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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.

Publication ,  Journal Article
Blumenthal, JA; Smith, PJ; Jiang, W; Hinderliter, A; Watkins, LL; Hoffman, BM; Kraus, WE; Mabe, S; Liao, L; Davidson, J; Sherwood, A
Published in: Am Heart J
September 2022

BACKGROUND: Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known. METHODS: Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years. RESULTS: Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences. CONCLUSION: In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months posttreatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.

Duke Scholars

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2022

Volume

251

Start / End Page

91 / 100

Location

United States

Related Subject Headings

  • Selective Serotonin Reuptake Inhibitors
  • Humans
  • Follow-Up Studies
  • Exercise
  • Escitalopram
  • Coronary Disease
  • Citalopram
  • Cardiovascular System & Hematology
  • Anxiety
  • 3201 Cardiovascular medicine and haematology
 

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Blumenthal, J. A., Smith, P. J., Jiang, W., Hinderliter, A., Watkins, L. L., Hoffman, B. M., … Sherwood, A. (2022). 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, 251, 91–100. https://doi.org/10.1016/j.ahj.2022.05.014
Blumenthal, James A., Patrick J. Smith, Wei Jiang, Alan Hinderliter, Lana L. Watkins, Benson M. Hoffman, William E. Kraus, 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 251 (September 2022): 91–100. https://doi.org/10.1016/j.ahj.2022.05.014.
Blumenthal, James A., 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, vol. 251, Sept. 2022, pp. 91–100. Pubmed, doi:10.1016/j.ahj.2022.05.014.
Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, Kraus WE, Mabe S, Liao L, Davidson J, Sherwood A. 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. 2022 Sep;251:91–100.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2022

Volume

251

Start / End Page

91 / 100

Location

United States

Related Subject Headings

  • Selective Serotonin Reuptake Inhibitors
  • Humans
  • Follow-Up Studies
  • Exercise
  • Escitalopram
  • Coronary Disease
  • Citalopram
  • Cardiovascular System & Hematology
  • Anxiety
  • 3201 Cardiovascular medicine and haematology