(Press-News.org) Among patients with stable coronary heart disease and mental stress-induced myocardial ischemia (MSIMI), 6 weeks of treatment with the antidepressant escitalopram, compared with placebo, resulted in a lower rate of MSIMI, according to a study in the May 22/29 issue of JAMA.
"A robust body of evidence has identified emotional stress as a potential triggering factor in coronary heart disease (CHD) and other cardiovascular events," according to background information in the article. "During the last 3 decades, the association of emotional distress and myocardial ischemic activity [insufficient blood flow to the heart muscle, often resulting in chest pain] in the laboratory has been well studied. In the laboratory setting, MSIMI occurs in up to 70 percent of patients with clinically stable CHD and is associated with increased risk of death and cardiovascular events." Few studies have examined therapeutics that effectively modify MSIMI. Recent evidence suggests that selective serotonin reuptake inhibitors (SSRIs) may reduce mental stress-induced hemodynamic response, metabolic risk factors, and platelet activity.
Wei Jiang, M.D., of the Duke University Medical Center, Durham, N.C., and colleagues conducted a study to investigate whether SSRI treatment can improve MSIMI. The randomized trial included patients with clinically stable coronary heart disease and laboratory-diagnosed MSIMI. Enrollment occurred from July 2007 through August 2011 at a tertiary medical center. Eligible participants were randomized 1:1 to receive escitalopram or placebo over 6 weeks. A total of 56 patients in each group completed end point assessments. Occurrence of MSIMI was defined via various measures during 1 or more of 3 mental stressor tasks: mental arithmetic, mirror trace, and public speaking with anger recall.
The researchers found that at the end of 6 weeks, more patients taking escitalopram (34.2 percent) had absence of MSIMI during the 3 mental stressors compared with patients taking placebo (17.5 percent). Analysis showed that the escitalopram group had a significantly higher rate (2.6 times) of no MSIMI compared with the placebo group. Also, hemodynamic responses to mental stress were all lower in the escitalopram group, with differences in systolic blood pressure and heart rate between the groups significant.
In addition, the 6-week escitalopram intervention was associated with greater improvements in certain measures of psychological functioning, including state anxiety and positive affect, during mental stress.
Exercise capacity was not significantly altered at week 6 in participants receiving escitalopram vs. those receiving placebo.
"In summary, 6-week pharmacologic enhancement of serotonergic function superimposed on the best evidence-based management of CHD appeared to significantly improve MSIMI occurrence. These results support and extend previous findings suggesting that modifying central and peripheral serotonergic function could improve CHD symptoms and may have implications for understanding the pathways by which negative emotions affect cardiovascular prognosis," the authors conclude.
###
(JAMA. 2013;309(20):2139-2149; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: This study was funded by the NHLBI, Bethesda, Md. Escitalopram and matched placebo were supplied by Forest Research Institute Inc., Germantown, Md. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
There will also be a digital news release available for this study, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, May 21 at this link.
Treatment with antidepressant results in lower rate of mental stress-induced cardiac ischemia
2013-05-22
ELSE PRESS RELEASES FROM THIS DATE:
Early use of tracheostomy for mechanically ventilated patients not associated with improved survival
2013-05-22
For critically ill patients receiving mechanical ventilation, early tracheostomy (within the first 4 days after admission) was not associated with an improvement in the risk of death within 30 days compared to patients who received tracheostomy placement after 10 days, according to a study in the May 22/29 issue of JAMA.
"A tracheostomy is commonly performed when clinicians predict a patient will need prolonged mechanical ventilation," according to background information in the article. The use of this procedure has increased, such that up to one-third of patients requiring ...
Surgery on adenoid, tonsils improves outcomes in children with obstructive sleep apnea
2013-05-22
Children with obstructive sleep apnea who had a common surgery to remove their adenoids and tonsils showed notable improvements in behavior, quality of life and other symptoms compared to those treated with "watchful waiting" and supportive care. However, there was no difference between both groups in attention and executive functioning, as measured by formal neuropsychological tests.
The Childhood Adenotonsillectomy Trial (CHAT) studied 464 children, aged 5 to 9, at seven academic sleep centers. "This was the first randomized clinical trial of surgery for obstructive ...
