Depressive symptom clusters and 5-year incidence of coronary artery calcification: the coronary artery risk development in young adults study.
BACKGROUND
Because depression is a multidimensional construct and few studies have compared the relative importance of its facets in predicting cardiovascular risk, we evaluated the utility of depressive symptom clusters in predicting the 5-year incidence of coronary artery calcification (CAC).


RESULTS
Participants were 2171 middle-aged adults (58% female; 43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of cardiovascular disease. Depressive symptom clusters (z scores) were measured by questionnaires in 2000 to 2001, and CAC was measured by electron beam computed tomography in 2000 to 2001 and 2005 to 2006. There were 243 cases (11%) of incident CAC, defined as the absence of CAC at baseline and the presence of CAC at follow-up. Total depressive symptoms (odds ratio, 1.16; 95% confidence interval, 1.02-1.33; P=0.03) and the depressed affect cluster (odds ratio, 1.17; 95% confidence interval, 1.03-1.33; P=0.02) predicted incident CAC; however, the somatic, interpersonal distress, low positive affect, and pessimism clusters did not. The depressed affect-incident CAC relationship was independent of age, sex, race, education, and antidepressant use; was similar across sex and racial groups; and was partially accounted for by tobacco use and mean arterial pressure.


CONCLUSIONS
In contrast to recent results indicating that the somatic cluster is the most predictive of cardiovascular outcomes, we found that the prospective association between depressive symptoms and incident CAC was driven by the depressed affect cluster. Our findings raise the possibility that there may not be 1 facet of depression that is the most cardiotoxic across all contexts.
Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N Blackford St, LD 100E, Indianapolis, IN 46202, USA. jstew@iupui.edu
Jesse C
JC
Stewart
Desiree J
DJ
Zielke
Misty A W
MA
Hawkins
David R
DR
Williams
Mercedes R
MR
Carnethon
Sarah S
SS
Knox
Karen A
KA
Matthews
D000328:Adult; D044383:Black People / Q000208:ethnology; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000208:ethnology; D016000:Cluster Analysis; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000208:ethnology; D003863:Depression / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D044465:White People / Q000208:ethnology