Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease: A random-effects modeling approach

Larry J. Brant, Luigi Ferrucci, Shan L. Sheng, Hans Concin, Alan B. Zonderman, Cecily C. Kelleher, Dan L. Longo, Hanno Ulmer, Alexander M. Strasak

Research output: Contribution to journalArticle

Abstract

Background: Previous studies on blood pressure (BP) indices as a predictor of coronary heart disease (CHD) have provided equivocal results and generally relied on Cox proportional hazards regression methodology, with age and sex accounting for most of the predictive capability of the model. Objective: The aim of the present study was to use serially collected BP measurements to examine age-and gender-related differences in BP indices for predicting CHD. Methods: The predictive accuracy of time-dependent BP indices for CHD was investigated using a method of risk prediction based on posterior probabilities calculated from mixed-effects regression to utilize intraindividual differences in serial BP measurements according to age changes within gender groups. Data were collected prospectively from 2 community-dwelling cohort studies in the United States (Baltimore Longitudinal Study of Aging [BLSA]) and Europe (Vorarlberg Health Monitoring and Promotion Program [VHM&PP]). Results: The study comprised 152,633 participants (aged 30-74 years) and 610,061 BP measurements. During mean follow-up of 7.5 years, 2457 nonfatal and fatal CHD events were observed. In both study populations, pulse pressure (PP) and systolic blood pressure (SBP) performed best as individual predictors of CHD in women (area under the receiver operating characteristic curve [AUC ROC] was between 0.83 and 0.85 for PP, and between 0.77 and 0.81 for SBP). Mean arterial pressure (MAP) and diastolic blood pressure (DBP) performed better for men (AUCROC = 0.67 and 0.65 for MAP and DBP, respectively, in the BLSA; AUCROC = 0.77 and 0.75 in the VHM&PP) than for women (AUCROC = 0.60 for both MAP and DBP in the BLSA; AUC ROC = 0.75 and 0.52, respectively, in the VHM&PP). The degree of discrimination in both populations was overall greater but more varied for all BP indices for women (AUCROC estimates between 0.85 [PP in the VHM&PP] and 0.52 [DBP in the VHM&PP]) than for men (AUCROC estimates between 0.78 [MAP + PP in the VHM&PP] and 0.63 [PP in the BLSA]). Conclusion: Our findings indicate differences in discrimination between women and men in the accuracy of longitudinally collected BP measurements for predicting CHD, implicating the usefulness of gender-specific BP indices to assess individual CHD risk.

Original languageEnglish (US)
Pages (from-to)616-627
Number of pages12
JournalGender Medicine
Volume7
Issue number6
DOIs
StatePublished - Dec 2010
Externally publishedYes

Fingerprint

heart disease
Coronary Disease
gender-specific factors
Blood Pressure
longitudinal study
Vorarlberg
gender
discrimination
regression
Baltimore
time
promotion
recipient
Longitudinal Studies
Arterial Pressure
monitoring
event
methodology
health
community

Keywords

  • blood pressure indices
  • coronary heart disease
  • epidemiology
  • gender
  • prospective study
  • random effects models

ASJC Scopus subject areas

  • Medicine(all)
  • Gender Studies

Cite this

Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease : A random-effects modeling approach. / Brant, Larry J.; Ferrucci, Luigi; Sheng, Shan L.; Concin, Hans; Zonderman, Alan B.; Kelleher, Cecily C.; Longo, Dan L.; Ulmer, Hanno; Strasak, Alexander M.

In: Gender Medicine, Vol. 7, No. 6, 12.2010, p. 616-627.

