Progression of Coronary Artery Calcification by Depression and Social Support: A Longitudinal Study from the Multiethnic Study of Atherosclerosis (MESA)

Background: This study investigated the association between and the progression of coronary artery calcification (CAC) in a large, multiethnic sample using linear mixed effects models as well as the potential buffering role of social support in the association this association.
Methods: Data were drawn from the first five waves of the Multiethnic Study of Atherosclerosis (MESA) from 2000 to 2011. Depression was the covariate of interest and measured by the Center for Epidemiologic Studies Depression (CES-D) scale. The primary outcome, CAC progression, was measured at multiple time points across study waves using chest computed tomography (CT). Social support was measured using the ENRICHD Social Support Instrument (ESSI) at baseline and individuals were characterized by ESSI quartile. A linear mixed effects model with random slope and intercept was utilized to evaluate the association of baseline depression and the progression of repeated CAC measurements over time adjusted for relevant demographic and clinical covariates.
Results: A +1 SD difference in CES-D score was associated with a decrease in CAC progression of 1.5 Agatston units per year (B= -1.5, 95% CI = -2.9, -0.1). Estimates varied minimally when grouped by ESSI quartile (Q1: -1.0 [-3.2, 1.1], Q2: -3.7 [-6.8,-0.6], Q3: -0.1 [-3.5, 3.2], Q4: -2.1 [-7.8, 3.5]).
Discussion: We observed a small but clinically insignificant inverse association between baseline CES-D score and the progression of CAC overall, and no meaningful differences were observed by quartile of ESSI. This study was the first to use linear mixed effects modelling for the association between depression and CVD as well as the first to incorporate the potential buffering role of social support.