Lexapro may improve heart health
A commonly prescribed antidepressant could be used to treat a heart condition caused by stress, according to a study published in the May 22/29, 2013 issue of the Journal of the American Medical Association.
Researchers at Duke Medicine found that people with stable coronary heart disease and mental stress-induced myocardial ischemia (MSIMI) who took the antidepressant, escitalopram (Lexapro), experienced lower rates of MSIMI.
Escitalopram, the generic name for Lexapro, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety. According to a 2009 study, escitalopram has clear advantages as it pertains to efficacy and acceptability. It has also been shown to significantly improve the quality of life among those suffering from anxiety disorders.
People with stress-induced MSIMI have limited blood flow to the heart, and previous research has shown that emotional stress can trigger heart conditions, which is particularly concerning for those with MSIMI because they tend to experience more severe heart problems.
"Mental stress-induced myocardial ischemia is a serious condition, as patients with the condition tend to have worse heart problems compared to patients without it,” said the study’s lead author, Wei Jiang, M.D., associate professor of psychiatry and behavioral sciences and internal medicine at Duke. “This study showed for the first time that it is treatable with an emotion-modulating medication."
MSIM occurs as a result of changes in the heart, such as a reduction in the amount of blood pumped out of the heart's left ventricle and problems with new wall motion. Currently, there are few treatment options available.
"In order to advance our understanding of improving cardiovascular health, we believe that continued research between the intersection of mental health and cardiovascular disease should be a priority," said senior author, Christopher O'Connor, M.D., director of the Duke Heart Center and chief of the Division of Cardiology.
For the study, the research team evaluated possible ways to alleviate cardiovascular symptoms caused by mental stress. They enrolled 310 participants who had pre-existing coronary heart disease for the randomized, double blind, placebo controlled clinical trial.
The researchers then had the participants perform a simple exercise stress test, using a treadmill and three mental stress tests to determine how many experienced MSIMI as a result. They assessed heart function with echocardiography and electrocardiography.
Of the 310 participants who were tested, 127 of them had MSIMI. They were randomly selected to either receive escitalopram or placebo.
Compared to placebo, the researchers found that those who received escitalopram were 2.62 times less likely to experience MSIMI during the mental stress test. During the last of the three mental stress tests administered, the participants who received escitalopram reported feeling more in control and calmer than those who received a placebo.
"Our findings support the hypothesis that short-term use of SSRIs improves levels of biomarkers associated with adverse cardiovascular outcomes," said Jiang.
According to study author Eric Velazquez, M.D., SSRIs could play an important role in managing coronary heart disease.
"All physicians treating patients with coronary artery disease need to be aware of how emotional stressors may negatively impact their disease management,” wrote Eric Velazquez, M.D., associate professor of cardiology at Duke. “We should be having conversations with our patients about their lifestyles to gauge their levels of mental stress and whether the coping mechanisms they use are adequate or if more mental health-focused help is needed."
The authors of the study conclude by stating their results "may have implications for understanding the pathways by which negative emotions affect cardiovascular prognosis."
SOURCE: Jiang W, Velazquez EJ, Kuchibhatla M, et al. Effect of Escitalopram on Mental Stress–Induced Myocardial Ischemia: Results of the REMIT Trial. JAMA. 2013; 309(20):2139-2149. doi:10.1001/jama.2013.5566.