Prevention of cardiovascular complications with paroxetine in individuals with coronary heart disease and depressive/anxiety disorder. The PrevenPar project

Abstract

Results of clinical trials have confirmed that depressive/anxiety disorder as another cardiovascular risk factor. The risk is due to enhanced serotonin reuptake by the serotonin transporter. The reuptake not only blocks signal transmission within the brain, it also activates thrombocytes thereby raising the likelihood of thrombogenesis in the presence of coronary heart disease. Another factor affecting the degree of risk is the polymorphism of the serotonin transporter gene (5-HTTLPR) in its promoter segment (SLC6A4). The presence of a short allele (S) decreases the cardiovascular risk conversely increased by the presence of a long allele (L). Of all the currently known selective serotonin reuptake inhibitor (SSRI)-type antidepressants, paroxetine shows the highest affinity for the serotonin transporter. Transporter inhibition by paroxetine could thus make up for the effect of the gene polymorphism thereby reducing not only the degree of the depressive/anxiety disorder but, also, cardiovascular risk. Our working hypothesis is currently being tested in a newly developed project called "PrevenPar". Eligible for inclusion are patients with coronary heart disease and a positive finding of a depressive, anxiety or depressive/anxiety disorder. Patients are to receive parallel state-of-the-art treatment by a cardiologist and by a psychiatrist with paroxetine. The primary goal of the PrevenPar project is to determine the success rate of treatment of the depressive/anxiety disorder with paroxetine. A secondary goal is to correlate the success/ failure rates of cardiac treatment with the success/failure rates of psychiatric treatment. The PrevenPar project has been launched and involves general practitioners, cardiologists, and psychiatrists. If successful, the project should provide guidance to eliminate the impact of the depressive/anxiety disorder, a newly identified cardiovascular risk factor.