Background: Evidence supporting a bidirectional relationship between depression and recurrent cardiovascular disease (CVD) appears strong, but there remains a need to better characterize the role of depression in CVD risk and cardiovascular health (CVH) promotion, especially in the context of comorbid risk factors such as cigarette smoking. In the present study, we evaluated the association between the interaction of patterns of depression with patterns of smoking and three CVH outcomes: a clinical assessment, biomarkers of physiological processes associated with CVH, and additional behaviors associated with CVH. It was hypothesized that individuals with higher or increasing exposure to depression as well as higher or increasing exposure to smoking throughout young adulthood would have significantly worsening CVH throughout middle adulthood compared to individuals with depression exposure only, smoking exposure only, or neither. > Methods: Data for this study were from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Using PROC TRAJ in SAS, we modeled trajectories of depression (assessed on the Centers for Epidemiologic Studies Depression Scale: CES-D) from Year 5 to Year 15 and smoking (cigarettes per day: CPD) from Year 0 to Year 15. Three interactions were evaluated, including depression status trajectory x smoking status trajectory, CES-D score trajectory x CPD trajectory, and CES-D score trajectory x CPD trajectory among smokers. CVH was assessed by: 1) American Heart Association (AHA) CVH Score from Year 15 to Year 25, 2) biomarkers of inflammation (high-sensitivity C-reactive protein: hsCRP), oxidative stress (F2-isoprostanes and superoxide dismutase: SOD), and endothelial dysfunction (sP-selectin and sICAM1) at Year 15, and 3) behaviors, including physical activity and alcohol use from Year 15 to Year 25 and sleep patterns from Year 15 to Year 20. We used generalized linear mixed models to evaluate the associations between depressive symptoms trajectories, smoking trajectories, and both with change in CVH outcomes. Linear regression models were used for biomarkers, which were only measured at Year 15, and sleep outcomes, which only produced a single change score from Year 15 to Year 20. Results: The depression trajectory x smoking trajectory interaction was not associated with change in AHA CVH Score in the full sample or among smokers (all p-values > .05). The depression trajectory x smoking trajectory interaction was associated with hsCRP in the full sample (pinteraction<.001) and SOD among smokers (pinteraction=.003), but no associations were observed with sP-selectin, F2-isoprostanes, or sICAM1 (all p-values > .01). The depression trajectory x smoking trajectory interaction was associated with changes in alcohol use in the full sample (pinteraction=.008) and changes in sleep duration in the full sample (pinteraction<.001); no associations were observed with physical activity or sleep disturbance, and none of the models among smokers were significant (all p-values > .0125). Discussion: Overall, results did not support an association between depression, smoking, and CVH outcomes. Nonetheless, this was the first study to evaluate the potential modifying effect of smoking on the association between depressive symptom patterns and CVH outcomes. Future directions include further validation of CVH measures and assessments, understanding the mechanisms by which depressive symptoms and comorbid conditions negatively affect CVH, and developing interventions to address depressive symptoms for CVH promotion

Last modified

• 03/07/2019

Creator

• Allison Jane Carroll

DOI

• https://doi.org/10.21985/N2D491

Subject

• Clinical Psychology

Keyword

• multiple health behaviors
• depression
• cardiovascular health
• smoking

Date created

• 2017-01-01

Resource type

• Dissertation

Rights statement

• In Copyright