31,983 --> 00:29:33,885
CHANGE IN INCOME OR INCOME RISE.

666
00:29:33,885 --> 00:29:36,121
WHAT WAS INTERESTING IS THE 

667
00:29:36,121 --> 00:29:37,289
DIFFERENCES PERSIST AFTER 

668
00:29:37,289 --> 00:29:38,924
ADJUSTING FOR DISEASED RISK 

669
00:29:38,924 --> 00:29:39,591
FACTORS, HEALTH CARE AND INCOME 

670
00:29:39,591 --> 00:29:41,026
AT THE START OF THE STUDY.

671
00:29:41,026 --> 00:29:42,761
THE NEW CONCEPT FROM THIS STUDY 

672
00:29:42,761 --> 00:29:44,396
WAS THAT CHANGE IN INCOME WAS 

673
00:29:44,396 --> 00:29:45,797
ALSO IMPORTANT AS A PREDICTOR 

674
00:29:45,797 --> 00:29:47,432
FOR CARDIOVASCULAR DISEASE.

675
00:29:47,432 --> 00:29:49,367
WITH THAT AS A BACKGROUND, WE 

676
00:29:49,367 --> 00:29:53,071
CONDUCTED A STUDY WHERE WE ASKED

677
00:29:53,071 --> 00:29:54,606
IF INCOME LED TO CARDIOVASCULAR 

678
00:29:54,606 --> 00:29:57,008
DISEASE THROUGH CHANGES IN THE 

679
00:29:57,008 --> 00:29:57,275
BRAIN.

680
00:29:57,275 --> 00:29:59,411
WHAT WE FOUND FIRST IS THAT 

681
00:29:59,411 --> 00:30:01,580
INDIVIDUALS WITH THE LOWEST 

682
00:30:01,580 --> 00:30:02,781
INCOME HAD THE HIGHEST DISEASE 

683
00:30:02,781 --> 00:30:04,149
RISK COMPARED TO THOSE WITH 

684
00:30:04,149 --> 00:30:05,250
HIGHEST INCOME.

685
00:30:05,250 --> 00:30:06,918
FINDINGS THAT WERE SHOWN IN 

686
00:30:06,918 --> 00:30:08,753
SEVERAL PRIOR STUDIES.

687
00:30:08,753 --> 00:30:10,722
MOREOVER, WE OBSERVED THAT 

688
00:30:10,722 --> 00:30:13,658
AMYGDALAR ACTIVITY WAS HIGHEST 

689
00:30:13,658 --> 00:30:15,226
AMONG INDIVIDUALS WITH LOWEST 

690
00:30:15,226 --> 00:30:16,995
INCOME AND LOWEST AMONG 

691
00:30:16,995 --> 00:30:18,129
INDIVIDUALS WITH HIGHER INCOME 

692
00:30:18,129 --> 00:30:21,066
AND THE SAME TRENDS WERE SEEN 

693
00:30:21,066 --> 00:30:22,901
FOR ARTERIAL INFLAMMATION.

694
00:30:22,901 --> 00:30:25,170
WE FURTHERMORE NOTED THE 

695
00:30:25,170 --> 00:30:26,504
ASSOCIATION BETWEEN SOCIO 

696
00:30:26,504 --> 00:30:28,773
ECONOMIC STATUS AND MAJOR 

697
00:30:28,773 --> 00:30:29,708
ADVERSE CARDIOVASCULAR EVENTS 

698
00:30:29,708 --> 00:30:31,876
WERE LINKED TO THE AMYGDALAR 

699
00:30:31,876 --> 00:30:34,312
ACTIVITY AND THE BONE MARROW AND

700
00:30:34,312 --> 00:30:40,051
THE ARTERIES IN SERIES.

701
00:30:40,051 --> 00:30:41,720
GOING TO THE OTHER STRESSOR, WE 

702
00:30:41,720 --> 00:30:43,021
HAVE NOISE AND CARDIOVASCULAR 

703
00:30:43,021 --> 00:30:43,355
DISEASE.

704
00:30:43,355 --> 00:30:46,424
IT'S LONG BEEN SHOWN NOISE IS 

705
00:30:46,424 --> 00:30:48,793
UNHEALTHY, CHRONIC NOISE IN 

706
00:30:48,793 --> 00:30:49,194
PARTICULAR.

707
00:30:49,194 --> 00:30:51,696
THERE'S EVEN AN UNHEALTHY 

708
00:30:51,696 --> 00:30:53,565
THRESHOLD FOR NOISE AS MENTIONED

709
00:30:53,565 --> 00:30:55,467
BY SEVERAL AGENCIES INCLUDING 

710
00:30:55,467 --> 00:30:57,002
THE WORLD HEALTH ORGANIZATION 

711
00:30:57,002 --> 00:30:58,470
AND THERE'S BEEN SEVERAL 

712
00:30:58,470 --> 00:30:59,571
PATHWAYS THAT HAVE BEEN SHOWN TO

713
00:30:59,571 --> 00:31:02,374
BE ASSOCIATED WITH INCREASED 

714
00:31:02,374 --> 00:31:06,144
NOISE INCLUDING DOWN STREAM 

715
00:31:06,144 --> 00:31:08,113
CHANGES IN THE CORONARY 

716
00:31:08,113 --> 00:31:08,380
ARTERIES.

717
00:31:08,380 --> 00:31:10,081
THE QUESTION LONG OUT THERE IS 

718
00:31:10,081 --> 00:31:17,989
HOW IS DOES NOISE INITIATE THESE

719
00:31:17,989 --> 00:31:18,890
PATHOBIOLOGICAL LINES IN THE 

720
00:31:18,890 --> 00:31:19,724
FIRST PLACE.

721
00:31:19,724 --> 00:31:23,028
IT BEGINS WITH CHANGES IN THE 

722
00:31:23,028 --> 00:31:23,461
BRAIN.

723
00:31:23,461 --> 00:31:25,830
WE FIRST LOOKED AT MAJOR ADVERSE

724
00:31:25,830 --> 00:31:27,999
CARDIOVASCULAR EVENTS RELATIVE 

725
00:31:27,999 --> 00:31:29,501
TO NOISE EXPOSURE AND AS OTHER 

726
00:31:29,501 --> 00:31:34,406
GROUPS HAVE SHOWN, THOSE WHO ARE

727
00:31:34,406 --> 00:31:36,141
CHRONICALLY EXPOSED TO HIGHER 

728
00:31:36,141 --> 00:31:37,409
NOISE HAD A HIGHER 

729
00:31:37,409 --> 00:31:39,444
CARDIOVASCULAR RISK.

730
00:31:39,444 --> 00:31:40,779
INTERESTINGLY WE FOUND NOISE 

731
00:31:40,779 --> 00:31:42,681
ASSOCIATED WITH AMYGDALAR 

732
00:31:42,681 --> 00:31:42,947
ACTIVITY.

733
00:31:42,947 --> 00:31:45,183
PEOPLE LIVING IN LESS NOISY 

734
00:31:45,183 --> 00:31:47,318
AREAS HAD THE LOWEST ACTIVITY 

735
00:31:47,318 --> 00:31:48,653
AND THOSE IN THE NOISEST AREA 

736
00:31:48,653 --> 00:31:54,959
HAD THE HIGHEST AMYGDALAR 

737
00:31:54,959 --> 00:31:58,930
ACTIVITY AND NOISE LED TO MAJOR 

738
00:31:58,930 --> 00:32:02,133
EVENTS AND LED TO INCREASE IN 

739
00:32:02,133 --> 00:32:02,767
ARTERIAL INFLAMMATION.

740
00:32:02,767 --> 00:32:04,602
WE'VE BEEN TALKING ABOUT 

741
00:32:04,602 --> 00:32:07,605
STRESSORS BUT I WANT TO ASK, IS 

742
00:32:07,605 --> 00:32:09,340
IT THE STRESSOR OR STRESS 

743
00:32:09,340 --> 00:32:10,875
RESPONSE THAT CAUSES THE 

744
00:32:10,875 --> 00:32:11,109
DISEASE?

745
00:32:11,109 --> 00:32:13,144
IS IT SIMPLY LIVING IN A NOISY 

746
00:32:13,144 --> 00:32:16,715
AREA OR WHAT'S HAPPENING IN YOUR

747
00:32:16,715 --> 00:32:16,915
BRAIN?

748
00:32:16,915 --> 00:32:18,650
WE LOOKED AT THE NUMBER OF 

749
00:32:18,650 --> 00:32:20,785
STRESSORS VERSUS AMYGDALAR 

750
00:32:20,785 --> 00:32:22,554
ACTIVITY AND HAD MEASURES OF 

751
00:32:22,554 --> 00:32:23,288
STRESSORS INCLUDING INCOME, 

752
00:32:23,288 --> 00:32:24,422
CRIME AND NOISE AND THE FIRST 

753
00:32:24,422 --> 00:32:27,692
THING I'LL SHOW IS THERE'S A 

754
00:32:27,692 --> 00:32:30,428
NICE INCREASE IN AMYGDALAR 

755
00:32:30,428 --> 00:32:31,062
ACTIVITY AS YOU INCREASE 

756
00:32:31,062 --> 00:32:32,163
EXPOSURE TO STRESSORS.

757
00:32:32,163 --> 00:32:33,364
NOT SURPRISING.

758
00:32:33,364 --> 00:32:35,567
WHAT WAS INTERESTING THOUGH IS 

759
00:32:35,567 --> 00:32:36,901
THAT NOT EVERYBODY WHO IS 

760
00:32:36,901 --> 00:32:39,604
EXPOSED TO MANY STRESSORS HAVE 

761
00:32:39,604 --> 00:32:41,206
THE SAME AMYGDALA RESPONSE.

762
00:32:41,206 --> 00:32:43,374
LET ME TAKE YOU THREE THIS FOR A

763
00:32:43,374 --> 00:32:44,142
SECOND.

764
00:32:44,142 --> 00:32:46,077
INDIVIDUALS WHO ARE NOT EXPOSED 

765
00:32:46,077 --> 00:32:51,516
TO THOSE STRESSORS ON AVERAGE 

766
00:32:51,516 --> 00:32:54,552
HAVE LOWER AMYGDALA ACTIVITY.

767
00:32:54,552 --> 00:32:56,254
LESS THAN ONE STANDARD DEVIATION

768
00:32:56,254 --> 00:32:58,823
ACROSS THE MEDIAN AS LOWER 

769
00:32:58,823 --> 00:33:00,425
ACTIVITY AS IN YELLOW.

770
00:33:00,425 --> 00:33:02,093
HERE ARE INDIVIDUALS EXPOSED TO 

771
00:33:02,093 --> 00:33:04,696
THE STRESSORS CHRONICALLY AND 

772
00:33:04,696 --> 00:33:11,336
MANY OF THEM HAD LOWER AMYGDALAR

773
00:33:11,336 --> 00:33:14,939
ACTIVITY CALLING THEM 

774
00:33:14,939 --> 00:33:16,307
NEUROBIOLOGICAL ACTIVITY IS 

775
00:33:16,307 --> 00:33:18,076
LOWER DESPITE THE FACT THEY'RE 

776
00:33:18,076 --> 00:33:19,210
EXPOSED TO THE STRESSORS.

777
00:33:19,210 --> 00:33:21,980
ON THE OTHER HAND THESE PEOPLE 

778
00:33:21,980 --> 00:33:23,414
HERE WHO DEVELOPED MORE AMYGDALA

779
00:33:23,414 --> 00:33:25,784
ACTIVITY UPON EXPOSURE.

780
00:33:25,784 --> 00:33:28,520
THEY'RE LESS NEUROBIO LOGICALLY 

781
00:33:28,520 --> 00:33:28,787
RESILIENT.

782
00:33:28,787 --> 00:33:30,822
LET'S SEE IF IT MATTERS.

783
00:33:30,822 --> 00:33:33,124
IN THIS CASE WE TOOK JUST THE 

784
00:33:33,124 --> 00:33:34,959
INDIVIDUALS EXPOSED TO STRESSOR 

785
00:33:34,959 --> 00:33:38,396
AND LOOKED AT THOSE WHO ARE LESS

786
00:33:38,396 --> 00:33:43,968
VERSUS MORE NEUROBIOLOGICALLY 

787
00:33:43,968 --> 00:33:45,370
RESILIENT AND THEY HAD FEWER 

788
00:33:45,370 --> 00:33:45,603
EVENTS.

789
00:33:45,603 --> 00:33:49,374
IF YOU WERE EXPOSED TO THESE 

790
00:33:49,374 --> 00:33:50,775
STRESSORS AND YET YOUR BRAIN 

791
00:33:50,775 --> 00:33:56,447
RESPONSE IS NOT HIGH, YOUR 

792
00:33:56,447 --> 00:33:57,415
NEUROBIOLOGICAL RESILIENCE IS 

793
00:33:57,415 --> 00:33:58,917
GOOD YOU'RE LESS LIKELY TO 

794
00:33:58,917 --> 00:33:59,551
DEVELOP EVENTS.

795
00:33:59,551 --> 00:34:02,720
THERE'S A PAYOFF TO 

796
00:34:02,720 --> 00:34:04,155
NEUROBIOLOGICAL RESILIENCE, IN 

797
00:34:04,155 --> 00:34:04,455
OTHER WORDS.

798
00:34:04,455 --> 00:34:06,658
ONE QUESTION WE WOULD HAVE, 

799
00:34:06,658 --> 00:34:10,228
COULD NEUROBIOLOGICAL RESILIENCE

800
00:34:10,228 --> 00:34:12,497
INCREASE YOUR EVENTS TRIGGERED 

801
00:34:12,497 --> 00:34:12,997
BY ACUTE STRESS?

802
00:34:12,997 --> 00:34:15,767
LET ME TAKE YOU THROUGH THE 

803
00:34:15,767 --> 00:34:16,301
ACUTE STRESSORS.

804
00:34:16,301 --> 00:34:17,402
THERE ARE SEVERAL POTENTIAL 

805
00:34:17,402 --> 00:34:20,138
ACUTE STRESSORS.

806
00:34:20,138 --> 00:34:22,407
THIS IS A PARTICULARLY FAMOUS 

807
00:34:22,407 --> 00:34:22,941
STRESSOR.

808
00:34:22,941 --> 00:34:26,377
THE STUDY PUBLISHED IN THE '90s 

809
00:34:26,377 --> 00:34:28,112
SHOWED A SURGE IN HEART ATTACKS 

810
00:34:28,112 --> 00:34:29,180
AFTER EARTHQUAKES.