Research output: Contribution to journalArticle

Brant, LJ, Ferrucci, L, Sheng, SL, Concin, H, Zonderman, AB, Kelleher, CC, Longo, DL, Ulmer, H & Strasak, AM 2010, 'Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease: A random-effects modeling approach', Gender Medicine, vol. 7, no. 6, pp. 616-627. https://doi.org/10.1016/j.genm.2010.11.005
Brant, Larry J. ; Ferrucci, Luigi ; Sheng, Shan L. ; Concin, Hans ; Zonderman, Alan B. ; Kelleher, Cecily C. ; Longo, Dan L. ; Ulmer, Hanno ; Strasak, Alexander M. / Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease : A random-effects modeling approach. In: Gender Medicine. 2010 ; Vol. 7, No. 6. pp. 616-627.
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title = "Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease: A random-effects modeling approach",
abstract = "Background: Previous studies on blood pressure (BP) indices as a predictor of coronary heart disease (CHD) have provided equivocal results and generally relied on Cox proportional hazards regression methodology, with age and sex accounting for most of the predictive capability of the model. Objective: The aim of the present study was to use serially collected BP measurements to examine age-and gender-related differences in BP indices for predicting CHD. Methods: The predictive accuracy of time-dependent BP indices for CHD was investigated using a method of risk prediction based on posterior probabilities calculated from mixed-effects regression to utilize intraindividual differences in serial BP measurements according to age changes within gender groups. Data were collected prospectively from 2 community-dwelling cohort studies in the United States (Baltimore Longitudinal Study of Aging [BLSA]) and Europe (Vorarlberg Health Monitoring and Promotion Program [VHM&PP]). Results: The study comprised 152,633 participants (aged 30-74 years) and 610,061 BP measurements. During mean follow-up of 7.5 years, 2457 nonfatal and fatal CHD events were observed. In both study populations, pulse pressure (PP) and systolic blood pressure (SBP) performed best as individual predictors of CHD in women (area under the receiver operating characteristic curve [AUC ROC] was between 0.83 and 0.85 for PP, and between 0.77 and 0.81 for SBP). Mean arterial pressure (MAP) and diastolic blood pressure (DBP) performed better for men (AUCROC = 0.67 and 0.65 for MAP and DBP, respectively, in the BLSA; AUCROC = 0.77 and 0.75 in the VHM&PP) than for women (AUCROC = 0.60 for both MAP and DBP in the BLSA; AUC ROC = 0.75 and 0.52, respectively, in the VHM&PP). The degree of discrimination in both populations was overall greater but more varied for all BP indices for women (AUCROC estimates between 0.85 [PP in the VHM&PP] and 0.52 [DBP in the VHM&PP]) than for men (AUCROC estimates between 0.78 [MAP + PP in the VHM&PP] and 0.63 [PP in the BLSA]). Conclusion: Our findings indicate differences in discrimination between women and men in the accuracy of longitudinally collected BP measurements for predicting CHD, implicating the usefulness of gender-specific BP indices to assess individual CHD risk.",
keywords = "blood pressure indices, coronary heart disease, epidemiology, gender, prospective study, random effects models",
author = "Brant, {Larry J.} and Luigi Ferrucci and Sheng, {Shan L.} and Hans Concin and Zonderman, {Alan B.} and Kelleher, {Cecily C.} and Longo, {Dan L.} and Hanno Ulmer and Strasak, {Alexander M.}",
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T1 - Gender differences in the accuracy of time-dependent blood pressure indices for predicting coronary heart disease

T2 - A random-effects modeling approach

AU - Brant, Larry J.

AU - Ferrucci, Luigi

AU - Sheng, Shan L.

AU - Concin, Hans

AU - Zonderman, Alan B.

AU - Kelleher, Cecily C.

AU - Longo, Dan L.

AU - Ulmer, Hanno

AU - Strasak, Alexander M.

