Lexapro (Escitalopram) improves stress-induced heart problem

FDA Highlights by Bruce Sylvester – Lexapro (escitalopram), which is used to treat depression and anxiety, appears to improve a stress-related heart condition in persons with stable coronary heart disease.

Compared with placebo patients in the newly reported study, those treated with escitalopram were over two-and-a-half times less likely to have mental stress-induced myocardial ischemia (MSIMI), a heart condition induced by mental stress.

The findings were published in the May 22/29, 2013 issue of JAMA/Journal of the American Medical Association.

“Mental stress-induced myocardial ischemia [MSIMI] is a serious condition, as patients with the condition tend to have worse heart problems compared to patients without it,” said lead author Wei Jiang, M.D., associate professor of psychiatry and behavioral sciences and internal medicine at Duke University School of Medicine in Durham, North Carolina. “This study showed for the first time that it is treatable with an emotion-modulating medication.”

As background, the authors noted, that in myocardial ischemia, heart muscle receives inadequate enough blood flow. Prior research has indicated that emotional stress can induce myocardial ischemia. MSIMI can be serious, they added, but there is no standard of treatment. Previous studies looking at interventions have produced conflicting results.

“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.

Duke researchers led the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study, a randomized, double blind, placebo controlled clinical trial. They enrolled 310 subjects with existing and stable coronary heart disease.

The subjects underwent a common exercise stress test using a treadmill and three mental stress tests: a tricky mental math task, tracing a diagram of a star while looking at hand movement as a reflection in a mirror, and telling a story about a situation that evoked anger or sadness.

The investigators used echocardiography and electrocardiography testing and blood pressure and heart rate measures  to assess heart function during the stress tests.

Of the 310 participants who were tested, 127 developed MSIMI and were randomized to either receive escitalopram or placebo. And 112 of the MSIMI subjects completed the study.

At the end of the six-week study, the subjects took the same stress tests again. Cardiovascular function was compared to pre-treatment  findings.

The researchers reported that the escitalopram subjects were 2.62 times less likely to have MSIMI during the three mental stress tasks, compared with placebo subjects.

Escitalopram subjects also felt significantly more self-controlled and calm during the second series of tests than those in the placebo subjects. Escitalopram treatment also associated with several positive changes in cardiovascular markers, including  a drop in platelet serotonin receptor transporters.

“Our findings support the hypothesis that short-term use of SSRIs improves levels of biomarkers associated with adverse cardiovascular outcomes,” said Jiang.

“All physicians treating patients with coronary artery disease need to be aware of how emotional stressors may negatively impact their disease management,” said investigator 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 research was supported by funding from the National Heart, Lung, and Blood Institute (R01 HL085704).