Individual risk prediction model for incident cardiovascular disease: a Bayesian clinical reasoning approach.
BACKGROUND
A Bayesian clinical reasoning model was developed to predict an individual risk for cardiovascular disease (CVD) for desk-top reference.


METHODS
Three Bayesian models were constructed to estimate the CVD risk by sequentially incorporating demographic features (basic), six metabolic syndrome components (metabolic score) and conventional risk factors (enhanced model). By considering clinical weights (regression coefficients) of each model as normal distribution, individual risk can be predicted making allowance for uncertainty of clinical weights. A community-based cohort that enrolled 64,489 participants free of CVD at baseline and followed up over five years to ascertain newly diagnosed CVD cases during the period through 2000 to 2004 was used for the illustration of the three proposed models (full empirical data are available from website http://homepage.ntu.edu.tw/~chenlin/CVD_prediction_data.rar).


RESULTS
The proposed models can be applied to predicting the CVD risk with any combination of risk factors. For a 47-year-old man, the five-year risk for CVD with the basic model was 11.2% (95% CI: 7.8%-15.6%). His metabolic syndrome score, leading to 1.488 of likelihood ratio, enhanced the risk for CVD up to 15.8% (95% CI: 11.0%-21.5%) and put him in highest deciles. As with the habit of smoking over 2 packs per-day and family history of CVD, yielding the likelihood ratios of 1.62 and 1.47, respectively, the risk was further raised to 30.9% (95% CI: 20.7%-39.8%).


CONCLUSIONS
We demonstrate how to make individual risk prediction for CVD by incorporating routine information with a sequential Bayesian clinical reasoning approach.
Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Yi-Ming
YM
Liu
Sam Li-Sheng
SL
Chen
Amy Ming-Fang
AM
Yen
Hsiu-Hsi
HH
Chen
D000328:Adult; D001499:Bayes Theorem; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors