Title | Estimating the association between blood pressure variability and cardiovascular disease: An application using the ARIC Study. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Barrett JK, Huille R, Parker R, Yano Y |
Secondary Authors | Griswold M |
Journal | Stat Med |
Volume | 38 |
Issue | 10 |
Pagination | 1855-1868 |
Date Published | 2019 05 10 |
ISSN | 1097-0258 |
Keywords | Blood Pressure, Cardiovascular Diseases, Computer Simulation, Datasets as Topic, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Prognosis, Risk Factors, Systole, United States |
Abstract | The association between visit-to-visit systolic blood pressure variability and cardiovascular events has recently received a lot of attention in the cardiovascular literature. But, blood pressure variability is usually estimated on a person-by-person basis and is therefore subject to considerable measurement error. We demonstrate that hazard ratios estimated using this approach are subject to bias due to regression dilution, and we propose alternative methods to reduce this bias: a two-stage method and a joint model. For the two-stage method, in stage one, repeated measurements are modelled using a mixed effects model with a random component on the residual standard deviation (SD). The mixed effects model is used to estimate the blood pressure SD for each individual, which, in stage two, is used as a covariate in a time-to-event model. For the joint model, the mixed effects submodel and time-to-event submodel are fitted simultaneously using shared random effects. We illustrate the methods using data from the Atherosclerosis Risk in Communities study. |
DOI | 10.1002/sim.8074 |
Alternate Journal | Stat Med |
PubMed ID | 30575102 |
PubMed Central ID | PMC6445736 |
Grant List | MR/L003120/1 / MRC_ / Medical Research Council / United Kingdom RG/13/13/30194 / BHF_ / British Heart Foundation / United Kingdom MR/K014811/1 / MRC_ / Medical Research Council / United Kingdom HHSN268201700004I / HL / NHLBI NIH HHS / United States HHSN268201000021C / HL / NHLBI NIH HHS / United States MR/L501566/1 / MRC_ / Medical Research Council / United Kingdom HHSN2682017000021 / / National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services / International HHSN268201700001I / HL / NHLBI NIH HHS / United States MC_UU_00002/5 / MRC_ / Medical Research Council / United Kingdom HHSN268201700002I / HL / NHLBI NIH HHS / United States HHSN268201700005I / HL / NHLBI NIH HHS / United States HHSN268201700003I / HL / NHLBI NIH HHS / United States G0902100 / MRC_ / Medical Research Council / United Kingdom MR/N027485/1 / MRC_ / Medical Research Council / United Kingdom |