Association of the Interaction Between Smoking and Depressive Symptom Clusters With Coronary Artery Calcification: The CARDIA Study

Abstract

Objective Depressive symptom clusters are differentially associated with prognosis among patients with cardiovascular disease (CVD). Few studies have prospectively evaluated the association between somatic symptoms and risk for CVD. Previously, we observed that smoking and total depressive symptoms were synergistically associated with coronary artery calcification (CAC). The purpose of this study was to determine whether the smoking by depressive symptoms interaction, measured cumulatively over 25 years, differed by depressive symptom cluster (negative affect, anhedonia, and somatic symptoms) in association with CAC. Methods Participants (N=3,189: 54.5% female; 51.5% Black; average age=50.1 years) were followed from 1985–1986 through 2010–2011 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking exposure was measured by cumulative cigarette packyears (cigarette packs smoked per day × number of years smoking; Year 0 through Year 25). Depressive symptoms were measured using a 14-item, 3-factor (negative affect, anhedonia, somatic symptoms) analysis of the Center for Epidemiologic Studies Depression (CES-D) Scale (Years 5, 10, 15, 20, and 25). CAC was assessed at Year 25. Logistic regression models were used to evaluate the association between the smoking by depressive symptom clusters interactions with CAC (=0 vs. >0), adjusted for CVD-related sociodemographic, behavioral, and clinical covariates. Results 907 participants (28% of the sample) had CAC >0 at Year 25. The depressive symptom clusters did not differ significantly between the two groups. Only the cumulative somatic symptom cluster by cumulative smoking exposure interaction was significantly associated with CAC >0 at Year 25 (p=.028). Specifically, adults with elevated somatic symptoms (score 9 out of 18) who had 10, 20, or 30 packyears of smoking exposure had respective odds ratios (95% confidence intervals) of 2.06 (1.08–3.93), 3.71 (1.81–7.57), and 6.68 (2.87–15.53), ps<.05. Negative affect and anhedonia did not significantly interact with smoking exposure associated with CAC >0, ps>.05. Conclusions Somatic symptoms appear to be a particularly relevant cluster of depressive symptomatology in the relationship between smoking and CVD risk.

Associations between depressive symptoms, cigarette smoking, and cardiovascular health: Longitudinal results from CARDIA

“…A consideration for future studies is that certain clusters of depressive symptoms (e.g., somatic symptoms), rather than a global assessment, may have a greater influence on CVH compared to others, as has been frequently demonstrated among patients with CVD (Baune et al 2012). A 2017 analysis of CARDIA evaluating the interaction between depressive symptom clusters and smoking found that only somatic symptoms of depression significantly interacted with smoking exposure to predict greater odds of CAC (Carroll et al 2017a), while a 2012 analysis of CARDIA found that the negative affect cluster was associated with risk of developing CAC more so than somatic symptoms or other symptom clusters (Stewart et al 2012). Fewer studies have examined this association with incident CVD, but a 2014 study demonstrated that somatic symptoms of depression were associated with incident CAD events (Hawkins et al 2014).…”

Bilgisayarlı Tomografik Koroner Anjiyografi ile Erken Evre Koroner Arter Hastalığı Tespit Edilmiş Olan Hastalarda Anksiyete ve Depresyon Düzeylerinin Tespiti

“…[23][24][25][26][27] Bu faktörlerin birleşmesi ile endotel fonksiyonları bozulmakta, böylece koroner arterlerde ateroskleroz gelişmektedir. [17,[27][28][29][30][31] Ayrıca literatüre bakıldığında tedavi gereksinimi olan KAH olgularında daha yüksek kan basıncı düzeylerinin saptandığı gözlenmiştir. [18,[29][30][31] Bu faktörlerin yanında depresif duygudurum ile tetiklenen nöroendokrin sistemin insulin direnci arışı ile metabolik sendrom riskini artırdığı, obezite, kanser, Tip 2 diabetes mellitus ve hipertansiyon gibi birçok hastalık için de risk faktörü olduğu görülmektedir.…”

“…[17,[27][28][29][30][31] Ayrıca literatüre bakıldığında tedavi gereksinimi olan KAH olgularında daha yüksek kan basıncı düzeylerinin saptandığı gözlenmiştir. [18,[29][30][31] Bu faktörlerin yanında depresif duygudurum ile tetiklenen nöroendokrin sistemin insulin direnci arışı ile metabolik sendrom riskini artırdığı, obezite, kanser, Tip 2 diabetes mellitus ve hipertansiyon gibi birçok hastalık için de risk faktörü olduğu görülmektedir. [23][24][25][26][27] Anksiyetenin kardiyovasküler bozuklukların gelişiminde rol oynadığı bilinmektedir.…”

A Matched Case-Control Study on the Association Between Colds, Depressive Symptoms during Pregnancy and Congenital Heart Disease in Northwestern China

“…Previous studies had examined the interaction between depression and other characteristics. For instance, it was well-established in some studies about the multiplying effect between smoking exposure and depressive symptoms on promoting atherosclerosis and heart disease 26,40 . Lou et al .…”

“…Similarly, recall bias could have potentially affected our results because the interview was often based on parental recall after the birth of the child, especially when it came to assessing depression. Although controls were randomly matched at the rate of 1:2 by age of child, we may have missed some depressive symptom 40 . Moreover, colds and fever were largely determined by maternal self-reports, which it may lead to false exposure classification, and it was possible to miss a fever because women may be reluctant to disclose such information 47 .…”