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

Q: What are the key findings of this study?

Depressive symptoms (HR 1.63) and thoracic aortic calcification (HR 1.22) were independently associated with incident ASCVD events, with the highest risk observed in individuals having both.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Free of clinical cardiovascular disease (n=2600). Intervention: Depressive symptoms (CES-D ≥ 16) vs. No depressive symptoms (CES-D < 16). Primary outcome: Incident ASCVD events (HR 1.63, 95% CI 1.16-2.29, p=0.005).

Q: What does this research mean for the field?

While depressive symptoms are not directly associated with thoracic aortic calcification (TAC), their coexistence with elevated TAC significantly increases the risk of incident atherosclerotic cardiovascular disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Daiki Arai; Quinn White; Keishi Ichikawa; Robyn L. McClelland; W. Craig Johnson; Mio Yabuki; Spencer Hansen; Matthew J. Budoff

doi:10.1007/s10554-026-03771-0

August 19, 2026The International Journal of Cardiovascular ImagingOpen Access

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

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Key result

Depressive symptoms link to ~63% higher ASCVD risk, peaking when combined with thoracic aortic calcification.

HR 1.63
95% CI 1.16-2.29
P=0.005
n=2,600

Why the study?

Depression is highly prevalent, but its association with atherosclerotic cardiovascular disease events remains incompletely understood.

Does the presence of depressive symptoms increase the risk of incident ASCVD events in individuals without baseline ASCVD?

Key Points

To examine the association between depressive symptoms and thoracic aortic calcification, and determine their independent and joint prognostic utility for incident atherosclerotic cardiovascular disease.
Analyzed 2,600 participants (mean age 68 years; 47% male) free of baseline ASCVD from the Multi-Ethnic Study of Atherosclerosis (MESA) followed for a median of 10.35 years.
Quantified thoracic aortic calcification (TAC) via non-contrast chest CT and defined depressive symptoms using a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16.
Used multivariable linear regression to assess depressive symptoms and TAC, alongside Cox proportional hazards models to estimate incident ASCVD risk across TAC tertiles.
Across 230 incident ASCVD events, both depressive symptoms (HR 1.63; 95% CI 1.16–2.29; p = 0.005) and TAC (HR 1.22; 95% CI 1.13–1.33; p < 0.001) served as independent risk predictors.
Depressive symptoms significantly elevated ASCVD hazard in the highest TAC tertile (HR 1.897; 95% CI 1.203–2.990; p = 0.006), but not in tertile 1 (HR 1.107; 95% CI 0.423–2.894; p = 0.837) or tertile 2 (HR 1.500; 95% CI 0.833–2.698; p = 0.176).

Study Design

Type

Cohort (n=2,600)

Multicenter

Yes

Structured PICO

Does the presence of depressive symptoms increase the risk of incident ASCVD events in individuals without baseline ASCVD?

P

Population

2,600 diverse adults aged 45 to 84 years without baseline cardiovascular disease, followed for a median of 10.35 years.

E

Exposure

Presence of depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D] score ≥ 16)

C

Comparator

Absence of depressive symptoms (CES-D score < 16)

O

Outcome

Incident ASCVD events (composite of definite or probable myocardial infarction, resuscitated cardiac arrest, fatal or non-fatal stroke, coronary heart disease death, and stroke death) and thoracic aortic calcification (TAC) scorecomposite

Main Result

Hazard Ratio: 1.63 (95% CI 1.16–2.29)

p-value: p=0.005

Depressive symptoms and thoracic aortic calcification are independently associated with incident ASCVD, and their coexistence confers a significantly higher risk, suggesting the value of depression screening in cardiovascular risk stratification.

Limitations

Older average age (68 years) may have introduced survivor bias and limits generalizability to younger populations.
Did not account for other potentially relevant medications, such as anticoagulants, which could influence ASCVD outcomes.
Early study using non-contrast chest CT for TAC, requiring future research in diverse, younger cohorts to confirm associations.
Survivor bias due to average age of 68 years at Exam 5, making generalization to younger populations difficult
Did not account for other potentially relevant medications, such as anticoagulants, which could influence ASCVD outcomes
Early study to investigate the direct association between depressive symptoms and TAC using non-contrast chest CT, so results should not be interpreted as definitive answers

Implication

Depressive symptoms may identify higher ASCVD risk via TAC; leaves open whether screening or treatment alters events.

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.

Discussion

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Cite This Study

Arai et al. (2026) conducted a cohort in Free of clinical cardiovascular disease (n=2,600). Depressive symptoms (CES-D ≥ 16) vs. No depressive symptoms (CES-D < 16) was evaluated on Incident ASCVD events (HR 1.63, 95% CI 1.16-2.29, p=0.005). Depressive symptoms (HR 1.63) and thoracic aortic calcification (HR 1.22) were independently associated with incident ASCVD events, with the highest risk observed in individuals having both.

synapsesocial.com/papers/6a895f62ca7ade938187e00e https://doi.org/10.1007/s10554-026-03771-0

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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