Skip Navigation



American Journal of Epidemiology Advance Access published online on November 20, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwk025
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
165/4/464    most recent
kwk025v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Pencina, M. J.
Right arrow Articles by Ramachandran, V. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pencina, M. J.
Right arrow Articles by Ramachandran, V. S.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received April 13, 2006
Accepted July 18, 2006

PRACTICE OF EPIDEMIOLOGY

Estimating Lifetime Risk of Developing High Serum Total Cholesterol: Adjustment for Baseline Prevalence and Single-Occasion Measurements

Michael J. Pencina 1 *, Ralph B. D'Agostino 1, Alexa S. Beiser 2, Mark R.Cobain 3, and Vasan S. Ramachandran 4

1 Department of Mathematics and Statistics, Boston University, Boston, MA
2 School of Public Health, Boston University, Boston, MA
3 Unilever Research, Sharnbrook, Bedfordshire, United Kingdom
4 School of Medicine, Boston University, Framingham, MA

* To whom correspondence should be addressed.
Michael J. Pencina, E-mail: mpencina{at}bu.edu


  Abstract

The lifetime risk statistic is a powerful tool in epidemiology. It has been successfully applied to estimate and highlight the risks of numerous diseases, including breast cancer, Alzheimer's disease, stroke, and coronary heart disease and some of its risk factors. Application of this method to health-related conditions that may have an onset early in young adulthood or to measurements that can fluctuate over time introduces problems of under- or overestimation of risk. To correctly quantify the long-term risk of developing high serum total cholesterol (≥240 mg/dl or use of lipid-lowering medication), the authors propose a key modification of the lifetime risk statistic: adjustment for baseline prevalence. It accounts for the fact that many people already have the condition at a young age (an age often chosen as baseline). The authors derive point estimators and confidence intervals and supply a SAS macro (SAS Institute, Inc., Cary, North Carolina). For assessment of the risk inflation due to single-occasion measurement, the authors suggest two diagnostic tools, one requiring the condition to be present on two consecutive occasions and the other taking into account intrasubject variability. As an illustration, the authors calculate risk estimates for US Caucasians based on hypercholesterolemia incidence (1971-early 2001) from the Framingham Heart Study and prevalence data from the 1999-2000 National Health and Nutrition Examination Survey.

Keywords: cholesterol; disease-free survival; hypercholesterolemia; incidence; prevalence; risk adjustment; risk assessment; survival rate.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.