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

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

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 sin...

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Bibliographic Details
Published in:Annals of epidemiology 2012-03, Vol.22 (3), p.191-197
Main Authors: Paynter, Nina P., PhD, Crainiceanu, Ciprian M., PhD, Sharrett, A. Richey, MD, DrPH, Chambless, Lloyd E., PhD, Coresh, Josef, MD, PhD
Format: Article
Language:eng
Subjects:
Age
Atherosclerosis - blood
Atherosclerosis - epidemiology
Atherosclerosis - etiology
Blood Pressure
Cardiovascular diseases
Cardiovascular Models
Cholesterol
Cholesterol - blood
Cholesterol, HDL - blood
Classification
diabetes mellitus
Drugs
Epidemiology
Female
Heart Diseases
Humans
Hypertension
Internal Medicine
Male
Middle Aged
Prediction
Proportional Hazards Models
Prospective Studies
Regression Analysis
Risk Assessment
Risk Factors
ROC Curve
Statistics
United States - epidemiology
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Summary: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.
ISSN:1047-2797
1873-2585