811
00:34:29,180 --> 00:34:30,215
ON THIS PARTICULAR STUDY WHERE 

812
00:34:30,215 --> 00:34:35,353
THEY LOOKED AT THE DAILY RATES 

813
00:34:35,353 --> 00:34:36,454
OF CARDIOVASCULAR DISEASE THAT'S

814
00:34:36,454 --> 00:34:38,089
IN THE LOS ANGELES AREA YOU CAN 

815
00:34:38,089 --> 00:34:41,159
SEE THERE'S A RATHER PREDICTABLE

816
00:34:41,159 --> 00:34:43,494
NUMBER OF HEART ATTACKS THROUGH 

817
00:34:43,494 --> 00:34:46,965
1992 AND 1993 AND THE DAYS 

818
00:34:46,965 --> 00:34:48,466
PRECEDING THE EARTHQUAKE AND 

819
00:34:48,466 --> 00:34:50,001
THEN THERE'S A SURGE IN 

820
00:34:50,001 --> 00:34:50,668
EARTHQUAKES AROUND THE TIME OF 

821
00:34:50,668 --> 00:34:54,873
THE EARTHQUAKE.

822
00:34:54,873 --> 00:34:58,409
IT DOESN'T HAVE TO BE AN 

823
00:34:58,409 --> 00:34:58,710
EARTHQUAKE.

824
00:34:58,710 --> 00:35:00,912
IT COULD BE A CHAMPION GAME AND 

825
00:35:00,912 --> 00:35:03,448
HERE'S ACUTE STRESSORS WITH THE 

826
00:35:03,448 --> 00:35:04,382
WORLD CUP.

827
00:35:04,382 --> 00:35:06,417
THIS COMPARED HEART ATTACK RATES

828
00:35:06,417 --> 00:35:09,087
AROUND THE TIME OF THE WORLD CUP

829
00:35:09,087 --> 00:35:11,556
CHAMPIONSHIP AND COMPARED IT TO 

830
00:35:11,556 --> 00:35:13,057
OTHER YEARS AS WELL.

831
00:35:13,057 --> 00:35:18,930
THE RED LINES ARE FOR THE YEAR 

832
00:35:18,930 --> 00:35:20,598
OF THE QUARTERFINAL OF THE WORLD

833
00:35:20,598 --> 00:35:22,467
CUP THE YELLOW AND BLUE LINES 

834
00:35:22,467 --> 00:35:27,071
ARE FROM PROCEEDING YEARS.

835
00:35:27,071 --> 00:35:30,208
FOR YELLOW AND BLUE THERE'S 

836
00:35:30,208 --> 00:35:30,875
PREDICTABLE NUMBER OF 

837
00:35:30,875 --> 00:35:31,843
CARDIOVASCULAR DISEASE EVENTS 

838
00:35:31,843 --> 00:35:33,645
BUT DURING THE GAINS WHERE THE 

839
00:35:33,645 --> 00:35:35,179
HOME TEAM WAS PLAYING YOU CAN 

840
00:35:35,179 --> 00:35:42,120
SEE SURGES IN HEART ATTACKS.

841
00:35:42,120 --> 00:35:43,421
THE HIGHEST SURGES OCCURRED 

842
00:35:43,421 --> 00:35:46,691
DURING THE QUARTERFINALS WIN 

843
00:35:46,691 --> 00:35:49,594
AFTER DRAMATIC PENALTY SHOOTOUT 

844
00:35:49,594 --> 00:35:51,396
AND DURING THE SEMIFINALS LOSS 

845
00:35:51,396 --> 00:35:52,730
AND LOOK AT THIS.

846
00:35:52,730 --> 00:35:54,832
WHERE THE CONSOLATION PRIZE THE 

847
00:35:54,832 --> 00:35:55,700
EVENT WENT DOWN TO THE WEEDS AND

848
00:35:55,700 --> 00:35:56,868
DURING THE FINALS WITHOUT THE 

849
00:35:56,868 --> 00:35:59,470
HOME TEAM THERE WAS A SLIGHT 

850
00:35:59,470 --> 00:36:01,339
INCREASE BUT NOT NEARLY AS 

851
00:36:01,339 --> 00:36:06,878
SPECTACULAR AS DURING THE MORE 

852
00:36:06,878 --> 00:36:17,288
EXCITING GAMES AND THE 

853
00:36:31,436 --> 00:36:33,237
BACKGROUND RATE IS LOWER AND SO 

854
00:36:33,237 --> 00:36:35,440
STRESSFUL PERIODS ARE WELL KNOWN

855
00:36:35,440 --> 00:36:37,075
TO ASSOCIATE WITH CARDIOVASCULAR

856
00:36:37,075 --> 00:36:39,877
DISEASE EVENTS.

857
00:36:39,877 --> 00:36:40,345
WHY?

858
00:36:40,345 --> 00:36:49,354
WELL, ONE WAY TO STUDY THIS IS A

859
00:36:49,354 --> 00:36:54,359
CLASSIC TAKOTSUBO SYNDROME OFTEN

860
00:36:54,359 --> 00:36:56,928
TRIGGERED BY AN ACUTE EMOTIONAL 

861
00:36:56,928 --> 00:36:58,229
OR PHYSICAL STRESSOR.

862
00:36:58,229 --> 00:37:00,698
THE PATHOGENESIS HAS BEEN 

863
00:37:00,698 --> 00:37:01,799
DELINEATED BUT A LINK BETWEEN 

864
00:37:01,799 --> 00:37:03,334
THE BRAIN AND HEART HAS BEEN 

865
00:37:03,334 --> 00:37:13,711
PROPOSED AS A FACTOR.

866
00:37:16,681 --> 00:37:23,788
AND THEY FOUND TAKOTSUBO 

867
00:37:23,788 --> 00:37:25,890
IMPAIRED CORTICO-LIMBIC ACTIVITY

868
00:37:25,890 --> 00:37:33,297
INVOLVING THE AMYGDALA AND 

869
00:37:33,297 --> 00:37:34,432
PREFRONTAL CORTEX AND DIDN'T 

870
00:37:34,432 --> 00:37:36,567
KNOW IF IT WAS PRESENT PRIOR TO 

871
00:37:36,567 --> 00:37:41,572
THE ONSET OF THE DISEASE.

872
00:37:41,572 --> 00:37:46,310
WE HAD 104 INDIVIDUALS WHO 

873
00:37:46,310 --> 00:37:53,217
UNDERWENT CT IMAGING.

874
00:37:53,217 --> 00:38:03,761
41 DEVELOPED TAKOTSUBO AND THEN 

875
00:38:07,832 --> 00:38:17,275
IDENTIFIED 63 MATCH CONTROLS.

876
00:38:17,275 --> 00:38:21,579
TACK AT SUBO AND THEY HAD LOWER 

877
00:38:21,579 --> 00:38:26,517
IMAGING AND THERE WAS A BIG 

878
00:38:26,517 --> 00:38:27,952
RANGE OF AMYGDALA ACTIVITY AMONG

879
00:38:27,952 --> 00:38:32,156
THOSE WITH TAKOTSUBO AND THOSE 

880
00:38:32,156 --> 00:38:33,524
HAD A STANDARD DEVIATION OFFER 

881
00:38:33,524 --> 00:38:35,726
THE MEAN COMPARED TO THE REST 

882
00:38:35,726 --> 00:38:37,695
AND LOWER AMOUNT OF ACTIVITY.

883
00:38:37,695 --> 00:38:38,930
WHAT WAS INTERESTING HERE IS 

884
00:38:38,930 --> 00:38:42,266
THERE WAS A RELATIONSHIP BETWEEN

885
00:38:42,266 --> 00:38:47,839
AMYGDALA ACTIVITY AND TIMING OF 

886
00:38:47,839 --> 00:38:48,139
TAKOTSUBO.

887
00:38:48,139 --> 00:38:52,176
THOSE WITH LOWER AMYGDALA AC 

888
00:38:52,176 --> 00:38:55,546
TENDED TO HAVE TAKOTSUBO YEARS 

889
00:38:55,546 --> 00:38:58,382
HEARD AND THOSE WITH LOWER 

890
00:38:58,382 --> 00:38:59,217
ACTIVITY DEVELOPED IT LESS THAN 

891
00:38:59,217 --> 00:39:00,818
A YEAR AFTER IMAGING.

892
00:39:00,818 --> 00:39:02,453
IF YOU PUT THIS TOGETHER, WE CAN

893
00:39:02,453 --> 00:39:07,558
THINK OF A CONCEPT BY WHICH 

894
00:39:07,558 --> 00:39:16,634
INDIVIDUALS WHO ARE LESS 

895
00:39:16,634 --> 00:39:18,402
NEUROBIOLOGICALLY RESILIENT AND 

896
00:39:18,402 --> 00:39:21,072
AFFECTED BY STRESSFUL EVENTS AND

897
00:39:21,072 --> 00:39:26,144
LEAD TO GREATER TRIGGERING OF 

898
00:39:26,144 --> 00:39:36,087
EXAGGERATED RESPONSE TO STRESS 

899
00:39:36,087 --> 00:39:38,856
LEADING TO ARRHYTHMIA AND SUDDEN

900
00:39:38,856 --> 00:39:41,392
DEATH AND TAKOTSUBO AND THOSE 

901
00:39:41,392 --> 00:39:42,960
MORE RESILIENT WILL HAVE LOWER 

902
00:39:42,960 --> 00:39:47,465
SUSCEPTIBILITY TO ACTIVATION TO 

903
00:39:47,465 --> 00:39:50,968
STRESS WITH FEWER RESPONSES AND 

904
00:39:50,968 --> 00:39:51,569
BENIGN COURSE.

905
00:39:51,569 --> 00:39:52,837
THAT BEING SAID, CAN YOU DO 

906
00:39:52,837 --> 00:40:02,713
ANYTHING ABOUT OUR RESILIENCE?

907
00:40:02,713 --> 00:40:04,115
THERE'S LONG BEEN AN OBSERVATION

908
00:40:04,115 --> 00:40:07,818
THAT CHANGES IN PERCEIVED STRESS

909
00:40:07,818 --> 00:40:10,655
CAN BE SHOWN TO ASSOCIATE WITH 

910
00:40:10,655 --> 00:40:14,158
CHANGES IN WHAT HAPPENS IN THE 

911
00:40:14,158 --> 00:40:14,425
AMYGDALA.

912
00:40:14,425 --> 00:40:16,827
THAT'S PROMISING.

913
00:40:16,827 --> 00:40:17,929
HERE'S A STUDY.

914
00:40:17,929 --> 00:40:19,897
IT SHOWED THAT STRESS REDUCTION 

915
00:40:19,897 --> 00:40:23,401
ON TOP OF EXERCISE CAN IMPART 

916
00:40:23,401 --> 00:40:24,135
GREATER CARDIOVASCULAR DISEASE 

917
00:40:24,135 --> 00:40:24,402
BENEFITS.

918
00:40:24,402 --> 00:40:26,404
WHAT DO I MEAN BY THAT?

919
00:40:26,404 --> 00:40:27,838
IN THIS PARTICULAR STUDY THEY 

920
00:40:27,838 --> 00:40:30,141
LOOKED AT INDIVIDUALS WITH A 

921
00:40:30,141 --> 00:40:34,946
RECENT ACUTE CORONARY SYSTEM OR 

922
00:40:34,946 --> 00:40:36,314
REVASCULARIZATION AND RANDOMIZED

923
00:40:36,314 --> 00:40:38,316
A PORTION OF SUBJECTS TO 

924
00:40:38,316 --> 00:40:41,586
STANDARD CARDIOVASCULAR REHAB 

925
00:40:41,586 --> 00:40:43,688
WHICH FOCUSES ON EXERCISE VERSUS

926
00:40:43,688 --> 00:40:45,856
CARDIOVASCULAR REHAB WITH STRESS

927
00:40:45,856 --> 00:40:46,123
REDUCTION.

928
00:40:46,123 --> 00:40:48,226
LET'S CALL THIS ENHANCED 

929
00:40:48,226 --> 00:40:49,393
CARDIOVASCULAR REHAB AND 

930
00:40:49,393 --> 00:40:51,229
COMPARED THESE GROUPS TO 

931
00:40:51,229 --> 00:40:52,330
INDIVIDUALS WHO HAVE NO 

932
00:40:52,330 --> 00:40:53,965
CARDIOVASCULAR REHAB AND THEN 

933
00:40:53,965 --> 00:40:55,633
FOLLOWED FOR FIVE YEARS FOR 

934
00:40:55,633 --> 00:40:57,201
CARDIOVASCULAR DISEASE EVENTS.

935
00:40:57,201 --> 00:41:00,104
FIRST, THE INDIVIDUALS WITH NO 

936
00:41:00,104 --> 00:41:02,206
INTERVENTIONS WERE MOST LIKELY 

937
00:41:02,206 --> 00:41:03,241
TO DEVELOP CARDIOVASCULAR 

938
00:41:03,241 --> 00:41:04,642
DISEASE EVENTS.

939
00:41:04,642 --> 00:41:06,711
HERE, FREE FROM CLINICAL EVENTS.

940
00:41:06,711 --> 00:41:09,013
THOSE WITH NO INTERVENTION WERE 

941
00:41:09,013 --> 00:41:12,783
FAR MORE LIKELY TO HAVE EVENTS.

942
00:41:12,783 --> 00:41:14,518
NO SURPRISE, THERE WAS A 

943
00:41:14,518 --> 00:41:16,354
SUBSTANTIAL IMPROVEMENT IN 

944
00:41:16,354 --> 00:41:18,422
OUTCOMES AMONG INDIVIDUALS WHO 

945
00:41:18,422 --> 00:41:19,523
HAD EXERCISE.

946
00:41:19,523 --> 00:41:22,159
BUT WHAT WAS A SURPRISE WAS THAT

947
00:41:22,159 --> 00:41:23,995
THE ADDITION OF STRESS REDUCTION

948
00:41:23,995 --> 00:41:26,397
ON TOP OF EXERCISE BOUGHT AN 

949
00:41:26,397 --> 00:41:29,133
ADDITIONAL 50% RELATIVE RISK 

950
00:41:29,133 --> 00:41:30,935
REDUCTION IN TERMS OF HEART 

951
00:41:30,935 --> 00:41:32,637
EVENTS.

952
00:41:32,637 --> 00:41:36,807
I WOULD ADD THAT OTHER FORMS OF 

953
00:41:36,807 --> 00:41:38,142
STRESS REDUCTION ALSO IMPROVE 

954
00:41:38,142 --> 00:41:41,012
BUT HAPPENS IN THE BRAIN.

