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Escitalopram reduces risk for cardiac events in patients with depression, ACS
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Patients with depression and recent ACS who were treated with escitalopram had lower risk for major adverse cardiac events compared with those given placebo, according to a study published in JAMA.
Jae-Min Kim, MD, PhD, of the department of psychiatry at Chonnam National University Medical School in Gwangju, South Korea, and colleagues analyzed data from 300 patients with depression and recent ACS in South Korea who were assigned escitalopram (n = 149; mean age, 60 years; 59% men) or placebo (n = 151; mean age, 60 years; 62% men) for 24 weeks. Patients initially received a 10-mg dose of escitalopram per day, which could be adjusted from 5 mg per day to 20 mg per day based on the investigators’ clinical decision.
Other information analyzed included demographic data, history of depression and CV risk factors.
Patients were examined at baseline, 4, 8, 12, 16, 20 and 24 weeks, and depressive symptoms were assessed using the Beck Depression Inventory at baseline and every 4 weeks up to 12 weeks. Pill counts were performed to assess adherence at every visit.
The primary endpoint was major adverse cardiac events, a composite of MI, all-cause mortality and PCI. Secondary endpoints were cardiac death, all-cause mortality, PCI and MI.
During a median follow-up of 8.1 years, major adverse cardiac events occurred in 40.9% of patients assigned escitalopram vs. 53.6% assigned placebo (HR = 0.69; 95% CI, 0.49-0.96).
The incidence of MI was significantly higher in the placebo group vs. the escitalopram group (15.2% vs. 8.7%; HR = 0.54; 95% CI, 0.27-0.96). Incidence rates were not significantly different in the escitalopram and placebo groups for all-cause mortality (20.8% vs. 24.5%, respectively; HR = 0.82; 95% CI, 0.51-1.33), cardiac death (10.7% vs. 13.2%, respectively; HR = 0.79; 95% CI, 0.41-1.52) and PCI (12.8% vs. 19.9%, respectively; HR = 0.58; 95% CI, 0.33-1.04).
“Severity of ACS in the present study’s participants was relatively low, which might render it easier to demonstrate positive effects on both depressive and long-term cardiac outcomes,” Kim and colleagues wrote. “In the subgroup analysis with impaired left ventricular ejection fraction, no statistical group difference was observed in outcomes, although small numbers had diminished statistical power.” – by Darlene Dobkowski
Disclosures: Kim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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