Decisions to forgo life support may depend heavily on the ICU where patients are treated
2013-05-22
PHILADELPHIA—The decision to limit life support in patients in the intensive care unit (ICU) appears to be significantly influenced by physician practices and/or the culture of the hospital, suggests new findings from researchers at the Perelman School of Medicine at the University of Pennsylvania presented at the American Thoracic Society International Conference on May 21.
A retrospective analysis of over 269,000 ICU patients from the Project IMPACT database revealed a substantial variation in decisions to forgo life-sustaining therapies rates among 153 ICUs in the ...
Aggressive behavior linked specifically to secondhand smoke exposure in childhood
2013-05-22
This news release is available in French.
Children who are exposed to secondhand smoke in early childhood are more likely to grow up to physically aggressive and antisocial, regardless of whether they were exposed during pregnancy or their parents have a history of being antisocial, according to Linda Pagani and Caroline Fitzpatrick of the University of Montreal and its affiliated CHU Sainte-Justine hospital. No study to date has controlled for these factors. "Secondhand smoke is in fact more dangerous that inhaled smoke, and 40% of children worldwide are exposed ...
Encouraging signs for bee biodiversity
2013-05-22
Declines in the biodiversity of pollinating insects and wild plants have slowed in recent years, according to a new study.
Researchers led by the University of Leeds and the Naturalis Biodiversity Centre in the Netherlands found evidence of dramatic reductions in the diversity of species in Britain, Belgium and the Netherlands between the 1950s and 1980s.
But the picture brightened markedly after 1990, with a slowdown in local and national biodiversity losses among bees, hoverflies and wild plants.
Professor Bill Kunin, Professor of Ecology at the University of ...
Bird's playlist could signal mental strengths and weaknesses
2013-05-22
DURHAM, N.C. -- Having the biggest playlist doesn't make a male songbird the brainiest of the bunch, a new study shows.
"For songbirds, singing a lot of songs indicates a bird is smart, but that signal is not necessarily indicative of intelligence for everything," said Duke biologist Steve Nowicki.
In a series of problem-solving tests with the birds, he and his colleagues found that the male song sparrows that sang the most songs learned to solve food-finding puzzles more slowly than the birds singing fewer songs. The results are the first to show that a larger song ...
Small cancer risk following CT scans in childhood and adolescence confirmed
2013-05-22
The researchers say that in a group of 10,000 young people, they would expect 39 cancers to occur during the next 10 years, but if they all had one CT scan, up to six extra cancers would occur.
CT (computed tomography) scans have great medical benefits, but their increasing use since the 1980s has raised some concerns about possible cancer risks, particularly following exposures in childhood. Most previous studies have estimated risks indirectly, and some radiation experts have questioned the validity of these estimates.
There is currently much uncertainty and as ...
Life expectancy gap widens between those with mental illness and general population
2013-05-22
The higher death rate associated with mental illness has been extensively documented, but most of the attention has focused on the elevated risk of suicide, whereas most of the risk can be attributed to physical illness such as cardiovascular and respiratory diseases and cancer (80% of deaths). The higher death rate is also normally reported in terms of mortality rates but other measures can be used such as potential years of life lost, average age at death and life expectancy. Life expectancy is also a useful alternative as it can reflect changes in rates across ages. ...
Dietary advice on added sugar is damaging our health, warns heart expert
2013-05-22
He calls on the UK's Scientific Advisory Committee on Nutrition and the Department of Health "to act swiftly" to tackle the rising obesity crisis and increasing prevalence of type 2 diabetes.
In 2003 the World Health Organization stated that "added sugars" should contribute no more than 10% of total energy intake. This was in line with the UK government's Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommendations.
This nutritional advice has formed the basis of UK food labelling since 2003 and subsequently influenced European legislation, but Dr ...
Failure to use linked health records may lead to biased disease estimates
2013-05-22
They show that up to 50% of all heart attack cases are missed using just one data source.
These findings may be relevant to other common conditions, such as stroke, and support the wider use of linked multiple record sources by clinicians, policy makers and researchers, say the authors.
Electronic health records are increasingly used to measure health outcomes, and for research, but records from one part of the health service (e.g. primary care) may not capture health events occurring in other parts of the health system (e.g. hospital care).
So a team of researchers ...