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Estimating the association between blood pressure variability and cardiovascular disease: An application using the ARIC Study.

Published version
Peer-reviewed

Type

Article

Change log

Authors

Huille, Raphael 
Parker, Richard 
Yano, Yuichiro 
Griswold, Michael 

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.

Description

Keywords

cardiovascular disease, heteroscedasticity, joint model, mixed effects model, repeated measurements, survival analysis, Blood Pressure, Cardiovascular Diseases, Computer Simulation, Datasets as Topic, Female, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Prognosis, Risk Factors, Systole, United States

Journal Title

Stat Med

Conference Name

Journal ISSN

0277-6715
1097-0258

Volume Title

38

Publisher

Wiley
Sponsorship
Medical Research Council (MR/K014811/1)
MRC (unknown)
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
Medical Research Council (G0700463)
Medical Research Council (G0700463/1)
Medical Research Council (G0800270/1)