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Open Access Research article

Validation of a model to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD: the rotterdam ischemic heart disease and stroke computer simulation (RISC) model

Bob JH van Kempen12, Bart S Ferket12, Albert Hofman1, Ewout W Steyerberg3, Ersen B Colkesen6, S Matthijs Boekholdt5, Nicholas J Wareham7, Kay-Tee Khaw8 and MG Myriam Hunink124*

Author Affiliations

1 Department of Epidemiology, Erasmus MC Rotterdam, dr Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands

2 Department of Radiology, Erasmus MC Rotterdam, dr Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands

3 Department of Public Health, Erasmus MC Rotterdam, dr Molewaterplein 50, Rotterdam, 3015 GE, the Netherlands

4 Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA

5 Department of Cardiology, Amsterdam Medical Center, Meibergdreef 9, Amsterdam, 1150 AZ, the Netherlands

6 Department of Cardiology, Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, the Netherlands

7 Medical Research Council Epidemiology Unit, Hills Road, Cambridge, CB2 0QQ, UK

8 Department of Public Health and Primary Care, University of Cambridge, Robinson Way, Cambridge, CB2 0SR, UK

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BMC Medicine 2012, 10:158  doi:10.1186/1741-7015-10-158

Published: 6 December 2012

Abstract

Background

We developed a Monte Carlo Markov model designed to investigate the effects of modifying cardiovascular disease (CVD) risk factors on the burden of CVD. Internal, predictive, and external validity of the model have not yet been established.

Methods

The Rotterdam Ischemic Heart Disease and Stroke Computer Simulation (RISC) model was developed using data covering 5 years of follow-up from the Rotterdam Study. To prove 1) internal and 2) predictive validity, the incidences of coronary heart disease (CHD), stroke, CVD death, and non-CVD death simulated by the model over a 13-year period were compared with those recorded for 3,478 participants in the Rotterdam Study with at least 13 years of follow-up. 3) External validity was verified using 10 years of follow-up data from the European Prospective Investigation of Cancer (EPIC)-Norfolk study of 25,492 participants, for whom CVD and non-CVD mortality was compared.

Results

At year 5, the observed incidences (with simulated incidences in brackets) of CHD, stroke, and CVD and non-CVD mortality for the 3,478 Rotterdam Study participants were 5.30% (4.68%), 3.60% (3.23%), 4.70% (4.80%), and 7.50% (7.96%), respectively. At year 13, these percentages were 10.60% (10.91%), 9.90% (9.13%), 14.20% (15.12%), and 24.30% (23.42%). After recalibrating the model for the EPIC-Norfolk population, the 10-year observed (simulated) incidences of CVD and non-CVD mortality were 3.70% (4.95%) and 6.50% (6.29%). All observed incidences fell well within the 95% credibility intervals of the simulated incidences.

Conclusions

We have confirmed the internal, predictive, and external validity of the RISC model. These findings provide a basis for analyzing the effects of modifying cardiovascular disease risk factors on the burden of CVD with the RISC model.

Keywords:
Cardiovascular disease prevention; Simulation modeling; Model validation