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

Change in cardiovascular health among adults with current or past major depressive disorder enrolled in intensive smoking cessation treatment

BACKGROUND

Elevated depressive symptoms and cigarette smoking are independently associated with poorer cardiovascular health (CVH), but it is unknown whether their treatment can synergistically improve CVH. We sought to characterize CVH of adults with comorbid depression and smoking and examine changes in CVH associated with changes in smoking and depression.

METHODS

Participants (N = 300, 55 % women) were adult smokers (≥1 cigarette/day) with lifetime major depressive disorder enrolled in a 12-week intervention trial targeting depression and smoking. Multiple linear regression examined prospective associations between changes in depression (Beck Depression Inventory-II), smoking (past 24-hour cigarettes or smoking abstinence), and modified CVH score (per American Heart Association, excluding smoking: diet, physical activity, body mass index, blood glucose, cholesterol, blood pressure).

RESULTS

Baseline mean CVH score was 5.87/12 points (SD = 2.13). No participants met "ideal" on all CVH components (blood glucose: 48 %, cholesterol: 46 %, physical activity: 38 %, body mass index: 24 %, blood pressure: 22 %, diet: 3 %). CVH scores did not change from baseline to end-of-treatment (M = 0.18 points, SD = 1.36, p = .177), nor did change in depression × smoking predict change in CVH (p = .978). However, greater reductions in depression were significantly associated with greater improvement in CVH (β = -0.04, SE = 0.01, p = .015).

LIMITATIONS

This study was limited by a short follow-up period, missing blood glucose and cholesterol data, and treatment-seeking smokers.

CONCLUSIONS

Adults with comorbid depression and smoking had poor CVH. Although integrated treatment for depression and smoking improved both conditions, only reductions in depression were associated with improvements in CVH. These findings have implications for integrating psychosocial treatment into CVH promotion efforts.

REGISTRATION

NCT02378714 (clinicaltrials.gov).

Subclinical cardiovascular disease and utility of coronary artery calcium score

ASCVD are the leading causes of mortality and morbidity among Globe. Evaluation of patients' comprehensive and personalized risk provides risk management strategies and preventive interventions to achieve gain for patients. Framingham Risk Score (FRS) and Systemic Coronary Risk Evaluation Score (SCORE) are two well studied risk scoring models, however, can miss some (20-35%) of future cardiovascular events. To obtain more accurate risk assessment recalibrating risk models through utilizing novel risk markers have been studied in last 3 decades and both ESC and AHA recommends assessing Family History, hs-CRP, CACS, ABI, and CIMT. Subclinical Cardiovascular Disease (SCVD) has been conceptually developed for investigating gradually progressing asymptomatic development of atherosclerosis and among these novel risk markers it has been well established by literature that CACS having highest improvement in risk assessment. This review study mainly selectively discussing studies with CACS measurement. A CACS = 0 can down-stratify risk of patients otherwise treated or treatment eligible before test and can reduce unnecessary interventions and cost, whereas CACS ≥ 100 is equivalent to statin treatment threshold of ≥ 7.5% risk level otherwise statin ineligible before test. Since inflammation, insulin resistance, oxidative stress, dyslipidemia and ongoing endothelial damage due to hypertension could lead to CAC, ASCVD linked with comorbidities. Recent cohort studies have shown a CACS 100-300 as a sign of increased cancer risk. Physical activity, dietary factors, cigarette use, alcohol consumption, metabolic health, family history of CHD, aging, exposures of neighborhood environment and non-cardiovascular comorbidities can determine CACs changes.

Association of Depression with Subclinical Coronary Atherosclerosis: a Systematic Review

To assess causal association of depression with subclinical coronary atherosclerosis, we performed computer-based and manual search of literature for studies which had assessed relationship of depression disorder with coronary atherosclerosis. All studies had diagnosed depression with validated tools in patients without diagnosed coronary artery disease. The Bradford Hill criteria of cause-effect association was consistently fulfilled by those studies which achieved statistical significance and further showed incremental strength of association with one or more of the following attributes: (1) prospective cohort study, met cause-effect criteria of "temporality"; (2) relatively severe and/or longer period of depression, met cause-effect criteria of "dose-response"; (3) depression with predominantly somatic symptoms cluster, met cause-effect criteria of "scientific plausibility"; (4) multiethnic larger sample, met cause-effect criteria of "population equivalence"; and (5) multicenter study, met criteria of "environmental equivalence." Our results show that there is a significant association of depression with coronary atherosclerosis at its subclinical stages.

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

INTRODUCTION

Depression is associated with increased risk of incident and recurrent cardiovascular disease, while the association between depression and cardiovascular health (CVH) remains unknown. Because the natural course of depression varies widely, different patterns of depression, as well as co-occurring factors such as cigarette smoking, may influence this relationship. We examined potential interactions between longitudinal patterns of depression and smoking with CVH.

