Effect of Correcting for Long-Term Variation in Major Coronary Heart Disease Risk Factors: Relative Hazard Estimation and Risk Prediction in the Atherosclerosis Risk in Communities Study

Paynter, Nina P.; Crainiceanu, Ciprian M.; Sharrett, A. Richey; Chambless, Lloyd E.; Coresh, Josef

doi:10.1016/j.annepidem.2011.12.001

« Previous Next »Annals of Epidemiology
Volume 22, Issue 3 , Pages 191-197, March 2012

Effect of Correcting for Long-Term Variation in Major Coronary Heart Disease Risk Factors: Relative Hazard Estimation and Risk Prediction in the Atherosclerosis Risk in Communities Study

Nina P. Paynter, PhD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA
- Address correspondence to: Nina P. Paynter, PhD, Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave, Boston, MA 02215. Tel.: +1 617 278 0798; Fax: +1 617 731 3843.
Ciprian M. Crainiceanu, PhD
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
A. Richey Sharrett, MD, DrPH
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Lloyd E. Chambless, PhD
- Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC
Josef Coresh, MD, PhD
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD

Received 29 April 2011; accepted 13 December 2011. published online 05 January 2012.

Purpose

To examine the effect of correcting coronary heart disease (CHD) risk factors for long-term within-person variation on CHD risk.

Methods

By using 5533 men and 7301 women from the Atherosclerosis Risk in Communities (ARIC) study, we compared models incorporating risk factors measured at a single visit and models incorporating additional measurements for systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol taken 3 years before baseline.

Results

The largest change away from null was observed for systolic blood pressure, ie, hazard ratio (HR) 1.38 to 1.69 (+81%) in women and HR 1.26 to 1.41 (+56%) in men. HRs also decreased for age (−32% in women, −9% in men), race (−67% in women), the presence of diabetes (−13% in men and women), and medication use for hypertension (−27% in women, −26% in men) and cholesterol (−97% in women, HR 1.06–0.93 in men). The area under the ROC curve did not improve significantly in men or women, whereas reclassification was only significant in women (net reclassification improvement 5.4%, p = 0.016).

Conclusions

Modeling long-term variation in CHD risk factors had a substantial impact on HR estimates, with new effect estimates further from the null for some risk factors and closer for others including age and medication use, but only improved risk classification in women.

Key Words: Cardiovascular Models, Epidemiology, Heart Diseases, Risk Assessment, Risk Factors, Statistics

Selected Abbreviations and Acronyms: CHD, coronary heart disease, HDL, high-density lipoprotein, ARIC, Atherosclerosis Risk in Communities, AUC, area under the receiver operator characteristic curve