CNS Update: Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with CHD


eMediNexus    20 December 2022

Patients with coronary heart disease (CHD) often experience anxiety which is further associated with a worse prognosis. Yet, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial has shown the effectiveness of 12-week treatment with escitalopram in reducing anxiety in anxious CHD patients. But the longer-term benefits of treatment for anxiety are unknown.


A recent study randomized CHD patients to receive 12 weeks of Escitalopram (up to 20 mg) or Exercise (3 times/wk), or a placebo pill, after which the participants were followed for 6 months to determine the persistence of benefit on the primary anxiety endpoint [employing the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A)]. The study also assessed the effects of treatment on major adverse cardiac events for up to 6 years.


Of the 128 enrolled participants, 94% turned up for follow-up. Participants randomized to the Escitalopram group showed lower HADS-A scores than those randomized to Exercise and Placebo. 29 adverse events were reported over a median follow-up of 3.2 years, without any significant between-group differences.


Thus, the UNWIND trial demonstrated 12 weeks of escitalopram treatment to be effective in reducing anxiety and this effect stays for 6 months posttreatment. 

Furthermore, despite the numerous health benefits of moderate or vigorous physical activity, exercise is not an effective treatment for anxiety in patients with CHD.

American Heart Journal. 2022;251: 91-100. https://doi.org/10.1016/j.ahj.2022.05.014.

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