BALTIMORE -- For individuals who have high levels of hostility,
treatment with citalopram not only reduces hostility but improves the
cardiovascular risk factors that make up metabolic syndrome, according
to data presented at the annual meeting of the American Psychosomatic
Society.
The findings suggest a role for central serotonergic function in
the association of hostility with cardiovascular risk factors, said
Thomas W. Kamarck, Ph.D., a professor of psychology at the University of
Pittsburgh.
"We concluded that it's plausible that individual
difference in serotonergic function may in part drive the association
between hostility and metabolic risk factors observed in the
literature," Dr. Kamarck said.
This analysis draws on data from the larger Stress Treatment and
Health Risk (STAHR) project. This placebo-controlled study is aimed at
assessing the effect of a selective serotonin re-uptake inhibitor on
hostility and cardiovascular measures.
In the study on hostility, 229 healthy adults aged 30-50 years with
elevated hostility levels measured using standardized scales were
recruited. Exclusion criteria included a history of cardiovascular
conditions, a DSM-IV Axis I diagnosis, or use of medication for elevated
cholesterol, hypertension, diabetes, or psychiatric disorders.
Participants visited the laboratory five times during a 6-week
prerandomization period. During these visits, they were assessed for
waist circumference, fasting glucose and insulin, blood pressure, and
fasting HDL cholesterol and triglycerides.
The Buss Perry Aggression scale was used to assess hostility. The
scale is a self-report measure of hostility that involves four
subscales, measuring behavioral (verbal and physical aggression),
cognitive (suspiciousness), and affective (angry emotions) aspects of
hostility.
In all, 160 participants were then randomized to citalopram
(Celexa) or to placebo. During the first 6 weeks of treatment, the
subjects randomized to citalopram were titrated up to a maximum dose of
40 mg/day During the next 5 weeks, treatment continued, and the
pretreatment assessments were repeated.
The intention-to-treat analysis included 81 participants in the
citalopram group and 79 in the placebo group. However, only 72 and 67
participants in the citalopram and placebo groups, respectively,
completed the study protocol. The average age was 40 years, and half of
the participants were female. The sample was primarily white (84%).
The effect size for reducing hostility was greater for the
citalopram group--the effect size was 1.09 for the treatment group
versus 0.56 for the placebo group on the Buss Perry Aggression scale,
Dr. Kamarck reported.
Treatment with citalopram was associated with greater effect size
for waist circumference, glucose, insulin, HDL cholesterol, and
triglycerides than for the placebo group.
Hostility previously has been associated with an increased risk for
coronary heart disease and all-cause mortality, he said.
A recent meta-analysis showed that hostility is associated with the
group of metabolic risk factors for cardiovascular disease, including
waist-hip ratio, glucose and insulin resistance, lipid ratios, and
triglycerides, that are cumulatively known as metabolic syndrome (Health
Psychol. 2006;25:493-500).
Dr. Kamarck and his colleagues next adjusted their models for
changes in hostility scores over the study period. They found that
changes in hostility levels did not account for changes in metabolic
risk factors.
Treatment with citalopram also was associated with a small but
significant loss of weight. So the researchers also adjusted their
models to account for changes in body mass index.
After that adjustment, only the effect of citalopram on HDL
remained significant, he said.
"The serotonergic effects on hostility and metabolic risks are
not entirely overlapping. The latter effects may be largely mediated by
weight regulation processes, at least among a nondiabetic sample,"
Dr. Kamarck said.
The results suggest that augmentation of central serotonergic
function may benefit an individual with psychosocial risk factors for
cardiovascular disease.
Dr. Kamarck said in an interview that he had no conflicts of
interest.
BY KERRI WACHTER
Senior Writer
COPYRIGHT 2008 International Medical News
Group Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
Copyright 2008 Gale, Cengage Learning. All rights
reserved. Gale Group is a Thomson Corporation Company.
NOTE: All illustrations and photos have been removed from this article.