METHODS

Using data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, we modeled trajectories of depression (Center for Epidemiologic Studies Depression scale scores; Years 5, 10, 15, 20) and smoking (cigarettes/day; Years 0, 2, 5, 7, 10, 15, 20). We calculated a modified American Heart Association (AHA) CVH Score (weight, blood glucose, cholesterol, blood pressure, physical activity, and diet; Year 20); higher scores indicate better CVH. Generalized linear models evaluated associations between depression trajectories, smoking trajectories, and their interaction with CVH Score.

RESULTS

The depression trajectory x smoking trajectory interaction was not associated with CVH Score, but main effects of depression trajectory (p < .001) and smoking trajectory (p < .001) were observed. Participants with patterns of subthreshold depression (β = -0.26, SE=0.08), increasing depression (β = -0.51 SE = 0.14), and high depression (β = -0.65, SE = 0.32) had lower CVH Scores than those without depression. Compared to never smokers, participants who quit smoking had higher CVH Scores (β = 0.38, SE = 0.11), while participants with the greatest smoking exposure had lower CVH Scores (β = -0.49, SE = 0.22).

LIMITATIONS

CVH Scores were adapted from the AHA guidelines based on the available CARDIA data.

CONCLUSIONS

Deleterious depression and smoking trajectories are independently but not synergistically associated with worse CVH.

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

The purpose of this study was to explore the association between colds, depressive symptoms during pregnancy and offspring congenital heart disease (CHD). A 1:2 matching case-control study was conducted in Northwest China. Information was gathered by a structured questionnaire and was reviewed by investigators on the spot. Multivariate logistic regressions and nonlinear mixed effect model were performed. 614 cases and 1228 controls were available in this study. After adjusting for potential confounders, the colds during the entire pregnancy were associated with increased risk of offspring CHD (OR = 1.44(1.12-1.85)). Similarly, there was a higher depression score in CHD group than the control group (OR = 1.89(1.48-2.41)). In addition, the women with both colds and higher depression scores had a higher risk of offspring CHD (OR = 2.72(1.87-3.93)) than their counterparts with only colds (OR = 1.48(1.04-2.09)) or with only higher depression scores (OR = 1.94(1.37-2.74)). The combined effects were significant in the multiplication model (OR = 2.04(1.47-2.83)) but not in the additive model (S = 1.40(0.70-2.81), AP = 0.19(-0.15-0.53) and RERI = 0.55(-0.54-1.64)). In conclusion, the colds and depressive symptoms during pregnancy were found associated with increased risk of offspring CHD and we found for the first time that there existed a statistically multiplying interaction effect of colds and depression on increasing risk of offspring CHD.

The association between depression and coronary artery calcification: A meta-analysis of observational studies

BACKGROUND AND AIMS

Cardiovascular diseases and depression are responsible for a great global burden of disease; however, the association between depression and coronary artery calcification (CAC) remain controversial and no quantitative meta-analysis exists. Thus, we performed a meta-analysis aimed to evaluate the association between depression and CAC.

METHODS

We performed a systematic search strategy using PubMed, Web of science, Embase, China National Knowledge Infrastructure and Cochrane library for relevant observational studies investigating depression and CAC from inception until April 2017. The pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) and subgroup analyses were calculated using a random effects model.

RESULTS

After screening 411 non-duplicated articles, a total of 15 studies involving 32,884 were included. Our analyses demonstrated a positive association between diagnosed depression and CAC (OR = 1.15; 95% CI: 1.04-1.28; I² = 80.6), and a non-significant association between depressive symptoms and CAC (OR = 1.02; 95% CI: 0.97-1.07; I² = 73.5%). In subgroup analysis for cohort studies, the positive association between diagnosed depression and CAC was enhanced (OR = 2.20; 95% CI: 1.33-3.64; I² = 0).

CONCLUSIONS

Our study indicated that diagnosed depression was associated with higher odds of CAC. Systematic screening for CAC may be useful to identify clinically depressed patients at higher risk of future cardiovascular diseases.

Nonlinear analysis of heart rate variability for the assessment of Dysphoria

Dysphoric patients show symptoms associated with Major Depression, although within a narrowed symptomatology spectrum. In prevailing practice, clinicians assess Dysphoria through psychological scores and questionnaires exclusively, therefore without taking into account objective biomarkers. In this study, we investigated heartbeat linear and nonlinear dynamics aiming to an objective assessment of Dysphoria. To this end, we derived standard and nonlinear measures from heart rate variability (HRV) series gathered from dysphoric (n=14) and nondysphoric (n=17) undergraduate students during 5 minutes of resting state. We performed both statistical and pattern recognition analyses in order to discern the two groups. Results showed significant group-wise differences in HRV nonlinear metrics exclusively, suggesting a crucial role of nonlinear sympatho-vagal dynamics in Dysphoria. Furthermore, we achieved a classification accuracy of 77.52% for the automatic identification of Dysphoria at a single-subject level.