955
00:41:41,012 --> 00:41:47,318
FOR EXAMPLE, TAI CHI HAS BEEN 

956
00:41:47,318 --> 00:41:50,154
KNOWN TO IMPROVE CORTICAL 

957
00:41:50,154 --> 00:41:53,190
ACTIVITY AND TAI CHI HAS BEEN 

958
00:41:53,190 --> 00:41:54,425
SHOWN TO LEAD TO THICKER 

959
00:41:54,425 --> 00:41:55,760
CORTICAL REGIONS.

960
00:41:55,760 --> 00:41:58,262
TWO ATTRACTIVE SIGNS.

961
00:41:58,262 --> 00:42:02,099
SIMPLE IMPROVEMENT IN 

962
00:42:02,099 --> 00:42:03,534
RESPIRATIONS, RESPIRATORY 

963
00:42:03,534 --> 00:42:06,537
EXERCISES CAN LEAD TO CHANGES IN

964
00:42:06,537 --> 00:42:09,907
ACTIVITY WITHIN THE AMYGDALA.

965
00:42:09,907 --> 00:42:11,509
SO THERE ARE GROWING DATA TO 

966
00:42:11,509 --> 00:42:14,178
SUPPORT THAT STRESS REDUCTION 

967
00:42:14,178 --> 00:42:16,213
TECHNIQUES AND APPROACHES SUCH 

968
00:42:16,213 --> 00:42:18,916
AS TAI CHI HAVE IMPORTANT 

969
00:42:18,916 --> 00:42:25,890
IMPACTS ON THE BRAIN.

970
00:42:25,890 --> 00:42:28,025
WHAT ABOUT LIFESTYLE FACTORS?

971
00:42:28,025 --> 00:42:29,126
THERE'S SEVERAL WE'VE LOOKED AT 

972
00:42:29,126 --> 00:42:32,229
CAREFULLY IN THE CONTEXT OF THE 

973
00:42:32,229 --> 00:42:33,798
MASS GENERAL BRIGHAM BIO BANK.

974
00:42:33,798 --> 00:42:36,667
IN THE BIO BANK WE HAVE OVER 

975
00:42:36,667 --> 00:42:38,869
50,000 INDIVIDUALS WHO HAVE 

976
00:42:38,869 --> 00:42:42,306
REPORTED THEIR LIFESTYLE DATA 

977
00:42:42,306 --> 00:42:45,242
INCLUDING SLEEP, PHYSICAL 

978
00:42:45,242 --> 00:42:46,977
ACTIVITY AND ALCOHOL AND A 

979
00:42:46,977 --> 00:42:48,479
SUBSET WHO HAVE BRAIN IMAGING 

980
00:42:48,479 --> 00:42:50,214
DATA FOR OUR ANALYSIS.

981
00:42:50,214 --> 00:42:51,982
 THIS IS WHAT WE FOUND.

982
00:42:51,982 --> 00:42:55,653
IN ONE STUDY WE FOUND IF ALCOHOL

983
00:42:55,653 --> 00:42:56,954
LIGHT TO MODERATE ALCOHOL WILL 

984
00:42:56,954 --> 00:42:57,922
IMPACT THE BRAIN REGIONS I JUST 

985
00:42:57,922 --> 00:43:02,526
DESCRIBED.

986
00:43:02,526 --> 00:43:05,262
WE OBSERVED LIGHT TO MODERATE 

987
00:43:05,262 --> 00:43:06,997
ALCOHOL REDUCES CARDIOVASCULAR 

988
00:43:06,997 --> 00:43:09,166
DISEASE EVENTS.

989
00:43:09,166 --> 00:43:12,903
SO HERE ARE 10-YEAR MACE EVENT 

990
00:43:12,903 --> 00:43:14,939
RATE IS REDUCED AND WHEN WE 

991
00:43:14,939 --> 00:43:17,174
ADJUST FOR HEALTH BEHAVIORS AND 

992
00:43:17,174 --> 00:43:18,409
SOCIO ECONOMIC AND PSYCHOLOGICAL

993
00:43:18,409 --> 00:43:21,145
AND OTHER COMORBIDITIES WE 

994
00:43:21,145 --> 00:43:22,847
CONTINUED TO SEE A NICE 

995
00:43:22,847 --> 00:43:23,714
REDUCTION IN CARDIOVASCULAR 

996
00:43:23,714 --> 00:43:24,782
DISEASE EVENTS.

997
00:43:24,782 --> 00:43:27,184
MOREOVER, IF YOU LOOK AT ALL 

998
00:43:27,184 --> 00:43:28,185
MAJOR ADVERSE CARDIOVASCULAR 

999
00:43:28,185 --> 00:43:31,122
EVENTS OR THE COMPONENTS SUCH AS

1000
00:43:31,122 --> 00:43:34,258
HEART FAILURE, PERIPHERAL 

1001
00:43:34,258 --> 00:43:36,427
VASCULAR DISEASE OR STROKE IT 

1002
00:43:36,427 --> 00:43:37,862
ALL GOES DOWN NICELY.

1003
00:43:37,862 --> 00:43:39,764
BUT BEFORE PEOPLE GET EXCITED 

1004
00:43:39,764 --> 00:43:41,732
LOOK AT WHAT HAPPENS WITH 

1005
00:43:41,732 --> 00:43:42,433
CANCERS.

1006
00:43:42,433 --> 00:43:45,202
LIGHT TO MODERATE ALCOHOL INTAKE

1007
00:43:45,202 --> 00:43:47,271
ALSO ASSOCIATES WITH AN 

1008
00:43:47,271 --> 00:43:48,539
INCREASED RATE OF CANCER SO IT'S

1009
00:43:48,539 --> 00:43:49,306
NOT ALL GOOD.

1010
00:43:49,306 --> 00:43:52,243
FOCUSSING BACK ON ALCOHOL AND 

1011
00:43:52,243 --> 00:43:54,044
THE BRAIN, THIS IS WHAT WE FOUND

1012
00:43:54,044 --> 00:43:57,615
WHEN WE LOOK AT AMYGDALAR 

1013
00:43:57,615 --> 00:43:59,417
ACTIVITY GOES DOWN NICELY WITH 

1014
00:43:59,417 --> 00:44:01,652
LIGHT TO MODERATE ALCOHOL INTAKE

1015
00:44:01,652 --> 00:44:02,753
AND WITH HIGH ALCOHOL IT GOES 

1016
00:44:02,753 --> 00:44:04,288
BACK UP.

1017
00:44:04,288 --> 00:44:06,524
I ALSO WANT TO MENTION HOW 

1018
00:44:06,524 --> 00:44:08,359
AMYGDALAR ACTIVITY GOES DOWN.

1019
00:44:08,359 --> 00:44:10,594
NOTICE I KEEP REFERRING TO 

1020
00:44:10,594 --> 00:44:11,529
AMYGDALAR ACTIVITY AND PUT A C 

1021
00:44:11,529 --> 00:44:12,363
THERE.

1022
00:44:12,363 --> 00:44:16,734
 THIS IS FOR THE CORTICAL 

1023
00:44:16,734 --> 00:44:19,270
ACTIVITY BECAUSE THE AMYGDALA 

1024
00:44:19,270 --> 00:44:22,940
ACTIVITY IS RATIO AMYGDALA TO 

1025
00:44:22,940 --> 00:44:25,309
THE CORTEX.

1026
00:44:25,309 --> 00:44:29,113
IS AMYGDALA ACTIVITY BECAUSE OF 

1027
00:44:29,113 --> 00:44:34,952
REDUCTIONS IN THE AMYGDALA OR 

1028
00:44:34,952 --> 00:44:38,656
INCREASES IN THE PRE FRONTAL 

1029
00:44:38,656 --> 00:44:40,157
CORTEX, THE AMYGDALA HAS LOWER 

1030
00:44:40,157 --> 00:44:42,526
METABOLIC ACTIVITY IN 

1031
00:44:42,526 --> 00:44:43,861
INDIVIDUALS WHO DRINK LIGHT TO 

1032
00:44:43,861 --> 00:44:44,395
MODERATE ALCOHOL.

1033
00:44:44,395 --> 00:44:47,531
ON THE OTHER HAND WE DID NOT SEE

1034
00:44:47,531 --> 00:44:50,768
A SIGNIFICANT INCREASE IN 

1035
00:44:50,768 --> 00:44:53,070
PREFRONTAL CORTICAL ACTIVITY AND

1036
00:44:53,070 --> 00:44:54,705
NO SURPRISE ALCOHOL IS NOT 

1037
00:44:54,705 --> 00:44:55,940
MAKING YOU SMARTER.

1038
00:44:55,940 --> 00:44:58,542
WHAT WE DID FIND AS A CAUTIONARY

1039
00:44:58,542 --> 00:45:01,212
NOTE IS WITH HIGHER AMOUNTS OF 

1040
00:45:01,212 --> 00:45:03,047
ALCOHOL THERE WAS A TREND 

1041
00:45:03,047 --> 00:45:04,849
TOWARDS REDUCTION IN OVER ALL 

1042
00:45:04,849 --> 00:45:06,884
BRAIN METABOLIC ACTIVITY.

1043
00:45:06,884 --> 00:45:11,455
SO THIS IS NOT A SURPRISE BUT 

1044
00:45:11,455 --> 00:45:14,925
AGAIN A NOTE OF CAUTION AS 

1045
00:45:14,925 --> 00:45:20,965
DRINKS GO OVER 14 THERE WAS A 

1046
00:45:20,965 --> 00:45:22,933
CONCERNING SIGNAL AS WELL.

1047
00:45:22,933 --> 00:45:24,902
WE ASKED IF MODERATE ALCOHOL 

1048
00:45:24,902 --> 00:45:27,872
ASSOCIATES WITH IMPROVEMENTS IN 

1049
00:45:27,872 --> 00:45:29,707
MACE RISK THROUGH THE BRAIN AND 

1050
00:45:29,707 --> 00:45:33,043
FOUND MODERATE ALCOHOL REDUCES 

1051
00:45:33,043 --> 00:45:35,079
MACE RISK IN PART THROUGH 

1052
00:45:35,079 --> 00:45:36,413
REDUCTIONS IN THE STRESS 

1053
00:45:36,413 --> 00:45:38,349
ASSOCIATED NEURAL NETWORK 

1054
00:45:38,349 --> 00:45:43,254
ACTIVITY.

1055
00:45:43,254 --> 00:45:46,290
WITH THAT IF INDEED ALCOHOL IN 

1056
00:45:46,290 --> 00:45:47,258
PART REDUCING HEART ATTACKS 

1057
00:45:47,258 --> 00:45:50,261
THROUGH IMPACTS ON THE BRAIN, WE

1058
00:45:50,261 --> 00:45:52,062
WOULD EXPECT IT TO BE MORE 

1059
00:45:52,062 --> 00:45:54,532
EFFECTIVE AT REDUCING HEART 

1060
00:45:54,532 --> 00:45:55,699
ATTACKS AMONG INDIVIDUALS 

1061
00:45:55,699 --> 00:45:56,767
ANXIOUS TO BEGIN WITH.

1062
00:45:56,767 --> 00:45:59,069
IN FACT WE TESTED THAT SO WE 

1063
00:45:59,069 --> 00:46:01,505
LOOKED AT 10-YEAR RISK OF HEART 

1064
00:46:01,505 --> 00:46:03,407
ATTACKS AMONG INDIVIDUALS WITH 

1065
00:46:03,407 --> 00:46:06,477
OR WITHOUT PRE EXISTING ANXIETY 

1066
00:46:06,477 --> 00:46:09,346
AND FOUND THAT THOSE WITH 

1067
00:46:09,346 --> 00:46:11,715
PRE-EXISTING ANXIETY HAD A 

1068
00:46:11,715 --> 00:46:12,516
GREATER REDUCTION IN THE HEART 

1069
00:46:12,516 --> 00:46:17,521
ATTACK RISK COMPARED TO THOSE 

1070
00:46:17,521 --> 00:46:21,592
WITHOUT ANXIETY.

1071
00:46:21,592 --> 00:46:23,260
ALCOHOL IS REDUCING HEART ATTACK

1072
00:46:23,260 --> 00:46:25,563
RATES DUE IN PART TO THE IMPACT 

1073
00:46:25,563 --> 00:46:27,197
ON THE BRAIN AFFECT WAS ROUGHLY 

1074
00:46:27,197 --> 00:46:28,098
DOUBLE AMONG INDIVIDUALS WITH 

1075
00:46:28,098 --> 00:46:36,307
PRE-EXISTING ANXIETY.

1076
00:46:36,307 --> 00:46:39,743
AND ATTENUATED STRESS-RELATED 

1077
00:46:39,743 --> 00:46:41,979
PATHWAYS HOWEVER, THERE'S NO 

1078
00:46:41,979 --> 00:46:43,447
SAFE LEVEL OF ALCOHOL AND NEED 

1079
00:46:43,447 --> 00:46:44,882
ADDITIONAL INTERVENTIONS THAT 

1080
00:46:44,882 --> 00:46:46,350
REDUCE NEURAL MECHANISMS WITHOUT

1081
00:46:46,350 --> 00:46:48,352
THE SIDE EFFECTS OF ALCOHOL 

1082
00:46:48,352 --> 00:46:58,829
WHICH TAKES ME TO EXERCISE.

1083
00:47:20,084 --> 00:47:22,820
WE ADDED EVERY INDIVIDUAL WAS 

1084
00:47:22,820 --> 00:47:28,626
THEN PUT INTO QUINTILES 

1085
00:47:28,626 --> 00:47:31,895
DEPENDING ON THEIR OVER ALL 

1086
00:47:31,895 --> 00:47:33,197
ACTIVITY AND THOSE WITH THE 

1087
00:47:33,197 --> 00:47:35,532
GREATEST ACTIVITY HAVE THE 

1088
00:47:35,532 --> 00:47:37,267
LOWEST AMYGDALA ACTIVITY AND 

1089
00:47:37,267 --> 00:47:39,536
NICE DOSE RESPONSE BETWEEN 

1090
00:47:39,536 --> 00:47:40,938
PHYSICAL AND AMYGDALA ACTIVITY 

1091
00:47:40,938 --> 00:47:42,940
AND THIS REMAINED SIGNIFICANT 

1092
00:47:42,940 --> 00:47:44,174
AFTER ADJUSTING FOR MULTIPLE 

1093
00:47:44,174 --> 00:47:48,178
CONFOUNDERS.

