京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19624号 / 医博第4131号 / 新制||医||1015(附属図書館) / 32660 / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤 学, 教授 今中 雄一, 教授 佐藤 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

BACKGROUND: Several studies have demonstrated the association between the time to hypertension event and multiple baseline measurements for adults, yet other survival cardiovascular disease (CVD) outcomes such as high cholesterol and heart attack have been somewhat less considered. The Fels Longitudinal Study (FLS) provides us an opportunity to connect adult blood pressure (BP) at certain ages to the time to first CVD outcomes. The availability of long-term serial BP measurements from FLS also potentially allows us to evaluate if the trend of the measured BP biomarkers over time predicts survival outcomes in adulthood through statistical modeling. METHODS: When the reference standard is right-censored time-to-event (survival) outcome, the C index or concordance C, is commonly used as a summary measure of discrimination between a survival outcome that is possibly right censored and a predictive-score variable, say, a measured biomarker or a composite-score output from a statistical model that combines multiple biomarkers. When we have subjects longitudinally followed up, it is of primary interest to assess if some baseline measurements predict the time-to-event outcome. Specifically, in this study, systolic blood pressure, diastolic blood pressure, as well as their variation over time, are considered predictive biomarkers, and we assess their predictive ability for certain time-to-event outcomes in terms of the C index. RESULTS: There are a few summary C index differences that are statistically significant in predicting and discriminating certain CVD metric at certain age stage, though some of these differences are altered in the presence of medicine treatment and lifestyle characteristics. The variation of systolic BP measures over time has a significantly different predicting ability comparing with systolic BP measures at certain given time point, for predicting certain survival outcome such as high cholesterol level. CONCLUSIONS: Adult systolic and diastolic BP measurements may have significantly different ability in predicting time to first CVD events. The fluctuation of BP measurements over time may have better association than BP measurement at a single baseline time point, with the time to first CVD events.