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.