1094
00:47:48,178 --> 00:47:51,982
NOW IS PHYSICAL ACTIVITY ACTING 

1095
00:47:51,982 --> 00:47:54,918
MORE ON THE AMYGDALA OR MORE ON 

1096
00:47:54,918 --> 00:48:05,429
THE PREFRONTAL CORTEX AND WE 

1097
00:48:05,663 --> 00:48:08,932
FOUND A NICE INCREASE IN PRE 

1098
00:48:08,932 --> 00:48:14,938
FRONTAL CORTICAL CONTROL AND 

1099
00:48:14,938 --> 00:48:15,939
ENHANCES THE CONTROL AND 

1100
00:48:15,939 --> 00:48:19,810
PHYSICAL ACTIVITY REDUCES MAJOR 

1101
00:48:19,810 --> 00:48:21,879
ADVERSE CARDIAC EVENTS IN PART 

1102
00:48:21,879 --> 00:48:23,280
THROUGH CHANGES IN THE BRAIN.

1103
00:48:23,280 --> 00:48:26,350
THE NEXT QUESTION WE ASKED IF 

1104
00:48:26,350 --> 00:48:28,786
EXERCISE REDUCES HEART ATTACKS 

1105
00:48:28,786 --> 00:48:31,655
IN PART BY ATTENUATING 

1106
00:48:31,655 --> 00:48:32,256
STRESS-ASSOCIATED MECHANISMS 

1107
00:48:32,256 --> 00:48:33,457
THEN EXERCISE SHOULD HAVE A 

1108
00:48:33,457 --> 00:48:38,128
LARGER IMPACT ON MACE RISK AMONG

1109
00:48:38,128 --> 00:48:39,396
INDIVIDUALS WITH CHRONIC HIGHER 

1110
00:48:39,396 --> 00:48:41,265
AMYGDALA ACTIVITY SUCH AS 

1111
00:48:41,265 --> 00:48:42,933
INDIVIDUALS WITH DEPRESSION OR 

1112
00:48:42,933 --> 00:48:44,902
ANXIETY.

1113
00:48:44,902 --> 00:48:46,637
IN INDIVIDUALS WITHOUT 

1114
00:48:46,637 --> 00:48:47,738
DEPRESSION, EXERCISE WAS 

1115
00:48:47,738 --> 00:48:48,172
EFFECTIVE.

1116
00:48:48,172 --> 00:48:50,941
NO SURPRISE AND WE FOUND ABOUT A

1117
00:48:50,941 --> 00:48:52,476
12% REDUCTION IN HEART ATTACK 

1118
00:48:52,476 --> 00:48:53,277
RATE.

1119
00:48:53,277 --> 00:48:55,279
BUT, AMONG INDIVIDUALS WITH 

1120
00:48:55,279 --> 00:48:58,916
DEPRESSION, EXERCISING TO THE 

1121
00:48:58,916 --> 00:48:59,950
GUIDELINES ACTUALLY 

1122
00:48:59,950 --> 00:49:02,152
SUBSTANTIALLY IMPROVES YOUR RISK

1123
00:49:02,152 --> 00:49:12,663
OF HEART ATTACKS EVEN FURTHER.

1124
00:49:13,230 --> 00:49:15,866
LET ME WALK YOU THROUGH THIS.

1125
00:49:15,866 --> 00:49:18,902
FIRST, THIS IS THE ADJUSTED 

1126
00:49:18,902 --> 00:49:21,371
HAZARD RATIO FOR INDIVIDUALS 

1127
00:49:21,371 --> 00:49:22,940
WITHOUT PRIOR DEPRESSION ACROSS 

1128
00:49:22,940 --> 00:49:27,878
QUINTILES OF EXERCISE.

1129
00:49:27,878 --> 00:49:28,979
AND THE EXERCISE 

1130
00:49:28,979 --> 00:49:29,346
RECOMMENDATIONS.

1131
00:49:29,346 --> 00:49:33,283
WE TELL PATIENTS TO ACHIEVE 150 

1132
00:49:33,283 --> 00:49:37,788
TO 300 MINUTES OF MODERATE 

1133
00:49:37,788 --> 00:49:38,355
INTENSITY EXERCISE PER WEEK.

1134
00:49:38,355 --> 00:49:40,057
WE CAN SEE HERE THAT THERE IS A 

1135
00:49:40,057 --> 00:49:41,792
STEEP REDUCTION IN EVENTS 

1136
00:49:41,792 --> 00:49:43,894
FOLLOWED BY A PLATEAU.

1137
00:49:43,894 --> 00:49:46,930
MULTIPLE PRIOR STUDIES HAVE 

1138
00:49:46,930 --> 00:49:50,200
SHOWN SIMILAR CURVES FOR 

1139
00:49:50,200 --> 00:49:51,068
EXERCISE VERSUS HEART ATTACK 

1140
00:49:51,068 --> 00:49:53,670
RATES AND HENCE WE TALK ABOUT 

1141
00:49:53,670 --> 00:49:56,740
THIS 150 TO 300 MINUTES OF 

1142
00:49:56,740 --> 00:49:58,509
MODERATE EXERCISE BECAUSE OF THE

1143
00:49:58,509 --> 00:50:01,178
PLATEAU WE SEE AFTERWARDS.

1144
00:50:01,178 --> 00:50:06,350
THERE'S MINIMAL RETURNS ABOVE A 

1145
00:50:06,350 --> 00:50:08,152
CERTAIN THRESHOLD OF EXERCISE 

1146
00:50:08,152 --> 00:50:09,586
AND AMONG THOSE WITH DEPRESSION 

1147
00:50:09,586 --> 00:50:10,721
WE SAW CONTINUED IMPROVEMENTS 

1148
00:50:10,721 --> 00:50:12,756
AND NO PLATEAU WHICH WE 

1149
00:50:12,756 --> 00:50:15,125
HYPOTHESIZED WAS DUE TO THE FACT

1150
00:50:15,125 --> 00:50:17,661
MAYBE INDIVIDUALS WITH 

1151
00:50:17,661 --> 00:50:19,863
DEPRESSION STAND TO GAIN MORE 

1152
00:50:19,863 --> 00:50:21,098
FROM EXERCISE BECAUSE OF THOSE 

1153
00:50:21,098 --> 00:50:31,041
INCREASED IMPACTS ON THE BRAIN.

1154
00:50:31,041 --> 00:50:32,643
AND IN THE RELATIVE SMALL 

1155
00:50:32,643 --> 00:50:34,812
PERSPECTIVE STUDY EVALUATING 

1156
00:50:34,812 --> 00:50:37,514
EXERCISE, THEY FOUND THAT 

1157
00:50:37,514 --> 00:50:38,782
INDIVIDUALS WHO WENT TO EXERCISE

1158
00:50:38,782 --> 00:50:42,920
HAD A NICE REDUCTION IN AMYGDALA

1159
00:50:42,920 --> 00:50:50,460
ACTIVITY FOLLOWING EXERCISE.

1160
00:50:50,460 --> 00:50:51,895
>> WE HAVE FIVE MINUTES
JUST A 

1161
00:50:51,895 --> 00:50:52,396
HEADS UP.

1162
00:50:52,396 --> 00:50:57,100
>> I ALSO WANT TO TALK
ABOUT 

1163
00:50:57,100 --> 00:50:57,401
SLEEP.

1164
00:50:57,401 --> 00:51:00,037
SO HERE IS AND SLEEP CAN ALSO 

1165
00:51:00,037 --> 00:51:01,505
INCREASE CARDIOVASCULAR DISEASE 

1166
00:51:01,505 --> 00:51:01,705
RISK.

1167
00:51:01,705 --> 00:51:04,942
HERE'S TIME TO HEART ATTACKS AND

1168
00:51:04,942 --> 00:51:10,514
THIS IS HEART SURVIVAL IN 

1169
00:51:10,514 --> 00:51:11,081
INDIVIDUALS WITHOUT SLEEP 

1170
00:51:11,081 --> 00:51:16,553
DEPRIVATION THERE'S A LOWER RATE

1171
00:51:16,553 --> 00:51:18,856
COMPARED TO INDIVIDUALS WITH 

1172
00:51:18,856 --> 00:51:20,724
SLEEP DEF RIFFATION AND FOUND 

1173
00:51:20,724 --> 00:51:25,462
THE INTERACTION BETWEEN GENETICS

1174
00:51:25,462 --> 00:51:27,264
AND SLEEP AND LET ME TAKE YOU 

1175
00:51:27,264 --> 00:51:29,199
THROUGH THIS.

1176
00:51:29,199 --> 00:51:31,635
INDIVIDUALS WITH HIGHER STRESS 

1177
00:51:31,635 --> 00:51:34,938
SENSITIVITY -- A HIGHER 

1178
00:51:34,938 --> 00:51:37,174
POLYGENIC RISK SCORE FOR MORE 

1179
00:51:37,174 --> 00:51:42,079
LIKELY TO DEVELOP HEART ATTACKS 

1180
00:51:42,079 --> 00:51:45,849
IN RELATION TO SLEEP DEPRIVATION

1181
00:51:45,849 --> 00:51:50,420
AND THOSE WITH LOWER STRESS HAD 

1182
00:51:50,420 --> 00:51:52,189
LESS EVENTS BUT THOSE WITH A 

1183
00:51:52,189 --> 00:51:55,592
HIGHER STRESS SENSITIVITY HAD A 

1184
00:51:55,592 --> 00:51:56,026
GREATER RISK.

1185
00:51:56,026 --> 00:52:00,564
SO YOUR GENETICS OF STRESS WILL 

1186
00:52:00,564 --> 00:52:02,266
SOMEHOW MODIFY YOUR RISK OF 

1187
00:52:02,266 --> 00:52:03,967
HEART ATTACKS WHEN YOU'RE SLEEP 

1188
00:52:03,967 --> 00:52:04,234
DEPRIVED.

1189
00:52:04,234 --> 00:52:05,969
AS YOU FOLLOW THE CARTOON HERE, 

1190
00:52:05,969 --> 00:52:09,573
THOSE WHO ARE UNHEALTHY SLEEP 

1191
00:52:09,573 --> 00:52:10,874
BUT LOWER STRESS SENSITIVE GENES

1192
00:52:10,874 --> 00:52:13,810
HAVE A MODERATELY INCREASED RISK

1193
00:52:13,810 --> 00:52:17,080
OF MAJOR ADVERSE EVENTS WHEREAS 

1194
00:52:17,080 --> 00:52:18,315
THOSE WITH A HIGHER STRESS 

1195
00:52:18,315 --> 00:52:20,217
SENSITIVITY GENETICS HAVE DOUBLE

1196
00:52:20,217 --> 00:52:25,022
THE MACE RISK.

1197
00:52:25,022 --> 00:52:27,257
I ALSO WANT TO TALK ABOUT STRESS

1198
00:52:27,257 --> 00:52:28,292
AND CANCER.

1199
00:52:28,292 --> 00:52:29,593
SO HERE IN THE PARTICULAR STUDY 

1200
00:52:29,593 --> 00:52:32,195
WE LOOKED AT INDIVIDUALS WHO 

1201
00:52:32,195 --> 00:52:33,964
WERE COMING TO OUR HOSPITAL WITH

1202
00:52:33,964 --> 00:52:35,899
A SUSPICION OF HEAD AND NECK 

1203
00:52:35,899 --> 00:52:37,868
CANCER AND GETTING THEIR STAGES 

1204
00:52:37,868 --> 00:52:39,202
PET CTs.

1205
00:52:39,202 --> 00:52:40,370
THAT GAVE US AN OPPORTUNITY TO 

1206
00:52:40,370 --> 00:52:41,905
MEASURE THE ACTIVITY IN THEIR 

1207
00:52:41,905 --> 00:52:42,406
BRAIN.

1208
00:52:42,406 --> 00:52:45,075
FIRST, WHAT WE FOUND IS THAT THE

1209
00:52:45,075 --> 00:52:46,176
BRAIN ACTIVITY PREDICTED THE 

1210
00:52:46,176 --> 00:52:47,577
BONE MARROW ACTIVITY IN THE 

1211
00:52:47,577 --> 00:52:49,947
PATIENTS AND THE BRAIN ACTIVITY 

1212
00:52:49,947 --> 00:52:51,548
ALSO RELATED TO INFLAMMATORY 

1213
00:52:51,548 --> 00:52:51,848
BIOMARKERS.

1214
00:52:51,848 --> 00:52:55,652
BUT MORE IMPORTANTLY, WE FOUND 

1215
00:52:55,652 --> 00:52:57,354
THAT INDIVIDUALS WITH HEIGHTENED

1216
00:52:57,354 --> 00:53:00,390
BRAIN ACTIVITY HERE IN BLUE HAD 

1217
00:53:00,390 --> 00:53:01,625
A HIGHER RISK OF DYING FROM 

1218
00:53:01,625 --> 00:53:03,427
THEIR HEAD AND NECK CANCER AND 

1219
00:53:03,427 --> 00:53:05,028
THAT'S OVER ALL SURVIVAL FOR ALL

1220
00:53:05,028 --> 00:53:07,564
THE PATIENTS AND EVEN IF THEY 

1221
00:53:07,564 --> 00:53:09,132
CAME IN WITH AN ADVANCED STAGE 

1222
00:53:09,132 --> 00:53:10,968
OF CANCER WE STILL FOUND AN 

1223
00:53:10,968 --> 00:53:11,902
ASSOCIATION BETWEEN THE BRAIN 

1224
00:53:11,902 --> 00:53:13,537
IMAGING AND LIKELIHOOD OF 

1225
00:53:13,537 --> 00:53:14,371
SURVIVING THEIR CANCER.

1226
00:53:14,371 --> 00:53:16,173
HERE IF YOU LOOK AT THE BRAIN 

1227
00:53:16,173 --> 00:53:18,608
IMAGING, THOSE WHO SURVIVED WITH

1228
00:53:18,608 --> 00:53:20,777
NO PROGRESSION OF DISEASE CAME 

1229
00:53:20,777 --> 00:53:22,946
IN WITH LOWER SIGNALS OF STRESS 

1230
00:53:22,946 --> 00:53:24,715
COMPARED TO THOSE WHO SURVIVED 

1231
00:53:24,715 --> 00:53:26,416
WITH SOME PROGRESSION VERSUS 

1232
00:53:26,416 --> 00:53:30,620
THOSE WHO DIED IN THE COURSE OF 

1233
00:53:30,620 --> 00:53:30,954
THERAPY.

