Utility of single versus sequential measurements of risk factors for prediction of stroke in Chinese adults
Authors: Chun Matthew , Clarke Robert , Zhu Tingting , Clifton David , Bennett Derrick , Chen Yiping , Guo Yu , Pei Pei , Lv Jun , Yu Canqing , Yang Ling , Li Liming , Chen Zhengming , Cairns Benjamin J. ,   the China Kadoorie Biobank Collaborative Group,   International Steering Committee, Chen Junshi , Chen Zhengming , Clarke Robert , Collins Rory , Guo Yu , Li Liming , Lv Jun , Peto Richard , Walters Robin ,   International Co-ordinating Centre, Oxford, Avery Daniel , Bennett Derrick , Boxall Ruth , Bragg Fiona , Burgess Sushila , Chan Kahung , Chang Yumei , Chen Yiping , Chen Zhengming , Clarke Robert , Du Huaidong , Fairhurst-Hunter Zammy , Gilbert Simon , Hacker Alex , Hariri Parisa , Holmes Michael , Iona Andri , Im Becky , Kakkoura Maria , Kartsonaki Christiana , Kerosi Rene , Lin Kuang , Millwood Iona , Nie Qunhua , Pozaricki Alfred , Ryder Paul , Sansome Sam , Schmidt Dan , Sohoni Rajani , Stevens Rebecca , Turnbull Iain , Walters Robin , Wang Lin , Wright Neil , Yang Ling , Yang Xiaoming , Yao Pang ,   National Co-ordinating Centre, Beijing, Guo Yu , Han Xiao , Hou Can , Liu Chao , Lv Jun , Pei Pei , Yu Canqing , Li Chun ,   Regional Co-ordinating Centres, Pang Zengchang , Gao Ruqin , Li Shanpeng , Wang Shaojie , Liu Yongmei , Du Ranran , Cheng Liang , Tian Xiaocao , Zhang Hua , Zhai Yaoming , Ning Feng , Sun Xiaohui , Li Feifei , Lv Silu , Wang Junzheng , Hou Wei , Zou Mingyuan , Yan Shichun , Zhou Xue , Yu Bo , Li Yanjie , Xu Qinai , Kang Quan , Guo Ziyan , Hu Ximin , Chen Jinyan , Wang Xiaohuan , Weng Min , Guo Zhendong , Wu Shukuan , Li Yilei , Li Huimei , Wu Ming , Zhou Yonglin , Zhou Jinyi , Tao Ran , Yang Jie , Su Jian , Liu Fang , Zhang Jun , Hu Yihe , Lu Yan , Ma Liangcai , Tang Aiyu , Hua Yujie , Jin Jianrong , Liu Jingchao , Tang Zhenzhu , Chen Naying , Liu Duo , Li Mingqiang , Meng Jinhuai , Pan Rong , Jiang Qilian , Lan Jian , Liu Yun , Wei Liuping , Zhou Liyuan , Chen Ningyu , Wang Ping , Meng Fanwen , Qin Yulu , Wang Sisi , Wu Xianping , Zhang Ningmei , Chen Xiaofang , Zhong Xunfu , Liu Jiaqiu , Sun Qiang , Luo Guojin , Li Jianguo , Chen Xiaofang , Zhong Xunfu , Liu Jiaqiu , Sun Qiang , Ge Pengfei , Ren Xiaolan , Dong Caixia , Zhang Hui , Mao Enke , Li Zhongxiao , Wang Tao , Zhang Xi , Zhang Ding , Zhou Gang , Feng Shixian , Chang Liang , Fan Lei , Gao Yulian , He Tianyou , Sun Huarong , He Pan , Hu Chen , Zhang Xukui , Yu Min , Hu Ruying , Wang Hao , Gong Weiwei , Wang Meng , Wang Chunmei , Zhang Xiaoyi , Xie Kaixu , Chen Lingli , Pan Dongxia , Gu Qijun , Huang Yuelong , Chen Biyun , Yin Li , Liu Huilin , Fu Zhongxi , Xu Qiaohua , Xu Xin , Zhang Hao , Long Huajun , Zhang Libo 
Published: September 2021

Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three separate visits on 13,753 individuals in the prospective China Kadoorie Biobank. All participants were stroke-free at baseline (2004–2008), first resurvey (2008), and second resurvey (2013–2014), and were followed-up for incident cases of first stroke in the 3 years following the second resurvey. To reflect the models currently used in clinical practice, sex-specific Cox models were developed to estimate 3-year risks of stroke using single measurements recorded at second resurvey and were retrospectively applied to risk factor data from previous visits. Temporal trends in the Cox-generated risk estimates from 2004 to 2014 were analyzed using linear mixed effects models. To assess the value of more flexible machine learning approaches and the incorporation of longitudinal data, we developed gradient boosted tree (GBT) models for 3-year prediction of stroke using both single measurements and sequential measurements of risk factor inputs. Overall, Cox-generated estimates for 3-year stroke risk increased by 0.3% per annum in men and 0.2% per annum in women, but varied substantially between individuals. The risk estimates at second resurvey were highly correlated with the annual increase of risk for each individual (men: r = 0.91, women: r = 0.89), and performance of the longitudinal GBT models was comparable with both Cox and GBT models that considered measurements from only a single visit (AUCs: 0.779–0.811 in men, 0.724–0.756 in women). These results provide support for current clinical guidelines, which recommend using risk factor measurements recorded at a single visit for stroke prediction.