title: The use of repeated blood pressure measures for cardiovascular risk prediction: a comparison of statistical models in the ARIC study.
abstract: Many prediction models have been developed for the risk assessment and the prevention of cardiovascular disease in primary care. Recent efforts have focused on improving the accuracy of these prediction models by adding novel biomarkers to a common set of baseline risk predictors. Few have considered incorporating repeated measures of the common risk predictors. Through application to the Atherosclerosis Risk in Communities study and simulations, we compare models that use simple summary measures of the repeat information on systolic blood pressure, such as (i) baseline only; (ii) last observation carried forward; and (iii) cumulative mean, against more complex methods that model the repeat information using (iv) ordinary regression calibration; (v) risk-set regression calibration; and (vi) joint longitudinal and survival models. In comparison with the baseline-only model, we observed modest improvements in discrimination and calibration using the cumulative mean of systolic blood pressure, but little further improvement from any of the complex methods. © 2016 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, U.K.
authors.forename: Michael J
authors.identifier: http://orcid.org/0000-0003-0980-8965
authors.initials: MJ
authors.lastname: Sweeting
authors.affiliation: Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, U.K.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Barrett
authors.affiliation: Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, U.K.
authors.forename: Simon G
authors.identifier: http://orcid.org/0000-0002-5274-7814
authors.initials: SG
authors.lastname: Thompson
authors.affiliation: Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, U.K.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Wood
mesh_terms: D015982:Bias; D015415:Biomarkers; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers
keywords: C-index; cardiovascular risk prediction; joint models; regression calibration; repeat measures