PY - 2010/12

Y1 - 2010/12

N2 - Background: Previous studies on blood pressure (BP) indices as a predictor of coronary heart disease (CHD) have provided equivocal results and generally relied on Cox proportional hazards regression methodology, with age and sex accounting for most of the predictive capability of the model. Objective: The aim of the present study was to use serially collected BP measurements to examine age-and gender-related differences in BP indices for predicting CHD. Methods: The predictive accuracy of time-dependent BP indices for CHD was investigated using a method of risk prediction based on posterior probabilities calculated from mixed-effects regression to utilize intraindividual differences in serial BP measurements according to age changes within gender groups. Data were collected prospectively from 2 community-dwelling cohort studies in the United States (Baltimore Longitudinal Study of Aging [BLSA]) and Europe (Vorarlberg Health Monitoring and Promotion Program [VHM&PP]). Results: The study comprised 152,633 participants (aged 30-74 years) and 610,061 BP measurements. During mean follow-up of 7.5 years, 2457 nonfatal and fatal CHD events were observed. In both study populations, pulse pressure (PP) and systolic blood pressure (SBP) performed best as individual predictors of CHD in women (area under the receiver operating characteristic curve [AUC ROC] was between 0.83 and 0.85 for PP, and between 0.77 and 0.81 for SBP). Mean arterial pressure (MAP) and diastolic blood pressure (DBP) performed better for men (AUCROC = 0.67 and 0.65 for MAP and DBP, respectively, in the BLSA; AUCROC = 0.77 and 0.75 in the VHM&PP) than for women (AUCROC = 0.60 for both MAP and DBP in the BLSA; AUC ROC = 0.75 and 0.52, respectively, in the VHM&PP). The degree of discrimination in both populations was overall greater but more varied for all BP indices for women (AUCROC estimates between 0.85 [PP in the VHM&PP] and 0.52 [DBP in the VHM&PP]) than for men (AUCROC estimates between 0.78 [MAP + PP in the VHM&PP] and 0.63 [PP in the BLSA]). Conclusion: Our findings indicate differences in discrimination between women and men in the accuracy of longitudinally collected BP measurements for predicting CHD, implicating the usefulness of gender-specific BP indices to assess individual CHD risk.

AB - Background: Previous studies on blood pressure (BP) indices as a predictor of coronary heart disease (CHD) have provided equivocal results and generally relied on Cox proportional hazards regression methodology, with age and sex accounting for most of the predictive capability of the model. Objective: The aim of the present study was to use serially collected BP measurements to examine age-and gender-related differences in BP indices for predicting CHD. Methods: The predictive accuracy of time-dependent BP indices for CHD was investigated using a method of risk prediction based on posterior probabilities calculated from mixed-effects regression to utilize intraindividual differences in serial BP measurements according to age changes within gender groups. Data were collected prospectively from 2 community-dwelling cohort studies in the United States (Baltimore Longitudinal Study of Aging [BLSA]) and Europe (Vorarlberg Health Monitoring and Promotion Program [VHM&PP]). Results: The study comprised 152,633 participants (aged 30-74 years) and 610,061 BP measurements. During mean follow-up of 7.5 years, 2457 nonfatal and fatal CHD events were observed. In both study populations, pulse pressure (PP) and systolic blood pressure (SBP) performed best as individual predictors of CHD in women (area under the receiver operating characteristic curve [AUC ROC] was between 0.83 and 0.85 for PP, and between 0.77 and 0.81 for SBP). Mean arterial pressure (MAP) and diastolic blood pressure (DBP) performed better for men (AUCROC = 0.67 and 0.65 for MAP and DBP, respectively, in the BLSA; AUCROC = 0.77 and 0.75 in the VHM&PP) than for women (AUCROC = 0.60 for both MAP and DBP in the BLSA; AUC ROC = 0.75 and 0.52, respectively, in the VHM&PP). The degree of discrimination in both populations was overall greater but more varied for all BP indices for women (AUCROC estimates between 0.85 [PP in the VHM&PP] and 0.52 [DBP in the VHM&PP]) than for men (AUCROC estimates between 0.78 [MAP + PP in the VHM&PP] and 0.63 [PP in the BLSA]). Conclusion: Our findings indicate differences in discrimination between women and men in the accuracy of longitudinally collected BP measurements for predicting CHD, implicating the usefulness of gender-specific BP indices to assess individual CHD risk.

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KW - coronary heart disease

KW - epidemiology

KW - gender

KW - prospective study

KW - random effects models

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