Escitalopram May Ease Mental Stress-Induced Myocardial Ischemia

The antidepressant drug escitalopram may reduce the rate of mental stress-induced myocardial ischemia in patients with stable coronary heart disease, according to results from the REMIT Trial published in the Journal of the American Medical Association.  Escitalopram is a selective serotonin reuptake inhibitor (SSRI). Current research suggests SSRIs may reduce hemodynamic factors associated with mental stress, and may also reduce metabolic risk factors and platelet activity associated with risk for cardiac events.

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The trial, which looked at 112 adults with documented coronary heart disease who also exhibited mental stress-induced myocardial ischemia during baseline screening, found that after six weeks, 34.2 percent of escitalopram patients had no mental stress-induced myocardial ischemia during the three mental stressors versus 17.5 percent in the placebo group. The odds ratio for mental stress-induced myocardial ischemia was 2.62 in the placebo group (p=0.04) compared to the drug group. However, the study investigators did note that association between escitalopram and mental stress-induced myocardial ischemia improvement disappeared after adjustment for sex and baseline left ventricular ejection fraction (LVEF).

In addition, the drug group showed a significant reduction in the number of serotonin receptor transporters and alteration in the transporter binding affinity density of 5HT uptake sites. Hemodynamic responses were lower in the escitalopram group; differences in heart rate and rate-pressure product were statistically significant. Weight and body mass index also were reduced in the escitalopram group, but the reduction was not statistically significant. There was no significant difference in exercise capacity between the two groups. Scores for depression, anxiety and perceived stress improved similarly for both the treatment and placebo groups, but escitalopram patients felt more in control and calmer than placebo patients.

According to the study investigators, their findings could have clinical implications in reducing cardiac events in patients with mental stress-induced myocardial ischemia. "These results support and extend previous findings suggesting that modifying central and peripheral serotonergic function could improve coronary heart disease symptoms and may have implications for understanding the pathways by which negative emotions affect cardiovascular prognosis," they said. However, the investigators also caution that the loss of statistical significance after adjustment for sex and baseline LVEF adds ambiguity to the interpretation of the findings and emphasizes the need for confirmation of these results in larger trials before they are considered definitive.

Clinical Topics: Prevention, Statins, Stress

Keywords: Depression, Odds Ratio, Coronary Disease, Blood Platelets, Risk Factors, Heart Rate, Stress, Psychological, Prognosis, Body Mass Index, Serotonin, Stroke Volume, United States

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