Association between depressive symptoms and thoracic aortic calcification, and their independent and joint prognostic value for incident atherosclerotic cardiovascular disease in the MESA cohort.

Abstract

Depression is highly prevalent; however, its association with atherosclerotic cardiovascular disease (ASCVD) events remains incompletely understood. This study aimed to evaluate the association between depressive symptoms and thoracic aortic calcification (TAC) and assess their joint prognostic value for future ASCVD events. We analyzed 2,600 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) without baseline ASCVD. TAC was quantified using non-contrast chest CT as a marker of subclinical atherosclerosis. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D ≥ 16). Linear regression assessed the association between depressive symptoms and log-transformed TAC. Cox proportional hazards models evaluated independent and joint associations of depressive symptoms and TAC tertiles with incident ASCVD, adjusting for covariates. Overall, 389 participants (15%) exhibited depressive symptoms. In fully adjusted models, depressive symptoms were not associated with TAC (β = 0.08; 95% CI -0.13-0.29), without sex-specific differences. Both depressive symptoms (HR 1.63; 95% CI 1.16-2.29) and TAC (HR 1.22; 95% CI 1.13-1.33) were independently associated with ASCVD events. Individuals with depressive symptoms had significantly higher ASCVD risk in the highest tertile TAC group, whereas no difference was observed in lower TAC tertiles. Although depressive symptoms were not directly associated with TAC, their presence was significantly associated with increased ASCVD risk, particularly among participants with elevated TAC. Coexisting depressive symptoms and substantial atherosclerotic burden confer a higher ASCVD risk. Thus, evaluating depressive symptoms may provide additional context for cardiovascular risk stratification, particularly among individuals with advanced subclinical atherosclerosis.