If your coronary arteries have a blockage, blood flow to the heart decreases, potentially causing damage. A common depression medication may help the condition.
In myocardial ischemia, the heart muscle receives insufficient blood supply. When the heart muscle is deprived of oxygen from the blood, it can lead to a heart attack.
While previous studies have shown that emotional stress can trigger the condition, investigators recently found the antidepressant escitalopram (brand name Lexapro) may improve mental stress-induced myocardial ischemia (MSIMI).
Wei Jiang, MD, associate professor of psychiatry and behavioral sciences and internal medicine at Duke University in Durham, North Carolina, and his colleagues tested patients who had existing coronary heart disease that was in stable condition.
Myocardial ischemia often has no noticeable symptoms. It may or may not cause chest pain.
The researchers tested 310 patients to see who may be experiencing MSIMI.
Participants completed a common exercise stress test using a treadmill, as well as three mental stress tests. They were asked to perform a tricky mental math task, trace a diagram of a star while looking at hand movement as a reflection in a mirror and tell a story about a situation that made them angry or sad.
To assess heart function and identify those with MSIMI, the researchers conducted echocardiography and electrocardiography testing and took blood pressure and heart rate measurements.
Mental stress-induced myocardial ischemia was identified in 127 patients who were randomly given a placebo (fake medication) or escitalopram. This medication is a common selective serotonin reuptake inhibitor (SSRI) used to treat depression and anxiety.
After six weeks, individuals completed the same stress tests and their cardiovascular function was evaluated against measurements taken before receiving the medication or placebo.
A total of 112 participants completed the full study and final assessments.
The authors observed that those who took escitalopram were 2.62 times less likely to experience myocardial ischemia during the three mental stress tasks compared with those taking placebo.
The researchers noted that the escitalopram group felt significantly more in control and calmer than the placebo group during the final mental stress tasks.
Taking escitalopram was also linked with several positive changes in cardiovascular markers, including changes in platelet serotonin receptor function.
Serotonin is a neurotransmitter that helps send messages from one part of the brain to another. Researchers believe an imbalance in serotonin levels can lead to depression.
"Our findings support the hypothesis that short-term use of SSRIs improves levels of biomarkers associated with adverse cardiovascular outcomes," said Dr. Jiang.
Study co-author Eric Velazquez, MD, associate professor of cardiology at Duke, added, "All physicians treating patients with coronary artery disease need to be aware of how emotional stressors may negatively impact their disease management."
"We should be having conversations with our patients about their lifestyles to gauge their levels of mental stress and whether the coping mechanisms they use are adequate or if more mental health-focused help is needed."
The authors indicated that additional investigation is warranted to fully understand the mechanisms behind myocardial ischemia and whether improvements in the condition from taking escitalopram may result in reducing occurrence or recurrence of serious health conditions, including heart attack or angina, stroke, heart failure and death.
A study is also necessary to determine how long escitalopram should be taken, and whether the participants already achieved the maximum benefit at six weeks.
The study was published in the May 22/29 issue of the Journal of the American Medical Association. The research was supported by funding from the National Heart, Lung, and Blood Institute.