Carroll Allison J, Auer Reto, Colangelo Laura A, Carnethon Mercedes R, Jacobs David R, Stewart Jesse C, Widome Rachel, Carr John Jeffrey, Liu Kiang, Hitsman Brian
a Department of Preventive Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA.
b Department of Ambulatory Care and Community Medicine , University Hospital , Lausanne , Switzerland.
J Dual Diagn. 2017 Jan-Mar;13(1):43-51. doi: 10.1080/15504263.2017.1287455. Epub 2017 Jan 27.
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.
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.
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.
Somatic symptoms appear to be a particularly relevant cluster of depressive symptomatology in the relationship between smoking and CVD risk.
在心血管疾病（CVD）患者中，抑郁症状群与预后的关联存在差异。很少有研究前瞻性地评估抑郁症状群与CVD风险之间的关联。此前，我们观察到吸烟与总体抑郁症状与冠状动脉钙化（CAC）存在协同关联。本研究的目的是确定在25年期间累积测量的吸烟与抑郁症状的相互作用，在与CAC的关联中，是否因抑郁症状群（消极情绪、快感缺乏和躯体症状）而有所不同。
在青年成人冠状动脉风险发展（CARDIA）研究中，对1985 - 1986年至2010 - 2011年期间的参与者（N = 3189：54.5%为女性；51.5%为黑人；平均年龄 = 5岁）进行随访。吸烟暴露通过累积吸烟包年数来衡量（每天吸烟包数×吸烟年数；第0年至第25年）。使用流行病学研究中心抑郁量表（CES - D量表）的14项、3因子（消极情绪、快感缺乏、躯体症状）模型测量抑郁症状（第5年、第10年、第15年、第20年和第25年）。在第25年评估CAC。使用逻辑回归模型评估抑郁症状群与吸烟的相互作用与CAC（CAC>0与CAC = 0）之间的关联，并对与CVD相关的社会人口统计学、行为和临床协变量进行调整。
907名参与者（样本的28%）在第25年时CAC>0。两组之间的抑郁症状群没有显著差异。仅累积躯体症状群与累积吸烟暴露的相互作用在第25年时与CAC>0显著相关（p = 0.028）。具体而言，躯体症状升高（18分中得9分）且有10、20或30包年吸烟暴露的成年人，其优势比（95%置信区间）分别为2.06 [1.08, 3.93]、3.71 [1.81, 7.57]和6.68 [2.87, 15.53]，p值均<0.05。消极情绪和快感缺乏与吸烟暴露和CAC>0之间没有显著的相互作用，p值>0.05。
在吸烟与CVD风险的关系中躯体症状似乎是抑郁症状学中一个特别相关的症状群。
