The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study

Research output: Contribution to journalArticle

Standard

Harvard

APA

Vancouver

Author

Bibtex

@article{15074b0e6338485aae6a23359449c7d1,
title = "The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study",
abstract = "This simulation study investigates the effects of within-individual variability in estimated cardiovascular risk on categorization of patients as high risk. Published estimates of within-individual blood pressure and cholesterol variability were used to generate blood pressure and cholesterol levels for hypothetical subjects at a range of ages. These were used to calculate the estimated cardiovascular risk of each individual. The relationship between an individual's mean cardiovascular risk and within-individual coefficient of variation for cardiovascular risk was determined. Using the derived relationship, mean cardiovascular risk and within-individual variation in risk was calculated for 5018 adults from a population health survey. From this, was determined their probability of being classified as high risk (420% 10-year cardiovascular risk) and the test characteristics of risk estimation at a range of ages. Within-individual variability in cardiovascular risk and potential for misclassification are both greater in lower-risk populations. At age 35-44 years, the positive predictive value of a diagnosis of high risk is 0.61 (95% confidence interval (CI): 0.59-0.64), and at age 65-74 years, it is 0.94 (95% CI: 0.91-0.96). About 39% of adults under 45 years diagnosed as high risk are not at high risk. Cardiovascular risk assessment should be targeted at high-risk populations. Journal of Human Hypertension (2010) 24, 631-638; doi:10.1038/jhh.2009.114; published online 7 January 2010",
keywords = "primary care, screening, risk stratification, coronary heart disease, measurement error, diagnosis",
author = "Tom Marshall",
year = "2010",
month = oct
day = "1",
doi = "10.1038/jhh.2009.114",
language = "English",
volume = "24",
pages = "631--638",
journal = "Journal of Human Hypertension",
issn = "0950-9240",
publisher = "Nature Publishing Group",
number = "10",

}

RIS

TY - JOUR

T1 - The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study

AU - Marshall, Tom

PY - 2010/10/1

Y1 - 2010/10/1

N2 - This simulation study investigates the effects of within-individual variability in estimated cardiovascular risk on categorization of patients as high risk. Published estimates of within-individual blood pressure and cholesterol variability were used to generate blood pressure and cholesterol levels for hypothetical subjects at a range of ages. These were used to calculate the estimated cardiovascular risk of each individual. The relationship between an individual's mean cardiovascular risk and within-individual coefficient of variation for cardiovascular risk was determined. Using the derived relationship, mean cardiovascular risk and within-individual variation in risk was calculated for 5018 adults from a population health survey. From this, was determined their probability of being classified as high risk (420% 10-year cardiovascular risk) and the test characteristics of risk estimation at a range of ages. Within-individual variability in cardiovascular risk and potential for misclassification are both greater in lower-risk populations. At age 35-44 years, the positive predictive value of a diagnosis of high risk is 0.61 (95% confidence interval (CI): 0.59-0.64), and at age 65-74 years, it is 0.94 (95% CI: 0.91-0.96). About 39% of adults under 45 years diagnosed as high risk are not at high risk. Cardiovascular risk assessment should be targeted at high-risk populations. Journal of Human Hypertension (2010) 24, 631-638; doi:10.1038/jhh.2009.114; published online 7 January 2010

AB - This simulation study investigates the effects of within-individual variability in estimated cardiovascular risk on categorization of patients as high risk. Published estimates of within-individual blood pressure and cholesterol variability were used to generate blood pressure and cholesterol levels for hypothetical subjects at a range of ages. These were used to calculate the estimated cardiovascular risk of each individual. The relationship between an individual's mean cardiovascular risk and within-individual coefficient of variation for cardiovascular risk was determined. Using the derived relationship, mean cardiovascular risk and within-individual variation in risk was calculated for 5018 adults from a population health survey. From this, was determined their probability of being classified as high risk (420% 10-year cardiovascular risk) and the test characteristics of risk estimation at a range of ages. Within-individual variability in cardiovascular risk and potential for misclassification are both greater in lower-risk populations. At age 35-44 years, the positive predictive value of a diagnosis of high risk is 0.61 (95% confidence interval (CI): 0.59-0.64), and at age 65-74 years, it is 0.94 (95% CI: 0.91-0.96). About 39% of adults under 45 years diagnosed as high risk are not at high risk. Cardiovascular risk assessment should be targeted at high-risk populations. Journal of Human Hypertension (2010) 24, 631-638; doi:10.1038/jhh.2009.114; published online 7 January 2010

KW - primary care

KW - screening

KW - risk stratification

KW - coronary heart disease

KW - measurement error

KW - diagnosis

U2 - 10.1038/jhh.2009.114

DO - 10.1038/jhh.2009.114

M3 - Article

C2 - 20054346

VL - 24

SP - 631

EP - 638

JO - Journal of Human Hypertension

JF - Journal of Human Hypertension

SN - 0950-9240

IS - 10

ER -