title: 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 depressive symptom clusters and risk of CVD. Previously, we observed that smoking and global 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 pack-years (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) model 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 pack-years 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.
authors.affiliation: a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Allison J
authors.initials: AJ
authors.lastname: Carroll
authors.affiliation: b Department of Ambulatory Care and Community Medicine , University Hospital , Lausanne , Switzerland.|c Institute of Primary Health Care (BIHAM), University of Bern , Bern , Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Auer
authors.affiliation: a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Colangelo
authors.affiliation: a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Mercedes R
authors.initials: MR
authors.lastname: Carnethon
authors.affiliation: d Division of Epidemiology and Community Health , School of Public Health, University of Minnesota , Minneapolis , Minnesota , USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: e Department of Psychology , Indiana University-Purdue University Indianapolis , Indianapolis , Indiana , USA.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Stewart
authors.affiliation: d Division of Epidemiology and Community Health , School of Public Health, University of Minnesota , Minneapolis , Minnesota , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Widome
authors.affiliation: f Department of Radiology , Vanderbilt University , Nashville , Tennessee , USA.
authors.forename: John Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Hitsman
mesh_terms: D001741:Black or African American; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology*; D061205:Vascular Calcification / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D044465:White People
keywords: Depression; cardiovascular disease risk; coronary artery calcification; depressive symptom clusters; prospective study; smoking; somatic symptoms