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

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


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
Issue number2
StatePublished - Feb 1 2017

Bibliographical note

Funding Information:
The Coronary Artery Risk Development in Young Adults Study (CARDIA) is supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (HHSN268201300025C, HHSN268201300026C), Northwestern University (HHSN268201300027C), University of Minnesota (HHSN268201300028C), Kaiser Foundation Research Institute (HHSN268201300029C), and Johns Hopkins University School of Medicine (HHSN268200900041C). This project was also supported in part by NHLBI through (R01-HL098445) to Vanderbilt University and Wake Forest University. The funding agency had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of this article.

Publisher Copyright:
© 2016 American Psychological Association.


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


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