Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults

Abstract Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three...

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Autores principales:	Matthew Chun, Robert Clarke, Tingting Zhu, David Clifton, Derrick Bennett, Yiping Chen, Yu Guo, Pei Pei, Jun Lv, Canqing Yu, Ling Yang, Liming Li, Zhengming Chen, Benjamin J. Cairns, the China Kadoorie Biobank Collaborative Group
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/53fba185cdc84f49b6ee51fdea30a639
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spelling	oai:doaj.org-article:53fba185cdc84f49b6ee51fdea30a6392021-12-02T16:37:37ZUtility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults10.1038/s41598-021-95244-82045-2322https://doaj.org/article/53fba185cdc84f49b6ee51fdea30a6392021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-95244-8https://doaj.org/toc/2045-2322Abstract Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three separate visits on 13,753 individuals in the prospective China Kadoorie Biobank. All participants were stroke-free at baseline (2004–2008), first resurvey (2008), and second resurvey (2013–2014), and were followed-up for incident cases of first stroke in the 3 years following the second resurvey. To reflect the models currently used in clinical practice, sex-specific Cox models were developed to estimate 3-year risks of stroke using single measurements recorded at second resurvey and were retrospectively applied to risk factor data from previous visits. Temporal trends in the Cox-generated risk estimates from 2004 to 2014 were analyzed using linear mixed effects models. To assess the value of more flexible machine learning approaches and the incorporation of longitudinal data, we developed gradient boosted tree (GBT) models for 3-year prediction of stroke using both single measurements and sequential measurements of risk factor inputs. Overall, Cox-generated estimates for 3-year stroke risk increased by 0.3% per annum in men and 0.2% per annum in women, but varied substantially between individuals. The risk estimates at second resurvey were highly correlated with the annual increase of risk for each individual (men: r = 0.91, women: r = 0.89), and performance of the longitudinal GBT models was comparable with both Cox and GBT models that considered measurements from only a single visit (AUCs: 0.779–0.811 in men, 0.724–0.756 in women). These results provide support for current clinical guidelines, which recommend using risk factor measurements recorded at a single visit for stroke prediction.Matthew ChunRobert ClarkeTingting ZhuDavid CliftonDerrick BennettYiping ChenYu GuoPei PeiJun LvCanqing YuLing YangLiming LiZhengming ChenBenjamin J. Cairnsthe China Kadoorie Biobank Collaborative GroupNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Matthew Chun Robert Clarke Tingting Zhu David Clifton Derrick Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J. Cairns the China Kadoorie Biobank Collaborative Group Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
description	Abstract Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three separate visits on 13,753 individuals in the prospective China Kadoorie Biobank. All participants were stroke-free at baseline (2004–2008), first resurvey (2008), and second resurvey (2013–2014), and were followed-up for incident cases of first stroke in the 3 years following the second resurvey. To reflect the models currently used in clinical practice, sex-specific Cox models were developed to estimate 3-year risks of stroke using single measurements recorded at second resurvey and were retrospectively applied to risk factor data from previous visits. Temporal trends in the Cox-generated risk estimates from 2004 to 2014 were analyzed using linear mixed effects models. To assess the value of more flexible machine learning approaches and the incorporation of longitudinal data, we developed gradient boosted tree (GBT) models for 3-year prediction of stroke using both single measurements and sequential measurements of risk factor inputs. Overall, Cox-generated estimates for 3-year stroke risk increased by 0.3% per annum in men and 0.2% per annum in women, but varied substantially between individuals. The risk estimates at second resurvey were highly correlated with the annual increase of risk for each individual (men: r = 0.91, women: r = 0.89), and performance of the longitudinal GBT models was comparable with both Cox and GBT models that considered measurements from only a single visit (AUCs: 0.779–0.811 in men, 0.724–0.756 in women). These results provide support for current clinical guidelines, which recommend using risk factor measurements recorded at a single visit for stroke prediction.
format	article
author	Matthew Chun Robert Clarke Tingting Zhu David Clifton Derrick Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J. Cairns the China Kadoorie Biobank Collaborative Group
author_facet	Matthew Chun Robert Clarke Tingting Zhu David Clifton Derrick Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J. Cairns the China Kadoorie Biobank Collaborative Group
author_sort	Matthew Chun
title	Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
title_short	Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
title_full	Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
title_fullStr	Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
title_full_unstemmed	Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
title_sort	utility of single versus sequential measurements of risk factors for prediction of stroke in chinese adults
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/53fba185cdc84f49b6ee51fdea30a639
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Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults

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