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Heterogeneity in coronary heart disease risk.
Simonetto, Cristoforo; Rospleszcz, Susanne; Kaiser, Jan Christian; Furukawa, Kyoji.
Affiliation
  • Simonetto C; Institute of Radiation Medicine, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. cristoforo.simonetto@helmholtz-muenchen.de.
  • Rospleszcz S; Institute of Epidemiology, Helmholtz Zentrum München German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
  • Kaiser JC; Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany.
  • Furukawa K; German Center for Cardiovascular Disease (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Sci Rep ; 12(1): 10131, 2022 06 16.
Article in En | MEDLINE | ID: mdl-35710917
There is large inter-individual heterogeneity in risk of coronary heart disease (CHD). Risk factors traditionally used in primary risk assessment only partially explain this heterogeneity. Residual, unobserved heterogeneity leads to age-related attenuation of hazard rates and underestimation of hazard ratios. Its magnitude is unknown. Therefore, we aimed to estimate a lower and an approximate upper bound. Heterogeneity was parametrized by a log-normal distribution with shape parameter σ. Analysis was based on published data. From concordance indices of studies including traditional risk factors and additional diagnostic imaging data, we calculated the part of heterogeneity explained by imaging data. For traditional risk assessment, this part typically remains unexplained, thus constituting a lower bound on unobserved heterogeneity. Next, the potential impact of heterogeneity on CHD hazard rates in several large countries was investigated. CHD rates increase with age but the increase attenuates with age. Presuming this attenuation to be largely caused by heterogeneity, an approximate upper bound on σ was derived. Taking together both bounds, unobserved heterogeneity in studies without imaging information can be described by a shape parameter in the range σ = 1-2. It substantially contributes to observed age-dependences of hazard ratios and may lead to underestimation of hazard ratios by a factor of about two. Therefore, analysis of studies for primary CHD risk assessment should account for unobserved heterogeneity.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Disease Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Sci Rep Year: 2022 Document type: Article Affiliation country: Germany Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Coronary Disease Type of study: Etiology_studies / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: Sci Rep Year: 2022 Document type: Article Affiliation country: Germany Country of publication: United kingdom