1234
00:53:30,954 --> 00:53:32,222
THERE'S AN ASSOCIATION BETWEEN 

1235
00:53:32,222 --> 00:53:36,093
THE BRAIN IMAGING OF STRESS AND 

1236
00:53:36,093 --> 00:53:36,927
THE OUTCOMES.

1237
00:53:36,927 --> 00:53:39,496
SO WITH THIS ALL BEING TOGETHER,

1238
00:53:39,496 --> 00:53:42,432
STRESS AND STRESS-RELATED 

1239
00:53:42,432 --> 00:53:43,533
DISORDERS ARE IMPORTANT RISK 

1240
00:53:43,533 --> 00:53:44,368
FACTORS FOR CARDIOVASCULAR 

1241
00:53:44,368 --> 00:53:45,268
DISEASE.

1242
00:53:45,268 --> 00:53:48,739
IT'S ATTRIBUTABLE RISK ON PAR 

1243
00:53:48,739 --> 00:53:53,810
WITH HIGHER TENSION, SMOKING AND

1244
00:53:53,810 --> 00:53:57,047
DIABETES AND RELATED TO POIETIC 

1245
00:53:57,047 --> 00:54:02,953
ACTIVITY AND NON-CALCIFIED 

1246
00:54:02,953 --> 00:54:03,620
PLAQUE AND CARDIOVASCULAR 

1247
00:54:03,620 --> 00:54:05,322
DISEASE IMPACTS MAY BE 

1248
00:54:05,322 --> 00:54:07,257
MODIFIABLE BUT LARGE TRIALS ARE 

1249
00:54:07,257 --> 00:54:09,526
NEEDED TO PROVE CAUSATION AND 

1250
00:54:09,526 --> 00:54:11,328
DETERMINE EFFICACY OF 

1251
00:54:11,328 --> 00:54:11,695
INTERVENTIONS.

1252
00:54:11,695 --> 00:54:13,163
UNTIL THEN, WE WOULD RECOMMEND 

1253
00:54:13,163 --> 00:54:18,268
THAT FOR INDIVIDUALS WITH HIGHER

1254
00:54:18,268 --> 00:54:18,902
ATHEROSCLEROTIC EVENTS AND 

1255
00:54:18,902 --> 00:54:20,737
STRESS TO UNDER GO STRESS 

1256
00:54:20,737 --> 00:54:22,839
REDUCTION APPROACHES, LOOK FOR 

1257
00:54:22,839 --> 00:54:24,074
PHYSICAL ACTIVITY AND HEALTHY 

1258
00:54:24,074 --> 00:54:24,274
SLEEP.

1259
00:54:24,274 --> 00:54:26,209
THANK YOU VERY MUCH FOR YOUR 

1260
00:54:26,209 --> 00:54:33,650
ATTENTION.

1261
00:54:33,650 --> 00:54:35,485
>> THANK YOU, FOR THE
WONDERFUL 

1262
00:54:35,485 --> 00:54:41,224
TALK AND FASCINATING INFORMATION

1263
00:54:41,224 --> 00:54:43,927
WITH THAT WE'LL MOVE INTO OUR 

1264
00:54:43,927 --> 00:54:44,628
Q&A SESSION.

1265
00:54:44,628 --> 00:54:46,830
I BELIEVE DR. TAWAKOL YOU WANT 

1266
00:54:46,830 --> 00:54:52,803
TO KEEP YOUR SLIDES UP FOR THE 

1267
00:54:52,803 --> 00:54:54,838
Q&A AND REMINDER FOR OUR 

1268
00:54:54,838 --> 00:54:56,306
AUDIENCE, USE THE FEEDBACK FORM 

1269
00:54:56,306 --> 00:54:57,908
LINK IF YOU HAVE QUESTIONS YOU 

1270
00:54:57,908 --> 00:55:00,444
WANT TO SUBMIT AND LET'S KICK 

1271
00:55:00,444 --> 00:55:03,980
THIS OFF AND LEN AND DAVID, DO 

1272
00:55:03,980 --> 00:55:05,449
YOU HAVE A FIRST QUESTION YOU'D 

1273
00:55:05,449 --> 00:55:07,017
LIKE TO POSE TO DR. TAWAKOL TO 

1274
00:55:07,017 --> 00:55:17,394
START OUR Q&A SESSION?

1275
00:55:23,133 --> 00:55:28,004
>> YOU COVERED A GREAT
DEAL.

1276
00:55:28,004 --> 00:55:30,073
I WANTED TO BACK TO THE 

1277
00:55:30,073 --> 00:55:31,475
BEGINNING OF THE PRESENTATION TO

1278
00:55:31,475 --> 00:55:33,243
TALK ABOUT SO MANY QUESTIONS I'D

1279
00:55:33,243 --> 00:55:35,612
LIKE TO ASK BUT THIS QUESTION 

1280
00:55:35,612 --> 00:55:37,814
I'M CURIOUS, YOU TALKED ABOUT 

1281
00:55:37,814 --> 00:55:40,584
USING PET IMAGING TO LOOK AT 

1282
00:55:40,584 --> 00:55:44,521
VARIOUS DIFFERENT PARTS OF THE 

1283
00:55:44,521 --> 00:55:44,888
BODY.

1284
00:55:44,888 --> 00:55:46,723
SAME METHOD AS TOMOGRAPHY 

1285
00:55:46,723 --> 00:55:48,125
LOOKING AT THE BRAIN AND 

1286
00:55:48,125 --> 00:55:57,400
ARTERIES AND BONE MARROW, 

1287
00:55:57,400 --> 00:56:02,739
THERE'S A TENDENCY IN PET 

1288
00:56:02,739 --> 00:56:03,406
IMAGING FOR THE WHOLE BODY AND 

1289
00:56:03,406 --> 00:56:05,542
WHAT ABOUT THE LIVER OR OTHER 

1290
00:56:05,542 --> 00:56:07,711
MUSCLE -- IS THAT SOMETHING YOU 

1291
00:56:07,711 --> 00:56:09,079
THINK IS POSSIBLE IN THE NEAR 

1292
00:56:09,079 --> 00:56:10,747
FUTURE TOO LOOK AT THE EFFECTS 

1293
00:56:10,747 --> 00:56:11,314
OF STRESS ON ALL THE OTHER 

1294
00:56:11,314 --> 00:56:21,424
PARTS?

1295
00:56:24,027 --> 00:56:26,963
>> IF YOU'RE INTERESTED IN
A 

1296
00:56:26,963 --> 00:56:29,099
DISEASE PROCESS THAT INVOLVES 

1297
00:56:29,099 --> 00:56:32,169
MULTIPLE ORGANS YOU NEED TO 

1298
00:56:32,169 --> 00:56:33,870
BROADEN THE WAY TO OBTAIN YOUR 

1299
00:56:33,870 --> 00:56:34,204
DATA.

1300
00:56:34,204 --> 00:56:36,373
AND PET IMAGING GIVES YOU BE AN 

1301
00:56:36,373 --> 00:56:38,642
OPPORTUNITY TO LOOK AT THE 

1302
00:56:38,642 --> 00:56:42,879
ENTIRE BODY AT THE SAME TIME AND

1303
00:56:42,879 --> 00:56:45,515
GO BACK AND LOOK AT SEVERAL 

1304
00:56:45,515 --> 00:56:47,817
ASPECTS AND ASK QUESTIONS ONE 

1305
00:56:47,817 --> 00:56:49,920
DAY ABOUT ONE GROUP OF ORGANS 

1306
00:56:49,920 --> 00:56:51,021
AND ON ANOTHER DAY RECESS OTHER 

1307
00:56:51,021 --> 00:57:01,164
ORGANS.

1308
00:57:03,934 --> 00:57:08,805
AND WE LOOM AT LYMPHNODES AND 

1309
00:57:08,805 --> 00:57:11,241
MEASURE MUSCLE AND LOTS OF END 

1310
00:57:11,241 --> 00:57:13,076
POINTS?

1311
00:57:13,076 --> 00:57:14,477
IT CAN GROW FROM THERE.

1312
00:57:14,477 --> 00:57:18,949
WITH SOME OF THE LATEST PET 

1313
00:57:18,949 --> 00:57:20,350
TECHNIQUES THE OPPORTUNITIES ARE

1314
00:57:20,350 --> 00:57:22,085
IMPROVING BECAUSE THE RESOLUTION

1315
00:57:22,085 --> 00:57:23,453
IS IMPROVING AND THE ABILITY TO 

1316
00:57:23,453 --> 00:57:25,155
GET MORE AND MORE SENSITIVE 

1317
00:57:25,155 --> 00:57:28,124
MEASURES OF METABOLIC ACTIVITY 

1318
00:57:28,124 --> 00:57:29,326
AREN'T PROVEN.

1319
00:57:29,326 --> 00:57:30,594
NOT ONLY THAT WE DON'T ONLY HAVE

1320
00:57:30,594 --> 00:57:32,596
TO LOOK AT METABOLIC ACTIVITY.

1321
00:57:32,596 --> 00:57:34,998
WITH PET WE CAN USE DIFFERENT 

1322
00:57:34,998 --> 00:57:37,300
TRACERS THAT WILL TARGET OTHER 

1323
00:57:37,300 --> 00:57:39,035
METABOLIC PROCESSES OR OTHER 

1324
00:57:39,035 --> 00:57:40,904
BIOLOGICAL PROCESSES.

1325
00:57:40,904 --> 00:57:49,813
SO IT'S QUITE AN EXCITING TOOL.

1326
00:57:49,813 --> 00:57:50,180
 

1327
00:57:50,180 --> 00:57:51,214
>> SOUND LIKE A WHOLE
WORLD 

1328
00:57:51,214 --> 00:57:54,951
OPENING UP.

1329
00:57:54,951 --> 00:57:56,886
>> THERE IS.

1330
00:58:08,798 --> 00:58:09,366
>> DAVID.

1331
00:58:09,366 --> 00:58:11,201
>> A GREAT PRESENTATION
AND 

1332
00:58:11,201 --> 00:58:11,868
MAKING THE CONNECTION BETWEEN 

1333
00:58:11,868 --> 00:58:13,970
MIND AND BODY AND HEALTH AND 

1334
00:58:13,970 --> 00:58:16,406
DISEASE AND SPEAKS TO NCCIH'S 

1335
00:58:16,406 --> 00:58:17,574
MISSION TO UNDERSTAND WHOLE 

1336
00:58:17,574 --> 00:58:17,941
PERSON HEALTH.

1337
00:58:17,941 --> 00:58:22,412
WHAT I WANTED TO ASK YOU ABOUT 

1338
00:58:22,412 --> 00:58:23,246
IS YOU BROUGHT UP AN IMPORTANT 

1339
00:58:23,246 --> 00:58:26,983
OTHER ASPECT OF YOUR WORK IS THE

1340
00:58:26,983 --> 00:58:30,954
GENE ENVIRONMENT INTERACTIONS 

1341
00:58:30,954 --> 00:58:38,328
HAPPENING.

1342
00:58:38,328 --> 00:58:44,934
AND WHEN YOU LOOK AT HOW SELF 

1343
00:58:44,934 --> 00:58:47,771
CARE MIGHT OUT AND AROUND THE 

1344
00:58:47,771 --> 00:58:48,638
DEVELOPMENT OF PRECISION 

1345
00:58:48,638 --> 00:58:50,940
MEDICINE AND HOW THAT CAN BE 

1346
00:58:50,940 --> 00:58:53,743
USED TO MAYBE TAKE YOUR FINDINGS

1347
00:58:53,743 --> 00:58:58,948
A STEP INTO THE CLINIC AND CARE 

1348
00:58:58,948 --> 00:58:59,916
FOR PATIENTS GENERALLY.

1349
00:58:59,916 --> 00:59:05,388
>> THAT'S A VERY NICE
QUESTION.

1350
00:59:05,388 --> 00:59:07,357
I APPRECIATE IT.

1351
00:59:07,357 --> 00:59:08,825
IT'S INTERESTING HOW DIFFERENT 

1352
00:59:08,825 --> 00:59:11,127
BIOMARKERS YOU CAN GET WITH 

1353
00:59:11,127 --> 00:59:14,864
GENETIC TOOLS AND POLY GENIC 

1354
00:59:14,864 --> 00:59:17,434
RISK SCORES CAN GIVE YOU INSIGHT

1355
00:59:17,434 --> 00:59:17,801
TO DISEASE.

1356
00:59:17,801 --> 00:59:20,070
WE'VE BEEN LOOKING AT THE POLY 

1357
00:59:20,070 --> 00:59:21,971
GENIC RISK SCORE FOR LOOKING AT 

1358
00:59:21,971 --> 00:59:23,373
CARDIOVASCULAR DISEASE RISK.

1359
00:59:23,373 --> 00:59:26,142
IN THIS CASE WE'VE BEEN LOOKING 

1360
00:59:26,142 --> 00:59:27,644
ALSO AT STRESS SENSITIVITY 

1361
00:59:27,644 --> 00:59:27,844
GENES.

1362
00:59:27,844 --> 00:59:30,313
THERE'S SEVERAL WAYS YOU CAN DO 

1363
00:59:30,313 --> 00:59:30,513
THAT.

1364
00:59:30,513 --> 00:59:37,253
WE'VE BEEN USING THE POLY GENIC 

1365
00:59:37,253 --> 00:59:39,723
RISK SCORE THAT CRUNCHES ALL THE

1366
00:59:39,723 --> 00:59:41,358
NUMBERS AND GIVES A RELATIVE 

1367
00:59:41,358 --> 00:59:43,793
RISK FOR THE LIKELIHOOD YOU'LL 

1368
00:59:43,793 --> 00:59:45,662
DEVELOP A STRESS-RELATED 

1369
00:59:45,662 --> 00:59:46,663
SYNDROME SOME TIME IN YOUR LIFE.

1370
00:59:46,663 --> 00:59:49,866
I GAVE YOU ONE EXAMPLE.

1371
00:59:49,866 --> 00:59:51,167
THERE ARE SEVERAL OTHERS IN THE 

1372
00:59:51,167 --> 00:59:51,468
BACKGROUND.

