Interaction between smoking and depressive symptoms with subclinical heart disease in the coronary artery risk development in young adults (CARDIA) study

Allison J. Carroll*, Mercedes R. Carnethon, Kiang Liu, David R. Jacobs, Laura A. Colangelo, Jesse C. Stewart, J. Jeffrey Carr, Rachel Widome, Reto Auer, Brian Hitsman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objective: Evaluate whether smoking exposure and depressive symptoms accumulated over 25 years are synergistically associated with subclinical heart disease, measured by coronary artery calcification (CAC). Method: Participants (baseline: 54.5% women; 51.5% Black; age range =18-30 years) were followed prospectively from 1985 to 2010 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking status was queried yearly from Year 0 to Year 25 to compute packyears of smoking exposure. Depressive symptoms were measured on the Center for Epidemiologic Studies Depression (CES-D) scale every 5 years to compute cumulative scores from Year 5 to Year 25. A three-level multinomial logistic regression was used to evaluate the association between cumulative smoking, cumulative depressive symptoms, and their interaction with moderate-risk CAC (score 1-99) and higher-risk CAC (score ≥100) compared with no CAC (score = 0) at Year 25. Models were adjusted for sociodemographic, clinical, and behavioral covariates. Results: Among 3,189 adults, the cumulative Smoking × Depressive Symptoms interaction was not significant for moderate-risk CAC (p = .057), but was significant for higher-risk CAC (p = .001). For adults with a 30-packyear smoking history, average CES-D scores 2, 10, and 16 were, respectively, associated with odds ratios (95% confidence intervals) 3.40 (2.36-4.90), 4.82 (3.03-7.66), and 6.25 (3.31-11.83) for higher-risk CAC (all ps < .05). Conclusion: Cumulative smoking exposure and cumulative depressive symptoms have a synergistic association with subclinical heart disease, where higher lifetime smoking exposure and depressive symptoms are associated with greater odds of CAC.

Original languageEnglish (US)
Pages (from-to)101-111
Number of pages11
JournalHealth Psychology
Volume36
Issue number2
DOIs
StatePublished - Feb 1 2017

Keywords

  • Atherosclerosis
  • Coronary artery calcification
  • Depression
  • Multiple risk factors
  • Smoking

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

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