Carroll, Allison J.Carnethon, Mercedes R.Liu, KiangJacobs, David R., Jr.Colangelo, Laura A.Stewart, Jesse C.Carr, J. JeffreyWidome, RachelAuer, RetoHitsman, Brian2018-07-192018-07-192017-02Carroll, A. J., Carnethon, M. R., Liu, K., Jacobs, D. R., Colangelo, L. A., Stewart, J. C., … Hitsman, B. (2017). Interaction between Smoking and Depressive Symptoms with Subclinical Heart Disease in the CARDIA study. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 36(2), 101–111. http://doi.org/10.1037/hea0000425https://hdl.handle.net/1805/16712OBJECTIVE: 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. (PsycINFO Database Recorden-USPublisher PolicySmokingDepressionCoronary artery calcificationAtherosclerosisMultiple risk factorsArticle