The effect of blood pressure and cholesterol variability on the precision of Framingham cardiovascular risk estimation: a simulation study.
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 (>20% 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.
Marshall
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Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, UK. T.P.Marshall@bham.ac.uk
D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
D015415:Biomarkers; D002784:Cholesterol