【medical-news】JAMA：选择性5-羟色胺再摄取抑制剂可显著减少精神刺激诱发的心肌缺血发生率
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Newswise — Among patients with stablecoronary heart disease and mental stress-induced myocardial ischemia (MSIMI), 6weeks 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 issueof JAMA.
“A robust body of evidence has identified emotional stress as apotential triggering factor in coronary heart disease (CHD) and othercardiovascular events,” according to background information in the article.“During the last 3 decades, the association of emotional distress andmyocardial ischemic activity [insufficient blood flow to the heart muscle, oftenresulting in chest pain] in the laboratory has been well studied. In thelaboratory setting, MSIMI occurs in up to 70 percent of patients withclinically stable CHD and is associated with increased risk of death andcardiovascular events.” Few studies have examined therapeutics that effectivelymodify MSIMI. Recent evidence suggests that selective serotonin reuptakeinhibitors (SSRIs) may reduce mental stress-induced hemodynamic response,metabolic risk factors, and platelet activity.
Wei Jiang, M.D., of the Duke UniversityMedical Center, Durham, N.C., and colleagues conducted a study to investigatewhether SSRI treatment can improve MSIMI. The randomized trial includedpatients with clinically stable coronary heart disease and laboratory-diagnosedMSIMI. Enrollment occurred from July 2007 through August 2011 at a tertiarymedical center. Eligible participants were randomized 1:1 to receiveescitalopram or placebo over 6 weeks. A total of 56 patients in each groupcompleted end point assessments. Occurrence of MSIMI was defined via variousmeasures during 1 or more of 3 mental stressor tasks: mental arithmetic, mirrortrace, and public speaking with anger recall.
The researchers found that at the end of 6weeks, more patients taking escitalopram (34.2 percent) had absence of MSIMIduring the 3 mental stressors compared with patients taking placebo (17.5percent). Analysis showed that the escitalopram group had a significantlyhigher rate (2.6 times) of no MSIMI compared with the placebo group. Also, hemodynamicresponses to mental stress were all lower in the escitalopram group, withdifferences in systolic blood pressure and heart rate between the groupssignificant.
In addition, the 6-week escitalopramintervention was associated with greater improvements in certain measures ofpsychological functioning, including state anxiety and positive affect, duringmental stress.
Exercise capacity was not significantlyaltered at week 6 in participants receiving escitalopram vs. those receivingplacebo.
“In summary, 6-week pharmacologic enhancement of serotonergicfunction superimposed on the best evidence-based management of CHD appeared tosignificantly improve MSIMI occurrence. These results support and extendprevious findings suggesting that modifying central and peripheral serotonergicfunction could improve CHD symptoms and may have implications for understandingthe pathways by which negative emotions affect cardiovascular prognosis,” theauthors conclude.
(JAMA. 2013;309(20):2139-2149; Availablepre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note: This study was funded by theNHLBI, Bethesda, Md. Escitalopram and matched placebo were supplied by ForestResearch Institute Inc., Germantown, Md. Please see the article for additionalinformation, including other authors, author contributions and affiliations,financial disclosures, etc.
There will also be a digital news releaseavailable for this study, including the JAMA Report video, embedded anddownloadable video, audio files, text, documents, and related links. Thiscontent will be available at 3 p.m. CT Tuesday, May 21 at this link.
“A robust body of evidence has identified emotional stress as apotential triggering factor in coronary heart disease (CHD) and othercardiovascular events,” according to background information in the article.“During the last 3 decades, the association of emotional distress andmyocardial ischemic activity [insufficient blood flow to the heart muscle, oftenresulting in chest pain] in the laboratory has been well studied. In thelaboratory setting, MSIMI occurs in up to 70 percent of patients withclinically stable CHD and is associated with increased risk of death andcardiovascular events.” Few studies have examined therapeutics that effectivelymodify MSIMI. Recent evidence suggests that selective serotonin reuptakeinhibitors (SSRIs) may reduce mental stress-induced hemodynamic response,metabolic risk factors, and platelet activity.
Wei Jiang, M.D., of the Duke UniversityMedical Center, Durham, N.C., and colleagues conducted a study to investigatewhether SSRI treatment can improve MSIMI. The randomized trial includedpatients with clinically stable coronary heart disease and laboratory-diagnosedMSIMI. Enrollment occurred from July 2007 through August 2011 at a tertiarymedical center. Eligible participants were randomized 1:1 to receiveescitalopram or placebo over 6 weeks. A total of 56 patients in each groupcompleted end point assessments. Occurrence of MSIMI was defined via variousmeasures during 1 or more of 3 mental stressor tasks: mental arithmetic, mirrortrace, and public speaking with anger recall.
The researchers found that at the end of 6weeks, more patients taking escitalopram (34.2 percent) had absence of MSIMIduring the 3 mental stressors compared with patients taking placebo (17.5percent). Analysis showed that the escitalopram group had a significantlyhigher rate (2.6 times) of no MSIMI compared with the placebo group. Also, hemodynamicresponses to mental stress were all lower in the escitalopram group, withdifferences in systolic blood pressure and heart rate between the groupssignificant.
In addition, the 6-week escitalopramintervention was associated with greater improvements in certain measures ofpsychological functioning, including state anxiety and positive affect, duringmental stress.
Exercise capacity was not significantlyaltered at week 6 in participants receiving escitalopram vs. those receivingplacebo.
“In summary, 6-week pharmacologic enhancement of serotonergicfunction superimposed on the best evidence-based management of CHD appeared tosignificantly improve MSIMI occurrence. These results support and extendprevious findings suggesting that modifying central and peripheral serotonergicfunction could improve CHD symptoms and may have implications for understandingthe pathways by which negative emotions affect cardiovascular prognosis,” theauthors conclude.
(JAMA. 2013;309(20):2139-2149; Availablepre-embargo to the media at http://media.jamanetwork.com)
Editor’s Note: This study was funded by theNHLBI, Bethesda, Md. Escitalopram and matched placebo were supplied by ForestResearch Institute Inc., Germantown, Md. Please see the article for additionalinformation, including other authors, author contributions and affiliations,financial disclosures, etc.
There will also be a digital news releaseavailable for this study, including the JAMA Report video, embedded anddownloadable video, audio files, text, documents, and related links. Thiscontent will be available at 3 p.m. CT Tuesday, May 21 at this link.
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