Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-16T01:20:55.745Z Has data issue: false hasContentIssue false
  • English
  • Français

A Model for Ischaemic Heart Disease and Stroke I: The Model

Published online by Cambridge University Press:  10 May 2011

T. Chatterjee ,
A. S. Macdonald  and
H. R. Waters
H. R. Waters
Affiliation:
Department of Actuarial Mathematics and Statistics, and the Maxwell Institute for Mathematical Sciences, Heriot-Watt University, Edinburgh EH14 4AS, U.K., Email: H.R.Waters@hw.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

We construct a stochastic model of an individual's lifetime that includes diagnosis with ischaemic heart disease and stroke and also the development of the major risk factors for these conditions: hypercholesterolaemia, hypertension, diabetes and obesity. Smoking, another major risk factor, is treated deterministically. Mathematically, the model is a continuous time, finite state space Markov process, with the individual's age playing the rôle of time. The model is parameterised using data from the Framingham Heart Study, with parameter values adjusted so that the model is appropriate for UK conditions in the early 21st century. The model has been designed so that it can be used to quantify the effects of:

(i) trends, in particular increasing prevalence of obesity.

(ii) changes in behaviour, in particular smoking patterns, and

(iii) treatments, in particular statins for hypercholesterolaemia.

These applications are covered in two accompanying papers.

Keywords

DiabetesFramingham Heart StudyHypercholesterolaemiaHypertensionIschaemic Heart DiseaseMarkov ModelObesitySmokingStatinsStroke
Type
Papers
Information
Annals of Actuarial Science , Volume 3 , Issue 1-2 , September 2008 , pp. 45 - 81
Copyright
Copyright © Institute and Faculty of Actuaries 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

