What question did this study set out to answer?

To determine whether aerobic exercise or escitalopram is more effective than placebo in reducing anxiety symptoms and improving cardiovascular risk biomarkers in patients with coronary heart disease.

August 18, 2021JAMA PsychiatryOpen Access

Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease

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Why the study?

Anxiety is common in patients with coronary heart disease and associated with worse outcomes, but effective treatment for anxiety in this population is uncertain.

Does exercise or escitalopram reduce anxiety symptoms and improve CHD risk biomarkers compared to placebo in patients with stable coronary heart disease and anxiety?

Key Points

To determine whether aerobic exercise or escitalopram is more effective than placebo in reducing anxiety symptoms and improving cardiovascular risk biomarkers in patients with coronary heart disease.
Randomized clinical trial conducted between January 2016 and May 2020 at a US tertiary care teaching hospital (NCT02516332).
Enrolled 128 sedentary outpatients aged >40 years with stable coronary heart disease and clinically significant anxiety (HADS-A score ≥8 or diagnosed anxiety disorder).
Participants were randomized to 12 weeks of aerobic exercise (3 times weekly at 70%-85% heart rate reserve), escitalopram (up to 20 mg/day), or an equivalent placebo pill.
Escitalopram (-5.7; 95% CI, -6.4 to -5.0) and exercise (-4.0; 95% CI, -4.7 to -3.2) achieved greater reductions in HADS-A scores than placebo (-3.5; 95% CI, -4.5 to -2.4; P = .03), with escitalopram superior to exercise (-1.67; 95% CI, -2.68 to -0.66; P = .002).
Postintervention 24-hour urinary catecholamine z scores decreased more with escitalopram (-0.24; 95% CI, -0.4 to 0) and exercise (0.05; 95% CI, -0.2 to 0.3) than placebo (0.36; 95% CI, 0 to 0.7; P = .01), with greater reductions under escitalopram versus exercise (P = .04).
Coronary heart disease biomarkers, including heart rate variability, baroreflex sensitivity, and flow-mediated dilation, showed only small changes, with no significant differences observed between treatment groups.

Structured PICO

Does exercise or escitalopram reduce anxiety symptoms and improve CHD risk biomarkers compared to placebo in patients with stable coronary heart disease and anxiety?

Population

128 outpatients older than 40 years with stable coronary heart disease (CHD) and a diagnosed anxiety disorder or a HADS-A score of 8 or higher, who were sedentary and not currently receiving mental health treatment. Mean age 64.6 years, 29% women, US-based.

Intervention

12 weeks of aerobic exercise (3 times per week at an intensity of 70% to 85% heart rate reserve) or escitalopram (up to 20 mg per day)

Comparator

Placebo pill equivalent

Outcome

Symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) scorepatient reported

Escitalopram is safe and effective for reducing anxiety symptoms in patients with stable coronary heart disease, though neither escitalopram nor exercise significantly improves CHD risk biomarkers.

Discussion

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Implication

Supports escitalopram for anxiety in stable CHD; confirms anxiolytic superiority over exercise while leaving biomarker effects unresolved.

Cite This Study

Blumenthal et al. (2021) studied this question.

synapsesocial.com/papers/6a1099f98090e499da616ac3 https://doi.org/10.1001/jamapsychiatry.2021.2236

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Implication

Supports escitalopram for anxiety in stable CHD; confirms anxiolytic superiority over exercise while leaving biomarker effects unresolved.

Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease

Key Points

Structured PICO

Discussion

Implication

Cite This Study

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