Can listening to music decrease inflammation and stress? Can music be beneficial to heart patients? To answer these questions, we have to understand inflammation and its role in heart disease.

What is inflammation? Inflammation is the body’s protective response to a harmful agent.  The purpose of inflammation is to eliminate the initial cause of an injury to the body, clear out the dead cells caused by the injury and repair the damaged tissue. The inflammatory process involves the vascular system, the immune system and specialized cells in the blood used to fight injury. In addition, with inflammation, a variety of proteins are released to help break down a foreign body. Unfortunately, these proteins may also break down healthy tissue and increase the blood clotting ability of the body. Acute inflammation occurs in response to specific injury, such as an infection by a virus or trauma to a body part. This inflammatory response is quick and of a short duration. For example, in a bacterial infection, the body sends cells to fight the bacteria, a fever is produced to help kill the bacteria, and there is swelling and redness in the area of the infection. Chronic inflammation occurs over years in a long-running cycle of tissue destruction and healing. An example of chronic inflammation is rheumatoid arthritis.

Is heart disease an inflammatory process? Atherosclerosis (plaque or blockage in the heart arteries) is now felt to be a type of chronic inflammatory process. Inflammation has a key role in atherosclerosis, from the initiation of plaque, through the build up of blockage to the blood clotting that occurs with an acute heart attack. When the inner lining of the heart artery is damaged by high blood flow or biochemical stimuli (smoking, high blood pressure, diabetes or high cholesterol), it permits cholesterol and inflammatory cells to enter and be deposited in the wall of the artery, thus forming plaque. Once the body realizes that there is damage to the artery wall, more cholesterol and inflammatory cells are deposited to try to repair the damaged wall causing the plaque to grow over time. Ultimately, the plaque starts to limit the blood flow through the artery, causing chest pain (angina) or the plaque breaks open stimulating blood clotting and an acute heart attack. The effect of inflammation can be measured via a simple blood test. Elevation in the inflammatory marker called C reactive protein (CRP) has been shown to increase the risk of heart artery disease.

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How is inflammation in the heart arteries treated? Aspirin is used to reduce the risk for a heart attack. It does this by reducing the body’s ability to clot, but it is also a powerful anti-inflammatory agent. Interestingly, other popular anti-inflammatories such as ibuprofen (Motrin, Advil) and naprosyn (Aleve) don’t reduce the risk for a heart attack and may in fact increase the risk. They should not be used in place of aspirin to reduce heart risks. The cholesterol lowering agents called statins have been shown to reduce the risk for heart attack and stroke. These medications lower total cholesterol and LDL (the bad cholesterol) and raise the good cholesterol (HDL). However there are many other medications which lower cholesterol, but have not been shown to reduce the risk of heart disease. It is felt that statins have anti-inflammatory properties. In patients with an elevated CRP treating with a statin reduces the risk for cardiac events by 50 percent. It is this anti-inflammatory effect, along with the cholesterol-lowering properties, that gives statins their edge over other medications and their power to reduce heart attacks and stroke. There are many non-pharmacologic therapies that are anti-inflammatory. These include foods such as fruits, vegetables and fish high in omega3 fatty acids. Other anti-inflammatory therapies include exercise, yoga, meditation and music.

Is music anti-inflammatory? Can music be used as therapy? Sounds in nature, such as a babbling brook or ocean waves on the shore, are known to be soothing and are promoted as a method to relax and to fall asleep. Many musical pieces can produce the same sense of calmness. When his biographer asked Steve Jobs, the inventor of ITunes, what music he listened to, the answer revealed the anti-inflammatory power of music.  Aside from songs by Bob Dylan and the Beatles, his favorites included a Gregorian chant, "Spiritus Domini" performed by Benedictine monks and the "Goldberg Variations", by J.S. Bach and performed by Glenn Gould. The interview took place during Jobs' third medical leave for treatment of pancreatic cancer. He felt the first piece was so calming it almost put him in a trance and the latter he felt was deep and reflective. After listening to those pieces, Jobs' insight is certainly supported. The data supporting music therapy comes from diverse medical fields. In patients with pregnancy or schizophrenia, listening to music provided clear-cut psychological benefits. In patients on respirators, music reduced the breathing rate and blood pressure. Surgical patients who listen to music, even under general anesthesia, have less anxiety and less need for pain medication during recovery. A large review of 23 trials with more than 1,000 participants looked at music therapy in heart attack patients. It concluded that music reduced anxiety, heart rate, respiratory rate and blood pressure in these patients, suggesting a psychological relaxation response.

Certainly what is good and soothing for one listener is cacophony to another listener. Everyone should find their own anti-inflammatory songs, as music therapy has no side effects or risks, assuming of course that the decibel level is reasonable. So, after a day of battling the world and increasing your inflammatory markers, go home, slip on a pair of headphones, find some good relaxing music and engage in your own form of anti-inflammatory therapy. Perhaps sing or listen to some holiday tunes to reduce the stress and increase the enjoyment of the holiday season.