Treatment with escitalopram for 12 weeks for patients with coronary heart disease (CHD) was associated with significantly reduced anxiety, which was sustained for 6 months posttreatment, according to findings from a randomized clinical trial published in the American Heart Journal.
For patients with CHD, anxiety is a common morbidity and is tied to poor prognosis. Yet, effective treatment for anxiety in this patient population remains unknown. The researchers of the current study sought to assess the efficacy of escitalopram, a selective serotonin reuptake inhibitor, compared with exercise training and placebo in reducing anxiety in patients with CHD.
The UNWIND study (ClinicalTrials.gov Identifier: NCT02516332) was a single-site, parallel group, randomized clinical trial designed to assess the effect of aerobic exercise, escitalopram, or placebo on anxiety. Between 2016 and 2020, patients (N=114) with CHD were recruited at the Duke University Medical Center and randomized to receive 12 weeks of exercise (n=44), 5 mg daily escitalopram titrated up to 15 mg at week 3 (n=49), or placebo (n=21). After 12 weeks, participants could switch to alternative treatments or discontinue therapy. Until December 2021, participants were followed up with annually. The exercise intervention comprised 3 45-minute supervised aerobic exercise sessions per week.
The study population comprised individuals aged mean 64.6 years, 71% were men, and 72% were White.
During the follow-up period, 28 of the escitalopram, 11 of the exercise, and 2 of the participants who received placebo reported taking psychotropic medications (χ2, 25.4; P <.001).
The participants randomized to the exercise treatment reported more weekly moderate-to-vigorous physical activity (median, 90 min/wk) than the escitalopram (median, 60 min/wk) or placebo (median, 30 min/wk) groups.
Participants who were lost to follow-up were significantly more anxious (P =.015) and more were women (P =.014).
At 6 months, escitalopram associated with significantly improved Spielberger State-Trait Anxiety Inventory-Trait (STAI-T; median, 34.3 vs 35.6 vs 37.6; P <.01), Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A; median, 3.9 vs 5.5 vs 5.3; P <.05), and Generalized Anxiety Disorder 7 items (GAD-7; median, 2.2 vs 3.7 vs 3.3; P <.05) scores compared with exercise and placebo, respectively.
Among the escitalopram group, patients who continued to take the medication were associated with lower HADS-A scores than those who discontinued use at 12 weeks (median, 3.7 vs 4.4).
Major adverse cardiovascular events (MACE) occurred among 7 in the escitalopram, 13 in the exercise, and 6 patients in the placebo groups. No significant difference in MACE was observed between the active treatment groups and placebo (hazard ratio [HR], 1.01; 95% CI, 0.77-1.32; P =.958) or between escitalopram and exercise (HR, 1.16; 95% CI, 0.59-2.26; P =.673).
This study was limited by the small sample size and short follow-up duration.
The researchers stated that the use of escitalopram for anxiety was an effective treatment for patients with CHD. “In the UNWIND trial, 12 weeks of treatment was effective in reducing anxiety, as well as depression and general distress. Moreover, these beneficial effects appeared to persist for 6 months posttreatment, especially for those who continued treatment,” they concluded.
Blumenthal JA, Smith PJ, Jiang W, et al. Longer Term Benefits of Exercise and Escitalopram in the Treatment of Anxiety in Patients with Coronary Heart Disease: Six Month Follow-up of the UNWIND Randomized Clinical Trial. Am Heart J. Published online May 22, 2022. doi:10.1016/j.ahj.2022.05.014