1373
00:59:51,468 --> 00:59:53,536
ONE EXAMPLE I GAVE YOU IS A 

1374
00:59:53,536 --> 00:59:59,175
SIMPLE ONE WHICH IS IF YOU HAVE 

1375
00:59:59,175 --> 01:00:08,585
A GREATER THAN AVERAGE ONE 

1376
01:00:08,585 --> 01:00:11,521
RECOMMENDATION I HAD IF SOMEHOW 

1377
01:00:11,521 --> 01:00:14,057
EVERYONE WAS GETTING THEIR 

1378
01:00:14,057 --> 01:00:15,125
POLYGENIC RISK SCORE THE 

1379
01:00:15,125 --> 01:00:16,126
RECOMMENDATION I HAVE WITH 

1380
01:00:16,126 --> 01:00:23,133
INDIVIDUALS FOR GREATER THAN 

1381
01:00:23,133 --> 01:00:24,434
MEDIAN RISK STORE BE CAREFUL 

1382
01:00:24,434 --> 01:00:30,707
ABOUT SLEEP SCORE AND THAT'S ONE

1383
01:00:30,707 --> 01:00:35,044
OPPORTUNITY FOR GIVING PRECISE 

1384
01:00:35,044 --> 01:00:37,781
RECOMMENDATIONS FOR INDIVIDUALS 

1385
01:00:37,781 --> 01:00:40,817
AND I HYPOTHESIZE MULTIPLE DOWN 

1386
01:00:40,817 --> 01:00:41,651
STREAM OPPORTUNITIES.

1387
01:00:41,651 --> 01:00:43,153
SOME I CAN TALK ABOUT.

1388
01:00:43,153 --> 01:00:44,854
FOR EXAMPLE, ONE COLLEAGUE 

1389
01:00:44,854 --> 01:00:48,558
RECENTLY PUBLISHED IF YOU LOOK 

1390
01:00:48,558 --> 01:00:50,927
AT INCOME DISPARITIES, THERE'S 

1391
01:00:50,927 --> 01:00:52,495
ANY INTERACTION BETWEEN INCOME 

1392
01:00:52,495 --> 01:00:58,334
AND SOME OF THESE POLY GENIC 

1393
01:00:58,334 --> 01:01:03,773
RISK SCORES AND PEOPLE WITH 

1394
01:01:03,773 --> 01:01:05,141
LOWER STRESS SENSITIVE GENES 

1395
01:01:05,141 --> 01:01:08,077
DON'T HAVE AS MUCH AS OF A 

1396
01:01:08,077 --> 01:01:11,314
DISEASE CONSEQUENCE OF LOWER 

1397
01:01:11,314 --> 01:01:12,882
INCOME WHERE PEOPLE WITH MORE 

1398
01:01:12,882 --> 01:01:14,951
STRESSFUL GENE HAVE A GREATER 

1399
01:01:14,951 --> 01:01:15,318
CONSEQUENCE.

1400
01:01:15,318 --> 01:01:17,554
WE LOOK FOR MORE LIFESTYLE 

1401
01:01:17,554 --> 01:01:22,225
INTERVENTIONS DEPENDING ON THE 

1402
01:01:22,225 --> 01:01:22,759
STRESS-RELATED GENES.

1403
01:01:22,759 --> 01:01:23,860
>> FASCINATING.

1404
01:01:23,860 --> 01:01:34,170
THANK YOU SO MUCH.

1405
01:01:46,316 --> 01:01:48,117
>> YOU DISCUSS MENTAL
STRESS CAN

1406
01:01:48,117 --> 01:01:49,719
LEAD TO ISCHEMIA.

1407
01:01:49,719 --> 01:01:51,821
WOULD THE INCREASED MENTAL 

1408
01:01:51,821 --> 01:01:55,592
STRESS BE INDUCED BY A CHRONIC 

1409
01:01:55,592 --> 01:02:00,296
SYMPATHETIC OVERDRIVE WHERE THE 

1410
01:02:00,296 --> 01:02:03,700
CORONARIES LEAD TO THE 

1411
01:02:03,700 --> 01:02:06,436
VASOCONSTRICTION AND ISCHEMIA.

1412
01:02:06,436 --> 01:02:07,170
THIS COMES IN FROM AN AUDIENCE 

1413
01:02:07,170 --> 01:02:17,313
MEMBER.

1414
01:02:22,652 --> 01:02:24,120
>> THEY LEAD TO OTHER RISK

1415
01:02:24,120 --> 01:02:28,658
FACTORS THAT TEND TO IMPAIR 

1416
01:02:28,658 --> 01:02:30,960
CORONARY FLOW INCLUDING CHRONIC 

1417
01:02:30,960 --> 01:02:37,033
INFLAMMATION ADIS POPAUC POPADI 

1418
01:02:37,033 --> 01:02:38,468
INFLAMMATION AND INCREASE THE 

1419
01:02:38,468 --> 01:02:39,636
FLOW RESPONSE WHEN NEEDED.

1420
01:02:39,636 --> 01:02:40,270
IT'S A COMBINATION OF ALL THESE 

1421
01:02:40,270 --> 01:02:50,413
THINGS.

1422
01:03:01,858 --> 01:03:07,830
AND THERE'S ADIPOSITY THAT 

1423
01:03:07,830 --> 01:03:08,097
COMES.

1424
01:03:08,097 --> 01:03:09,399
>> AND THERE'S ANOTHER
QUESTION 

1425
01:03:09,399 --> 01:03:12,101
FROM THE MEMBER OF THE AUDIENCE 

1426
01:03:12,101 --> 01:03:12,602
WATCHING.

1427
01:03:12,602 --> 01:03:15,405
WITH EXERCISE SO EFFECTIVE IN 

1428
01:03:15,405 --> 01:03:17,874
REDUCING STRESS AND THUS 

1429
01:03:17,874 --> 01:03:20,877
CARDIOVASCULAR EVENTS, WHY ISN'T

1430
01:03:20,877 --> 01:03:25,515
EXERCISE IN STANDARD 

1431
01:03:25,515 --> 01:03:27,750
CARDIOVASCULAR REHABILITATION 

1432
01:03:27,750 --> 01:03:34,991
SUFFICIENT WHY DOES FURTHER 

1433
01:03:34,991 --> 01:03:37,594
STRESS REDUCTION NEED TO BE 

1434
01:03:37,594 --> 01:03:37,860
INCLUDED?

1435
01:03:37,860 --> 01:03:38,828
>> I'M SHOWING THE DATA I 

1436
01:03:38,828 --> 01:03:49,172
REFERRED TO BEFORE.

1437
01:03:52,208 --> 01:03:54,544
THE ADDITION OF STRESS REDUCTION

1438
01:03:54,544 --> 01:03:56,245
GIVES FURTHER BENEFITS BECAUSE 

1439
01:03:56,245 --> 01:04:00,283
WE BELIEVE STRESS REDUCTION IS 

1440
01:04:00,283 --> 01:04:01,985
AUGMENTING WHAT HAPPENS WITH 

1441
01:04:01,985 --> 01:04:02,251
EXERCISE.

1442
01:04:02,251 --> 01:04:06,222
SO EXERCISE GETS YOU SO FAR WITH

1443
01:04:06,222 --> 01:04:09,292
THE IMPROVED BIOLOGY AND STRESS 

1444
01:04:09,292 --> 01:04:10,927
REDUCTION ADDS TO THOSE 

1445
01:04:10,927 --> 01:04:12,595
IMPRESSIVE CHANGES.

1446
01:04:12,595 --> 01:04:14,964
I HYPOTHESIZE EXERCISE MAY BE 

1447
01:04:14,964 --> 01:04:17,567
WORKING MORE ON THE PREFRONTAL 

1448
01:04:17,567 --> 01:04:19,902
CORTEX AND STRESS REDUCTION MAY 

1449
01:04:19,902 --> 01:04:21,471
BE WORKING MORE ON THE AMYGDALA.

1450
01:04:21,471 --> 01:04:23,840
THE COMBINATION OF THE TWO MAY 

1451
01:04:23,840 --> 01:04:26,242
GIVE YOU GREATER IMPROVEMENTS IN

1452
01:04:26,242 --> 01:04:28,511
STRESS NEURAL ACTIVITY.

1453
01:04:28,511 --> 01:04:30,413
ALSO, EXERCISE HAS A BUNCH OF 

1454
01:04:30,413 --> 01:04:32,081
BENEFITS THAT LEAD TO 

1455
01:04:32,081 --> 01:04:33,416
IMPROVEMENTS IN HEART HEALTH 

1456
01:04:33,416 --> 01:04:34,884
THAT HAVE LITTLE TO DO WITH THE 

1457
01:04:34,884 --> 01:04:35,084
BRAIN.

1458
01:04:35,084 --> 01:04:37,854
IT GIVES YOU OTHER COURSES OF 

1459
01:04:37,854 --> 01:04:38,121
BENEFITS.

1460
01:04:38,121 --> 01:04:40,089
SO THE COMBINATION OF THE 

1461
01:04:40,089 --> 01:04:41,357
VARIOUS COURSES GETS YOU TO AN 

1462
01:04:41,357 --> 01:04:51,901
IMPROVEMENT IN OUTCOMES.

1463
01:04:51,901 --> 01:04:53,169
>> ANOTHER QUESTION FROM
THE 

1464
01:04:53,169 --> 01:04:54,937
VIDEOCAST AUDIENCE.

1465
01:04:54,937 --> 01:04:56,472
I'M CURIOUS TO KNOW WHETHER YOU 

1466
01:04:56,472 --> 01:04:58,941
HAVE DATA OR IS THERE IS DATA IN

1467
01:04:58,941 --> 01:05:01,144
THE LITERATURE SHOWING AN 

1468
01:05:01,144 --> 01:05:05,314
ASSOCIATION BETWEEN ARIDGE 

1469
01:05:05,314 --> 01:05:09,619
CARDIAC DISEASES SUCH AS ATRAIL 

1470
01:05:09,619 --> 01:05:11,387
DEFIBRILLATION AND STRESS AND 

1471
01:05:11,387 --> 01:05:12,021
NEUROPSYCHIATRIC DISORDERS?

1472
01:05:12,021 --> 01:05:13,823
ANY COMMENTS THERE OR THOUGHTS?

1473
01:05:13,823 --> 01:05:16,492
>> YES, THERE'S BEEN
STUDIES 

1474
01:05:16,492 --> 01:05:26,069
THAT SHOW ASSOCIATIONS WITH 

1475
01:05:26,069 --> 01:05:26,769
ATRIAL FIBRILLATION AND MORE 

1476
01:05:26,769 --> 01:05:28,838
RESEARCH IS NEEDED IN THAT AREA.

1477
01:05:28,838 --> 01:05:30,306
ON ONE HAND STRESS ASSOCIATES 

1478
01:05:30,306 --> 01:05:37,246
WITH THE RISK FACTORS THAT 

1479
01:05:37,246 --> 01:05:40,817
INCREASE THIS AND ADIPOSITY AND 

1480
01:05:40,817 --> 01:05:41,150
INFLAMMATION.

1481
01:05:41,150 --> 01:05:42,618
ALL WILL INCREASE THE LIKELIHOOD

1482
01:05:42,618 --> 01:05:46,823
OF THE DEVELOPMENT OF ATRIAL 

1483
01:05:46,823 --> 01:05:47,190
DEFIBRILLATION.

1484
01:05:47,190 --> 01:05:50,159
HOW ROBUST IS THE ASSOCIATION 

1485
01:05:50,159 --> 01:05:52,161
BETWEEN STRESS AND ATRIAL 

1486
01:05:52,161 --> 01:05:53,162
DEFIBRILLATION AFTER ADJUSTING 

1487
01:05:53,162 --> 01:05:54,397
FOR THE RISK FACTORS.

1488
01:05:54,397 --> 01:05:56,766
THOSE STUDIES ARE STILL NEEDED.

1489
01:05:56,766 --> 01:05:57,900
>> RIGHT.

1490
01:05:57,900 --> 01:05:58,501
OKAY.

1491
01:05:58,501 --> 01:06:04,006
>> WE HAVE ANOTHER
QUESTION 

1492
01:06:04,006 --> 01:06:12,949
COMING IN, I'M CURIOUS ABOUT 

1493
01:06:12,949 --> 01:06:13,249
MINDFULNESS.

1494
01:06:13,249 --> 01:06:14,951
DID YOU RESEARCH THE AFFECT OF 

1495
01:06:14,951 --> 01:06:17,720
THIS AND THE AMYGDALA AND 

1496
01:06:17,720 --> 01:06:18,254
RESULTING CARDIOVASCULAR 

1497
01:06:18,254 --> 01:06:18,955
DISEASE?

1498
01:06:18,955 --> 01:06:20,123
>> ABSOLUTELY.

1499
01:06:20,123 --> 01:06:23,793
MINDFULNESS IS REALLY EFFECTIVE 

1500
01:06:23,793 --> 01:06:25,595
IN REDUCING THE DOWN STREAM 

1501
01:06:25,595 --> 01:06:27,663
SIGNALS I'VE BEEN DESCRIBING.

1502
01:06:27,663 --> 01:06:30,266
IT IMPROVES THE INFLAMMATORY 

1503
01:06:30,266 --> 01:06:32,802
SIGNALS AND NICELY IMPROVES 

1504
01:06:32,802 --> 01:06:33,736
BLOOD PRESSURE RESPONSE AND WE 

1505
01:06:33,736 --> 01:06:38,241
ARE DOING STUDIES NOW TO ASK IF 

1506
01:06:38,241 --> 01:06:42,545
A MINDFULNESS INTERVENTION WILL 

1507
01:06:42,545 --> 01:06:43,312
IMPROVE THE BRAIN SIGNALS 

1508
01:06:43,312 --> 01:06:44,914
WHETHER THAT IMPROVEMENT IN THE 

1509
01:06:44,914 --> 01:06:47,016
BRAIN SIGNALS WILL LEAD TO 

1510
01:06:47,016 --> 01:06:48,217
IMPROVEMENTS IN THE BONE MARROW 

1511
01:06:48,217 --> 01:06:49,852
AND RESULT IN IMPROVEMENTS IN 

1512
01:06:49,852 --> 01:06:51,154
THE ARTERIES AS WELL.

1513
01:06:51,154 --> 01:06:53,456
WE CURRENTLY HAVE TWO STUDIES 

1514
01:06:53,456 --> 01:06:56,225
ONGOING WHERE WE'RE TESTING THIS

1515
01:06:56,225 --> 01:06:58,394
INTERVENTION AND PEOPLE ARE 

1516
01:06:58,394 --> 01:06:59,729
RANDOMIZED TO EITHER AN 

1517
01:06:59,729 --> 01:07:02,532
EIGHT-WEEK COURSE OF THIS 

1518
01:07:02,532 --> 01:07:03,699
MINDFULNESS BASED STRESS 

1519
01:07:03,699 --> 01:07:04,567
REDUCTION VERSUS NO INTERVENTION

1520
01:07:04,567 --> 01:07:06,169
TO SEE CHANGES IN OUTCOME.

