title: Interaction between smoking and depressive symptoms with subclinical heart disease in the Coronary Artery Risk Development in Young Adults (CARDIA) study.
abstract: Evaluate whether smoking exposure and depressive symptoms accumulated over 25 years are synergistically associated with subclinical heart disease, measured by coronary artery calcification (CAC).
  
  
  
  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.
  
  
  
  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).
  
  
  
  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. (PsycINFO Database Record
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Carroll
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.affiliation: Department of Radiology, Vanderbilt University.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota.
authors.forename: Rachel
authors.initials: R
authors.lastname: Widome
authors.affiliation: Department of Ambulatory Care and Community Medicine, University Hospital, University of Bern.
authors.forename: Reto
authors.initials: R
authors.lastname: Auer
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine.
authors.forename: Brian
authors.initials: B
authors.lastname: Hitsman
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D002114:Calcinosis / Q000150:complications / Q000523:psychology*; D003324:Coronary Artery Disease / Q000150:complications / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D012907:Smoking / Q000523:psychology*; D055815:Young Adult