title: Moving beyond regression techniques in cardiovascular risk prediction: applying machine learning to address analytic challenges.
abstract: Risk prediction plays an important role in clinical cardiology research. Traditionally, most risk models have been based on regression models. While useful and robust, these statistical methods are limited to using a small number of predictors which operate in the same way on everyone, and uniformly throughout their range. The purpose of this review is to illustrate the use of machine-learning methods for development of risk prediction models. Typically presented as black box approaches, most machine-learning methods are aimed at solving particular challenges that arise in data analysis that are not well addressed by typical regression approaches. To illustrate these challenges, as well as how different methods can address them, we consider trying to predicting mortality after diagnosis of acute myocardial infarction. We use data derived from our institution's electronic health record and abstract data on 13 regularly measured laboratory markers. We walk through different challenges that arise in modelling these data and then introduce different machine-learning approaches. Finally, we discuss general issues in the application of machine-learning methods including tuning parameters, loss functions, variable importance, and missing data. Overall, this review serves as an introduction for those working on risk modelling to approach the diffuse field of machine learning.
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Suite 1104, Durham, NC 27705, USA.|Center for Predictive Medicine, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Goldstein
authors.affiliation: Center for Predictive Medicine, Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar
authors.affiliation: Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rickey E
authors.initials: RE
authors.lastname: Carter
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D006801:Humans; D000069550:Machine Learning; D008954:Models, Biological; D057285:Precision Medicine / Q000706:statistics & numerical data; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors
keywords: Electronic health records; Personalized medicine; Precision medicine; Risk prediction