1521
01:07:06,169 --> 01:07:07,103
>> OKAY.

1522
01:07:07,103 --> 01:07:09,639
WE HAD ANOTHER SIMILAR QUESTION 

1523
01:07:09,639 --> 01:07:11,574
THAT CAME IN SOMEBODY ASKING 

1524
01:07:11,574 --> 01:07:13,776
ABOUT MINDFULNESS BASED 

1525
01:07:13,776 --> 01:07:15,945
INTERVENTIONS AND AMYGDALA 

1526
01:07:15,945 --> 01:07:17,547
ACTIVITY OR STUDIES ON THAT AND 

1527
01:07:17,547 --> 01:07:18,948
I THINK YOU'VE JUST ANSWERED 

1528
01:07:18,948 --> 01:07:21,818
THAT QUESTION.

1529
01:07:21,818 --> 01:07:23,986
I WANT TO REMIND OUR VIDEOCAST 

1530
01:07:23,986 --> 01:07:26,956
AUDIENCE IF YOU HAVE ADDITIONAL 

1531
01:07:26,956 --> 01:07:29,492
QUESTIONS TO -- I'M SEEING MORE 

1532
01:07:29,492 --> 01:07:31,260
AND HERE'S A FEW MORE POPPING 

1533
01:07:31,260 --> 01:07:31,661
UP.

1534
01:07:31,661 --> 01:07:33,896
THE PERSON IS ASKING AND I'M 

1535
01:07:33,896 --> 01:07:36,165
GOING TO DROP THIS IN TO OUR 

1536
01:07:36,165 --> 01:07:41,671
CHAT FOR YOU SO YOU CAN SEE IT.

1537
01:07:41,671 --> 01:07:46,676
AND THE PERSON ASKED THIS 

1538
01:07:46,676 --> 01:07:46,943
QUESTION.

1539
01:07:46,943 --> 01:07:49,045
CURRENTLY, ASSESSMENT OF CBD 

1540
01:07:49,045 --> 01:07:51,447
RISK AND STATINS RELIES ON BLOOD

1541
01:07:51,447 --> 01:07:54,951
WITH THE PANELS A MEASURE OF 

1542
01:07:54,951 --> 01:07:55,518
ARTERIAL INFLAMMATION.

1543
01:07:55,518 --> 01:07:57,653
HOW DO YOU SEE THE FINDINGS, 

1544
01:07:57,653 --> 01:07:59,655
CHANGES, INFLUENCING THE 

1545
01:07:59,655 --> 01:08:04,894
DIAGNOSIS AND CHANGES IN CBD.

1546
01:08:04,894 --> 01:08:06,295
WHAT ROLE OR HEALTH STYLE 

1547
01:08:06,295 --> 01:08:06,896
MEDICINE AND COACHING DO YOU 

1548
01:08:06,896 --> 01:08:12,001
SEE?

1549
01:08:12,001 --> 01:08:22,411
>> SO, THERE'S EMERGING 

1550
01:08:27,450 --> 01:08:29,151
LITERATURE THAT SHOWS CHRONIC 

1551
01:08:29,151 --> 01:08:33,089
STRESS MAY IMPEDE THE ACTIONS OF

1552
01:08:33,089 --> 01:08:34,891
SOME EFFECTIVE DRUGS SUCH AS 

1553
01:08:34,891 --> 01:08:35,791
STATINS.

1554
01:08:35,791 --> 01:08:39,061
SO STATINS NICELY LOWER ARTERIAL

1555
01:08:39,061 --> 01:08:39,428
INFLAMMATION.

1556
01:08:39,428 --> 01:08:43,232
IT TURNS OUT THE LIPIDS THAT 

1557
01:08:43,232 --> 01:08:44,533
STATINS LOWER ARE SOME OF THE 

1558
01:08:44,533 --> 01:08:47,069
MOST POTENT INDUCERS OF 

1559
01:08:47,069 --> 01:08:50,439
INFLAMMATION IN THE ARTERIAL 

1560
01:08:50,439 --> 01:08:51,140
WALL.

1561
01:08:51,140 --> 01:08:54,377
WHAT WE ALSO FIND IS INDIVIDUALS

1562
01:08:54,377 --> 01:08:56,345
WHO ARE CHRONICALLY STRESSED 

1563
01:08:56,345 --> 01:09:03,085
TEND TO HAVE ONGOING BONE MARROW

1564
01:09:03,085 --> 01:09:06,856
PRODUCTION OF INFLAMMATORY CELLS

1565
01:09:06,856 --> 01:09:10,426
SO IF YOU ONLY LOWER THE LIPIDS 

1566
01:09:10,426 --> 01:09:13,095
BUT DON'T IMPROVE THE STRESS YOU

1567
01:09:13,095 --> 01:09:14,931
DON'T SEE THE AMOUNT YOU 

1568
01:09:14,931 --> 01:09:16,098
ANTICIPATED TO SEE.

1569
01:09:16,098 --> 01:09:17,099
IT'S A COMPLEX SCENARIO.

1570
01:09:17,099 --> 01:09:19,502
THERE'S ONGOING STUDIES BUT 

1571
01:09:19,502 --> 01:09:22,538
FASCINATING ANIMAL STUDIES THAT 

1572
01:09:22,538 --> 01:09:25,241
SHOW THAT STRESSED MICE RESOLVE 

1573
01:09:25,241 --> 01:09:34,984
THEIR ATHEROSCLEROTIC 

1574
01:09:34,984 --> 01:09:37,520
INFLAMMATION HALF AS WELL AS 

1575
01:09:37,520 --> 01:09:40,022
NON-STRESSED MICE.

1576
01:09:40,022 --> 01:09:41,490
>> INTERESTING.

1577
01:09:41,490 --> 01:09:46,929
IN TERMS OF THE LIFESTYLE 

1578
01:09:46,929 --> 01:09:49,265
COACHING DO YOU SEE ANYTHING 

1579
01:09:49,265 --> 01:09:49,966
THERE?

1580
01:09:49,966 --> 01:09:51,334
WHAT DO YOU THINK IS -- 

1581
01:09:51,334 --> 01:09:53,970
>> I THINK WE NEED TO
SPEND MORE

1582
01:09:53,970 --> 01:09:56,839
TIME DEVELOPING A LITERATURE 

1583
01:09:56,839 --> 01:09:58,107
THAT SHOWS THE EFFICACY OF SOME 

1584
01:09:58,107 --> 01:10:04,747
OF THESE INTERVENTIONS.

1585
01:10:04,747 --> 01:10:07,450
FOR INDIVIDUAL WHO'S HAVE 

1586
01:10:07,450 --> 01:10:10,252
ATHEROSCLEROTIC DISEASE, 

1587
01:10:10,252 --> 01:10:11,287
LIFESTYLE IS AN INCREDIBLY 

1588
01:10:11,287 --> 01:10:13,289
EFFECTIVE WAY TO REDUCE YOUR 

1589
01:10:13,289 --> 01:10:13,489
RISK.

1590
01:10:13,489 --> 01:10:16,826
I WOULD SAY A DECADE AGO HUMBLY,

1591
01:10:16,826 --> 01:10:18,894
I WOULD NOT HAVE ANTICIPATED THE

1592
01:10:18,894 --> 01:10:21,197
STRENGTH OF THE DATA THAT WE'RE 

1593
01:10:21,197 --> 01:10:22,131
SEEING EMERGE FROM THE 

1594
01:10:22,131 --> 01:10:24,834
LITERATURE SHOWING HOW EFFECTIVE

1595
01:10:24,834 --> 01:10:29,505
LIFESTYLE INTERVENTIONS ARE.

1596
01:10:29,505 --> 01:10:32,141
WE SHOW, FOR EXAMPLE, GREAT AN 

1597
01:10:32,141 --> 01:10:32,808
IMPACT EXERCISE HAS ON THE BRAIN

1598
01:10:32,808 --> 01:10:33,175
AS WELL.

1599
01:10:33,175 --> 01:10:35,578
WE'VE BEEN TALKING ABOUT STRESS 

1600
01:10:35,578 --> 01:10:42,318
AND I'VE BEEN TALKING ABOUT 

1601
01:10:42,318 --> 01:10:45,421
PREFRONTAL CORTEX AND DIDN'T 

1602
01:10:45,421 --> 01:10:46,856
MENTION COGNITION AND PROFOUND 

1603
01:10:46,856 --> 01:10:49,291
ASPECTS YOU EXPECT TO SEE WITH 

1604
01:10:49,291 --> 01:10:51,660
CHANGES IN THE PREFRONTAL 

1605
01:10:51,660 --> 01:10:52,228
CORTEX.

1606
01:10:52,228 --> 01:10:54,063
WHEN I RECOMMEND EXERCISE TO MY 

1607
01:10:54,063 --> 01:10:59,301
PATIENTS IN CLINICS I TALK ABOUT

1608
01:10:59,301 --> 01:11:01,370
CARDIOVASCULAR EVENTS AS A CARD 

1609
01:11:01,370 --> 01:11:02,938
CARRYING MEMBER OF CARDIOLOGY 

1610
01:11:02,938 --> 01:11:04,840
BUT HAS GREAT IMPACTS ON 

1611
01:11:04,840 --> 01:11:05,708
COGNITION AS WELL AND OF COURSE 

1612
01:11:05,708 --> 01:11:09,712
STRESS.

1613
01:11:09,712 --> 01:11:12,214
SO HALF YOUR PATIENTS RECOGNIZE 

1614
01:11:12,214 --> 01:11:14,250
THE MULTIPLE PATHS SOME OF THE 

1615
01:11:14,250 --> 01:11:16,886
LIFESTYLE INTERVENTIONS HAVE 

1616
01:11:16,886 --> 01:11:19,622
TOWARDS IMPROVING HEALTH AND 

1617
01:11:19,622 --> 01:11:22,958
CAUSES MANY OF THEM AND THEY'LL 

1618
01:11:22,958 --> 01:11:25,194
BE MORE ENGAGED IN THE LIFESTYLE

1619
01:11:25,194 --> 01:11:26,095
INTERVENTIONS BECAUSE THEY HAVE 

1620
01:11:26,095 --> 01:11:27,363
A BETTER UNDERSTANDING AS TO HOW

1621
01:11:27,363 --> 01:11:29,532
IT MIGHT WORK AND HOW IT MIGHT 

1622
01:11:29,532 --> 01:11:29,932
BENEFIT THEM.

1623
01:11:29,932 --> 01:11:32,068
AT THE END OF THE DAY WHEN 

1624
01:11:32,068 --> 01:11:34,136
YOU'RE CHOOSING TO EXERCISE YOUR

1625
01:11:34,136 --> 01:11:36,439
OFTEN HAVING TO CHOOSE IT OVER 

1626
01:11:36,439 --> 01:11:37,473
SOMETHING ELSE.

1627
01:11:37,473 --> 01:11:39,375
KNOWING THE DEGREE TO WHICH IT'S

1628
01:11:39,375 --> 01:11:42,578
HELPING YOU PERSONALLY ALLOWS 

1629
01:11:42,578 --> 01:11:44,480
YOU TO BETTER UNDERSTAND WHEN TO

1630
01:11:44,480 --> 01:11:46,949
PRIORITIZE THESE LIFESTYLE 

1631
01:11:46,949 --> 01:11:48,717
INTERVENTIONS.

1632
01:11:48,717 --> 01:11:50,086
>> THANK YOU.

1633
01:11:50,086 --> 01:11:51,787
I THINK THAT'S A WONDERFUL 

1634
01:11:51,787 --> 01:11:52,021
ANSWER.

1635
01:11:52,021 --> 01:11:54,223
WE ACTUALLY HAVE A DIFFERENT 

1636
01:11:54,223 --> 01:11:59,228
QUESTION SO I'LL MOVE IT ON THE 

1637
01:11:59,228 --> 01:12:01,964
NEXT ONE.

1638
01:12:01,964 --> 01:12:03,466
HOW DO YOU DETERMINE YOUR POLY 

1639
01:12:03,466 --> 01:12:08,671
GENIC SENSITIVITY AND WHAT GENES

1640
01:12:08,671 --> 01:12:12,241
ARE INVOLVED?

1641
01:12:12,241 --> 01:12:17,279
>> POLY GENIC RISK SCORES
ARE 

1642
01:12:17,279 --> 01:12:18,647
THROUGH ANALYSES AND AN 

1643
01:12:18,647 --> 01:12:19,315
INDIVIDUAL GETS THEIR GENES 

1644
01:12:19,315 --> 01:12:19,582
ASSESSED.

1645
01:12:19,582 --> 01:12:23,486
WE DO IT IN THE CONTEXT OF OUR 

1646
01:12:23,486 --> 01:12:26,255
BIO BANK STUDIES.

1647
01:12:26,255 --> 01:12:29,058
THE MASS GENERAL BRIGHAM BIO 

1648
01:12:29,058 --> 01:12:30,426
BANK BUT THERE ARE LARGER 

1649
01:12:30,426 --> 01:12:31,627
STUDIES INCLUDING THE U.K. BIO 

1650
01:12:31,627 --> 01:12:32,728
BANK THAT ALSO DO THAT.

1651
01:12:32,728 --> 01:12:36,232
ANOTHER WAY TO DO THAT IS YOU 

1652
01:12:36,232 --> 01:12:39,101
CAN GO TO ONE OF THE GROUPS THAT

1653
01:12:39,101 --> 01:12:40,469
WILL TAKE YOUR BLOOD SAMPLES AND

1654
01:12:40,469 --> 01:12:44,240
MEASURE YOUR GENETICS, 23 AND ME

1655
01:12:44,240 --> 01:12:45,741
FOR EXAMPLE NOT PUT IN A PLUG 

1656
01:12:45,741 --> 01:12:47,243
FOR ANY PARTICULAR COMPANY BUT 

1657
01:12:47,243 --> 01:12:49,011
THAT WOULD BE ONE PLACE YOU CAN 

1658
01:12:49,011 --> 01:12:49,178
GO.

1659
01:12:49,178 --> 01:12:52,014
THEN YOU WOULD HAVE TO HAVE A 

1660
01:12:52,014 --> 01:12:53,883
GROUP MEASURE THAT POLY GENIC 

1661
01:12:53,883 --> 01:12:54,950
RISK SCORE.

1662
01:12:54,950 --> 01:12:56,318
THAT'S NOT SO STRAIGHTFORWARD 

1663
01:12:56,318 --> 01:12:57,653
AND TRADITIONALLY DONE.