References for Papers I, II and III

Adams, K.F., Schatzkin, A., Harris, T.B., Kipnis, V., Mouw, T., Ballard-Barbash, R., Hollenbeck, A. & Leitzmann, M.F. (2006). Overweight, obesity and mortality in a large prospective cohort of persons 50 to 71 years old. The New England Journal of Medicine, 355(8), 763–778.CrossRefGoogle Scholar
Bender, R., Jockel, K.H., Trautner, C., Spraul, M. & Berger, M. (1999). Effect of age on excess mortality in obesity. The Journal of the American Medical Association, 281(16), 1498–1504.CrossRefGoogle ScholarPubMed
Burden, R.L. & Faires, J. (2001). Numerical Analysis, 7th Edition. Brooks/Cole, Pacific Grove, USA.Google Scholar
Butland, B., Jebb, S., Kopelman, P., McPherson, K., Thomas, S., Mardell, J. & Parry, V. (2007). Tackling Obesities: Future Choices — Project Report. Available from: www.foresight.gov.uk/Obesity/Obesity_final/Index.htmlGoogle Scholar
Caro, J., Migliaccio-Walle, K., Ishak, K.J. & Proskorovsky, I. (2005). The morbidity and mortality following a diagnosis of peripheral arterial disease: Long-term follow-up of a large datadase. Bio Med Central Cardiovascular Disorders, 5, 14.CrossRefGoogle Scholar
Chatterjee, T., Macdonald, A.S. & Waters, H.R. (2008a). A model for ischaemic heart disease and stroke I: the model. Annals of Actuarial Science, 3, 45–81.CrossRefGoogle Scholar
Chatterjee, T., Macdonald, A.S. & Waters, H.R. (2008b). A model for ischaemic heart disease and stroke II: modelling obesity. Annals of Actuarial Science, 3, 83–103.CrossRefGoogle Scholar
Chatterjee, T., Macdonald, A.S. & Waters, H.R. (2008c). A model for ischaemic heart disease and stroke III: applications. Annals of Actuarial Science, 3, 105–119.CrossRefGoogle Scholar
Chatterjee, T. (2008). An individual life history model for heart disease, stroke and death: structure, parameterisation and applications. Ph.D. thesis. Heriot-Watt University, Edinburgh. Available at http://www.ma.hw.ac.uk/ams.htmlGoogle Scholar
Cook, D.G., Shaper, A.G., Pocock, S.J. & Kussick, S.J. (1986). Giving up smoking and the risk of heart attacks. A report from the British Regional Heart Study. Lancet, 2, 1376–1380.CrossRefGoogle ScholarPubMed
Dobson, A.J., Alexander, H.M., Heller, R.F. & Lloyd, D.M. (1991). How soon after quitting smoking does risk of heart attack decline? Journal of Clinical Epidemiology, 44(11), 1247–1253.CrossRefGoogle Scholar
Flegal, K.M., Graubard, B.I., Williamson, D.F. & Gail, M.H. (2007). Cause-specific excess deaths associated with underweight, overweight and obesity. Journal of the American Medical Association, 298(17), 2028–2037.CrossRefGoogle ScholarPubMed
Flegal, K.M., Troiana, R.P., Pamuk, E.R., Kuczmarski, R.J., Campbell, P.H. & Campbell, S.M. (1995). The influence of smoking cessation on the prevalence of overweight in the United States. The New England Journal of Medicine, 333, Number 18.CrossRefGoogle ScholarPubMed
Fontaine, K.R., Redden, D.T., Wang, C., Westfall, A.O. & Allison, D.B. (2003). Years of life lost due to obesity. The Journal of the American Medical Association, 289(2), 187–193.CrossRefGoogle ScholarPubMed
Kawachi, I., Colditz, G.A., Stampfer, M.J., Willett, W.C., Manson, J.E., Rosner, B., Hunter, D.J., Hennekens, C.H. & Speizer, F.E. (1993). Smoking cessation in relation to total mortality rates in women: a prospective cohort study. Annals of Internal Medicine, 119(10), 992–1000.CrossRefGoogle ScholarPubMed
Law, M.R., Wald, N.J. & Rudnicka, A.R. (2003). Quantifying the effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. British Medical Journal, 326, 1423–1429.CrossRefGoogle ScholarPubMed
Lightwood, J.M., & Glantz, S.A. (1997). Short-term economic and health benefits of smoking cessation. Circulation, 96(4), 1089–1096.CrossRefGoogle ScholarPubMed
Macdonald, A.S., Waters, H.R. & Wekwete, C.T. (2005a). A model for coronary heart disease and stroke with applications to critical illness underwriting I: The model. North American Actuarial Journal, 2005, 13–40.CrossRefGoogle Scholar
Macdonald, A.S., Waters, H.R. & Wekwete, C.T. (2005b). A model for coronary heart disease and stroke with applications to critical illness underwriting II: Applications. North American Actuarial Journal, 2005, 41–56.CrossRefGoogle Scholar
McElduff, P., Jaefarnezhad, M. & Durrington, P.N. (2006). American, British and European recommendations for statins in the primary prevention of cardiovascular disease applied to British men studied prospectively. Heart, 92, 1213–1218.CrossRefGoogle ScholarPubMed
McPherson, K., Marsh, T. & Brown, M. (2007). Tackling obesities: Future choices — modelling future trends in obesity and the impact on health. Available at: www.foresight.gov.uk/Obesity/Obesity_final/Index.htmlGoogle Scholar
National Cholesterol Education Program (2004). Third report of the expert panel on detection, evaluation and treatment of high cholesterol in adults (adult treatment panel III). National Institute of Health Publication, 0–40.Google Scholar
Negri, E., La Vecchia, C., D'Avanzo, B., Nobili, A. & La Malfa, G. (1994). Acute myocardial infarction: association with time since stopping smoking in Italy. Journal of Epidemiology and Community Health, 48, 129–133.CrossRefGoogle ScholarPubMed
OTC (2007). Office of tobacco control — research reports. Available at: www.otc.ie/research_reports.aspGoogle Scholar
Palinski, W. (2001). New evidence for beneficial effects of statins unrelated to lipid lowering. Arteriosclerosis, Thrombosis and Vascular Biology, 21, 3–5.CrossRefGoogle ScholarPubMed
Richards, S.J., Kirkby, J.G. & Currie, I.D. (2006). The importance of year of birth in two-dimensional mortality data. British Actuarial Journal, 12, 5–38.CrossRefGoogle Scholar
Rickards, L. (2003). General household survey 2003. Office of National Statistics.Google Scholar
Rogers, R.G., Hummer, R.A. & Krueger, P.M. (2003). The effect of obesity on overall, circulatory disease and diabetes-specific mortality. Journal of Biosocial Science, 35, 107–209.CrossRefGoogle ScholarPubMed
Smith, R. (2003). The most important BMJ for 50 years? British Medical Journal, 326, 7404.CrossRefGoogle Scholar
Solomon, C.G. & Manson, J.E. (1997). Obesity and mortality: a review of the epidemiologic data. American Journal of Clinical Nutrition, 66(Suppl.), 1044S–1050S.CrossRefGoogle ScholarPubMed
Sproston, K. & Primtesta, P. (2004). Health survey for England 2003, Vols. 1, 2 & 3. Department of Health.Google Scholar
Stanner, S., ed. (2005). Cardiovascular disease: diet, nutrition and emerging risk factors. Blackwell, Oxford.Google Scholar
Times (2007). A daily dose of statins would save lives, says heart expert. Available at: www.timesonline.co.uk/tol/news/uk/health/article2155500.eceGoogle Scholar
Vaughan, C.J., Murphy, M.B. & Buckley, B.M. (1996). Statins do more than just lower cholesterol. The Lancet, 348, 1079–1082.CrossRefGoogle ScholarPubMed
Wald, N.J. & Law, M.R. (2003). A strategy to reduce cardiovascular disease by more than 80%. British Medical Journal, 326, 1419–1424.CrossRefGoogle ScholarPubMed
Wannamethee, G.S., Shaper, G.A. & Ebrahim, S. (2000). HDL–cholesterol, total cholesterol, and the risk of stroke in middle-aged British men. Stroke, 31, 1882–1888.CrossRefGoogle ScholarPubMed
Waters, H.R. (1984). An approach to the study of multiple state models. Journal of the Institute of Actuaries, 111, 363–374.CrossRefGoogle Scholar
Well-Connected Report 14 (2007). Available at: www.well-connected.comGoogle Scholar
Well-Connected Report 23 (2007). Available at: www.well-connected.comGoogle Scholar
Well-Connected Report 53 (2007). Available at: www.well-connected.comGoogle Scholar
Well-Connected Report 60 (2006). Available at: www.well-connected.comGoogle Scholar
Zaninotto, P., Wardle, H., Stamatakis, E., Mindell, J. & Head, J. (2006). Forecasting obesity to 2010. Prepared for the UK Department of Health.Google Scholar