Escitalopram for psychological symptoms and cardiovascular outcomes in patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.
5 affiliations
- 1Department of Psychiatry, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China.
- 2School of Basic Medical Sciences, Kunming University of Science and Technology, Kunming, Yunnan, China.
- 3Department of Science and Research, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China.
- 4Department of Imaging, Yanan Hospital of Kunming City, the Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, 650051, China. [email protected].
- 5Department of Psychiatry, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan, China. [email protected].
Abstract
Background and objective
Patients with coronary heart disease (CHD) often have comorbid depression and anxiety, which worsen prognosis. Escitalopram, a selective serotonin reuptake inhibitor, is used for these symptoms, but evidence on its psychological and cardiovascular effects in CHD is limited. This systematic review and meta-analysis evaluated its effects on psychological symptoms and cardiovascular outcomes in CHD.Methods
We systematically searched five databases for randomized controlled trials (RCTs) of escitalopram vs. control in adults with CHD. Data were extracted to avoid double counting; extended follow-up data were analyzed separately. Outcomes included depression/anxiety scale changes, major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction, and revascularization. Random-effects models and sensitivity analyses were used.Results
Five RCTs were included. Overall depression score change was not significant (SMD = -0.70, 95% CI -1.57 to 0.18), but medium-term (12-24 weeks) follow-up showed improvement (SMD = -0.39, 95% CI -0.58 to -0.20). Anxiety scores significantly decreased with escitalopram (SMD = -0.64, 95% CI -1.12 to -0.17). Pooled data from two studies were compatible with reductions in MACE (RR = 0.74, 95% CI 0.59 to 0.94) and myocardial infarction (RR = 0.53, 95% CI 0.29 to 0.96), however, approximately 90% of the pooled weight came from the post-treatment follow-up of a single trial, so these findings are hypothesis-generating. No statistically significant between-group differences were observed for all-cause mortality or revascularization.Conclusion
Escitalopram appears effective for selected psychological symptoms in CHD without evidence of major cardiovascular harm; current evidence is insufficient to establish a cardiovascular benefit, and the observed MACE and myocardial infarction reductions are hypothesis-generating. Treatment should aim primarily to improve psychological well-being and quality of life.
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BibTeX
@article{wang2026escitalopram,
title = {{Escitalopram for psychological symptoms and cardiovascular outcomes in patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.}},
author = {Xu Wang and Yijing Tan and Shiruo Hu and Bengang Pan and Weifen Qiu and Chun'e Wang and Guozhong Zhou and Qingyi Luo and Jun Qian},
journal = {BMC cardiovascular disorders},
year = {2026},
month = aug,
doi = {10.1186/s12872-026-06389-1},
url = {https://europepmc.org/article/MED/42963563},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Escitalopram for psychological symptoms and cardiovascular outcomes in patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials.
AU - Xu Wang
AU - Yijing Tan
AU - Shiruo Hu
AU - Bengang Pan
AU - Weifen Qiu
AU - Chun'e Wang
AU - Guozhong Zhou
AU - Qingyi Luo
AU - Jun Qian
PY - 2026
DA - 2026/08/04
JO - BMC cardiovascular disorders
DO - 10.1186/s12872-026-06389-1
UR - https://europepmc.org/article/MED/42963563
AB - Background and objective Patients with coronary heart disease (CHD) often have comorbid depression and anxiety, which worsen prognosis. Escitalopram, a selective serotonin reuptake inhibitor, is used for these symptoms, but evidence on its psychological and cardiovascular effects in CHD is limited. This systematic review and meta-analysis evaluated its effects on psychological symptoms and cardiovascular outcomes in CHD.Methods We systematically searched five databases for randomized controlled trials (RCTs) of escitalopram vs. control in adults with CHD. Data were extracted to avoid double counting; extended follow-up data were analyzed separately. Outcomes included depression/anxiety scale changes, major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction, and revascularization. Random-effects models and sensitivity analyses were used.Results Five RCTs were included. Overall depression score change was not significant (SMD = -0.70, 95% CI -1.57 to 0.18), but medium-term (12-24 weeks) follow-up showed improvement (SMD = -0.39, 95% CI -0.58 to -0.20). Anxiety scores significantly decreased with escitalopram (SMD = -0.64, 95% CI -1.12 to -0.17). Pooled data from two studies were compatible with reductions in MACE (RR = 0.74, 95% CI 0.59 to 0.94) and myocardial infarction (RR = 0.53, 95% CI 0.29 to 0.96), however, approximately 90% of the pooled weight came from the post-treatment follow-up of a single trial, so these findings are hypothesis-generating. No statistically significant between-group differences were observed for all-cause mortality or revascularization.Conclusion Escitalopram appears effective for selected psychological symptoms in CHD without evidence of major cardiovascular harm; current evidence is insufficient to establish a cardiovascular benefit, and the observed MACE and myocardial infarction reductions are hypothesis-generating. Treatment should aim primarily to improve psychological well-being and quality of life.
SN - 1471-2261
ER -