1664
01:12:57,653 --> 01:13:00,156
SOME GROUP NEEDS TO HAVE ACCESS 

1665
01:13:00,156 --> 01:13:02,958
TO POINT THE 2.2 MILLION SNIPS, 

1666
01:13:02,958 --> 01:13:04,126
INDIVIDUAL GENES AND CALCULATE 

1667
01:13:04,126 --> 01:13:08,864
THAT WEIGHTED SCORE FOR YOU.

1668
01:13:08,864 --> 01:13:12,201
I WISH I HAD A DIRECTOR ANSWER 

1669
01:13:12,201 --> 01:13:13,769
HOW THAT COULD BE ACHIEVED 

1670
01:13:13,769 --> 01:13:15,070
EASILY BUT I DON'T AT THIS 

1671
01:13:15,070 --> 01:13:15,271
POINT.

1672
01:13:15,271 --> 01:13:15,838
>> THANK YOU.

1673
01:13:15,838 --> 01:13:17,506
I THINK IT'S A GOOD INSIGHT INTO

1674
01:13:17,506 --> 01:13:20,342
THE FACT THAT THERE'S STILL MORE

1675
01:13:20,342 --> 01:13:23,345
TO BE DONE THERE EVEN IN THE 

1676
01:13:23,345 --> 01:13:23,612
INDICATOR.

1677
01:13:23,612 --> 01:13:26,949
WE HAVE A QUESTION THAT CAME IN 

1678
01:13:26,949 --> 01:13:29,285
FROM A COLLEGIATE NIAID.

1679
01:13:29,285 --> 01:13:32,788
AND THEY WERE ASKING IN THE WORK

1680
01:13:32,788 --> 01:13:35,558
SHOWING PREFRONTAL CORTEX 

1681
01:13:35,558 --> 01:13:37,693
AMYGDALA DIFFERENCES BETWEEN 

1682
01:13:37,693 --> 01:13:39,461
STUDIED POPULATIONS AND 

1683
01:13:39,461 --> 01:13:39,728
CONTROLS.

1684
01:13:39,728 --> 01:13:43,866
ARE CONDITIONS LIKE ADHD 

1685
01:13:43,866 --> 01:13:50,906
CONTROLLED FOR SINCE IT INT

1686
01:13:50,906 --> 01:13:57,580
INHERENTLY HAS LESS PHD UPTAKE.

1687
01:13:57,580 --> 01:13:58,714
>> NOT REGULARLY.

1688
01:13:58,714 --> 01:14:02,251
WE HAVE PSYCHO METRIC ANALYSES 

1689
01:14:02,251 --> 01:14:06,922
AND WE WILL ASSESS FOR SEVERAL 

1690
01:14:06,922 --> 01:14:17,366
STRESS-RELATED DISORDERS.

1691
01:14:19,802 --> 01:14:21,537
>> AND WE HAVE A COUPLE 

1692
01:14:21,537 --> 01:14:23,372
QUESTIONS FROM MEMBERS OF THE 

1693
01:14:23,372 --> 01:14:25,274
AUDIENCE ASKING WHAT TYPES OF 

1694
01:14:25,274 --> 01:14:26,909
STRESS REDUCTION ACTIVITIES ARE 

1695
01:14:26,909 --> 01:14:30,079
RECOMMENDED?

1696
01:14:30,079 --> 01:14:31,313
>> WELL, THE FIRST 

1697
01:14:31,313 --> 01:14:32,248
RECOMMENDATION I WOULD HAVE IS 

1698
01:14:32,248 --> 01:14:35,050
TO MAKE SURE YOU HAVE HEALTHY 

1699
01:14:35,050 --> 01:14:38,320
SLEEP BECAUSE UNHEALTHY SLEEP IS

1700
01:14:38,320 --> 01:14:41,557
GOING TO REALLY HURT YOUR STRESS

1701
01:14:41,557 --> 01:14:44,260
CONTROL AND REDUCE YOUR 

1702
01:14:44,260 --> 01:14:52,401
RESILIENCE AS A RESULT.

1703
01:14:52,401 --> 01:14:54,803
YOU'RE MORE LIKELY TO HAVE 

1704
01:14:54,803 --> 01:14:56,739
INFLAMMATORY REACTIONS IS WHEN 

1705
01:14:56,739 --> 01:14:58,607
YOU'RE STUDYING FOR YOUR EXAMS 

1706
01:14:58,607 --> 01:15:01,577
AND SLEEP DEPRIVED.

1707
01:15:01,577 --> 01:15:03,879
BUT FROM THERE WE SEE ALL SORTS 

1708
01:15:03,879 --> 01:15:07,316
OF RISKS OVER A LIFE TIME THAT 

1709
01:15:07,316 --> 01:15:10,386
ASSOCIATES WITH SLEEP 

1710
01:15:10,386 --> 01:15:10,819
DEPRIVATION.

1711
01:15:10,819 --> 01:15:11,353
NEXT IS EXERCISE.

1712
01:15:11,353 --> 01:15:13,455
IT'S A WONDERFUL WAY TO REDUCE 

1713
01:15:13,455 --> 01:15:13,822
YOUR STRESS.

1714
01:15:13,822 --> 01:15:17,459
I USED TO THINK IT WAS ALL ABOUT

1715
01:15:17,459 --> 01:15:24,333
THE FLASH IN THE PAN YOUR 

1716
01:15:24,333 --> 01:15:25,334
INCREASED PROTEINS THAT WILL 

1717
01:15:25,334 --> 01:15:27,670
REDUCE YOUR SENSE OF STRESS BUT 

1718
01:15:27,670 --> 01:15:29,672
SINCE THEN WE'VE LEARNED IT'S 

1719
01:15:29,672 --> 01:15:31,640
BECAUSE THE WIRING OF YOUR BRAIN

1720
01:15:31,640 --> 01:15:31,874
CHANGES.

1721
01:15:31,874 --> 01:15:35,277
IN ANIMAL MODELS WE SEE EXERCISE

1722
01:15:35,277 --> 01:15:38,247
LEADS TO ARBORIZATION OF THE 

1723
01:15:38,247 --> 01:15:46,488
NEURONS ESPECIALLY IN THE PRE 

1724
01:15:46,488 --> 01:15:47,122
FRONTAL CORTEX.

1725
01:15:47,122 --> 01:15:50,926
HOW ELSE WILL YOU INCREASE THE 

1726
01:15:50,926 --> 01:15:52,061
ARBORIZATION OF YOUR NERVES?

1727
01:15:52,061 --> 01:15:52,661
THAT'S A BEAUTIFUL WAY TO DO 

1728
01:15:52,661 --> 01:15:57,132
THAT.

1729
01:15:57,132 --> 01:16:02,471
STRESS REDUCTION CAN BE ACHIEVED

1730
01:16:02,471 --> 01:16:05,074
THROUGH ADDITIONAL APPROACH AND 

1731
01:16:05,074 --> 01:16:07,242
I GAVE SLIDES IN REGARDS TO TAI 

1732
01:16:07,242 --> 01:16:12,047
CHI, YOGA, BREATHING EXERCISE 

1733
01:16:12,047 --> 01:16:14,950
CAN BE EFFECTIVE AND 

1734
01:16:14,950 --> 01:16:16,585
MINDFULNESS-BASED, STRESS 

1735
01:16:16,585 --> 01:16:17,386
REDUCTION TECHNIQUES HAVE A NICE

1736
01:16:17,386 --> 01:16:20,255
LITERATURE SHOWING THAT IT 

1737
01:16:20,255 --> 01:16:22,958
REDUCES SEVERAL OF THE 

1738
01:16:22,958 --> 01:16:26,128
INFLAMMATORY END POINTS.

1739
01:16:26,128 --> 01:16:27,896
A LOT OF THE SYNTHETIC NERVOUS 

1740
01:16:27,896 --> 01:16:32,267
ACTIVITIES THINGS WE ASSOCIATE 

1741
01:16:32,267 --> 01:16:33,502
WITH THE HIGHER DISEASE RISK AND

1742
01:16:33,502 --> 01:16:37,239
TRY TO COMBINE THE TECHNIQUES 

1743
01:16:37,239 --> 01:16:39,141
YOU CAN COMBINE THAT DO AS MANY 

1744
01:16:39,141 --> 01:16:41,210
OF THE TECHNIQUES THAT YOU THINK

1745
01:16:41,210 --> 01:16:43,178
WORK WELL WITHIN YOUR LIFE AND 

1746
01:16:43,178 --> 01:16:45,280
PRIORITIZE THE ONES THAT YOU 

1747
01:16:45,280 --> 01:16:46,782
THINK WILL BENEFIT YOU THE MOST.

1748
01:16:46,782 --> 01:16:49,118
AS LONG AS YOU AT LEAST PUT IT 

1749
01:16:49,118 --> 01:16:51,854
ON YOUR RADAR SCREEN THAT STRESS

1750
01:16:51,854 --> 01:16:54,390
AND STRESS RELATED DISORDERS ARE

1751
01:16:54,390 --> 01:16:57,326
REALLY GOING TO WREAK HAVOC IN 

1752
01:16:57,326 --> 01:16:58,660
TERMS OF CARDIOVASCULAR HEALTH 

1753
01:16:58,660 --> 01:17:00,462
AND CANCER RISK AND ADVERSE 

1754
01:17:00,462 --> 01:17:04,867
OUTCOMES, THEN YOU'LL PRIORITIZE

1755
01:17:04,867 --> 01:17:06,835
REDUCING IT AND BY THE WAY, BY 

1756
01:17:06,835 --> 01:17:08,537
REDUCING THE STRESS YOU'LL FEEL 

1757
01:17:08,537 --> 01:17:08,804
BETTER.

1758
01:17:08,804 --> 01:17:13,976
IT HAS IMMEDIATE BENEFITS AND 

1759
01:17:13,976 --> 01:17:16,145
LONG TERM BENEFITS AND KEY IS TO

1760
01:17:16,145 --> 01:17:17,813
PRIORITIZE IT AND GET LONG TERM 

1761
01:17:17,813 --> 01:17:21,617
BENEFITS FROM THEM.

1762
01:17:21,617 --> 01:17:24,319
>> THANK YOU, DR. TAWAKOL.

1763
01:17:24,319 --> 01:17:26,021
I THINK WE'RE BRINGING THINGS TO

1764
01:17:26,021 --> 01:17:27,756
A CLOSE FOR OUR Q&A SESSION 

1765
01:17:27,756 --> 01:17:29,191
WHICH WAS VERY ROBUST AND WE 

1766
01:17:29,191 --> 01:17:30,692
HAVE A FEW QUESTIONS WE DIDN'T 

1767
01:17:30,692 --> 01:17:34,496
GET TO BUT DO NOT FEAR, FOLKS, 

1768
01:17:34,496 --> 01:17:36,932
WE'RE GOING TO GATHER THE 

1769
01:17:36,932 --> 01:17:38,267
QUESTIONS AND SHARE THEM WITH 

1770
01:17:38,267 --> 01:17:38,734
DR. TAWAKOL.

1771
01:17:38,734 --> 01:17:40,636
AT THIS POINT I WANT TO REMIND 

1772
01:17:40,636 --> 01:17:43,071
OUR VIEWERS AND THANK YOU FOR 

1773
01:17:43,071 --> 01:17:44,773
JOINING US AND REMIND YOU THIS 

1774
01:17:44,773 --> 01:17:46,975
HAS BEEN RECORDED AND WILL BE 

1775
01:17:46,975 --> 01:17:49,344
ARCHIVED IN THE NIH VIDEOCAST 

1776
01:17:49,344 --> 01:17:50,446
WEBSITE FOR FUTURE VIEWING.

1777
01:17:50,446 --> 01:17:58,320
WITH THAT I'D LIKE TO TURN 

1778
01:17:58,320 --> 01:17:59,054
HELENE FOR ANY CLOSING THOUGHTS 

1779
01:17:59,054 --> 01:18:00,622
FOR THE LECTURE.

1780
01:18:00,622 --> 01:18:02,925
>> I THINK YOU'VE GIVEN US
A 

1781
01:18:02,925 --> 01:18:06,261
BEAUTIFUL DEMONSTRATION OF 

1782
01:18:06,261 --> 01:18:06,728
INTEGRATIVE RESEARCH.

1783
01:18:06,728 --> 01:18:08,564
THIS IS A POINT WE MAKE 

1784
01:18:08,564 --> 01:18:11,300
NECESSARY ALL THE TIME THAT IN 

1785
01:18:11,300 --> 01:18:12,901
RESEARCH WE CAN DO IT ANALYSIS 

1786
01:18:12,901 --> 01:18:16,171
AND BREAK THINGS DOWN AND REALLY

1787
01:18:16,171 --> 01:18:18,073
LOOK AND DRILL INTO SPECIFIC 

1788
01:18:18,073 --> 01:18:19,675
GENES AND MOLECULES.

1789
01:18:19,675 --> 01:18:22,211
BUT EVENTUALLY YOU HAVE TO PUT 

1790
01:18:22,211 --> 01:18:23,011
THINGS BACK TOGETHER TO 

1791
01:18:23,011 --> 01:18:26,248
UNDERSTAND WHAT'S GOING ON AND 

1792
01:18:26,248 --> 01:18:27,349
YOU ARE DOING THAT IN SPADES.

1793
01:18:27,349 --> 01:18:31,019
I WANT TO CONGRATULATE FOR ALL 

1794
01:18:31,019 --> 01:18:33,889
THE WORK AND THIS WAS A LOVELY 

1795
01:18:33,889 --> 01:18:35,324
LECTURE YOU JUST GAVE US.

1796
01:18:35,324 --> 01:18:35,591
THANK YOU.

1797
01:18:35,591 --> 01:18:36,792
>> THANK YOU SO MUCH.

1798
01:18:36,792 --> 01:18:38,961
>> THANK YOU AS MUCH AND
AGAIN 

1799
01:18:38,961 --> 01:18:40,429
THANK YOU TO OUR AUDIENCE FOR 

1800
01:18:40,429 --> 01:18:42,564
JOINING US AND WE LOOK FORWARD 

1801
01:18:42,564 --> 01:18:46,335
TO SEEING YOU AS FUTURE ACTIVES 

1802
01:18:46,335 --> 01:18:48,770
AT NCCIH AND WITH THAT I'LL NOW 

1803
01:18:48,770 --> 01:18:49,972
CONCLUDE THIS VIDEOCAST.

1804
01:18:49,972 --> 01:18:59,972
THANK YOU AND HAVE A LOVELY DAY
EVERYONE.