Discovery Challenge – ECML/PKDD2004

September 20, 2004, Pisa, Italy

Atherosclerosis

Marie Tomečková EuroMISE Centre – Cardio

Institute of Computer Science, Academy of Sciences of the CR, Prague, The Czech Republic

Supported by the project LN00B107 of the Ministry of Education of the Czech Republic

Atherosclerosis

• a total complicated disease of the vessels in all organism

• a dynamic process, it begins in childhood and adolescence and continues for the whole life

• opinions on the origin and progress of the disease are developing

• interaction and influence of genetic predisposition and exterior environment

• the influence of so-called risk factors is still regarded• On the other hand – there some so-called protective

factors

Risk factors of atherosclerosis

• non-affectable: sex, age, family history

• affectable:• factors of life style

• physical activity• smoking• reaction on stress

• blood pressure, metabolic factors - level of lipids and glucose, homocystein

• many other factors: coagulopathies, infections, inflammation, factors changing the function of endothelium, social and psychological factors

• combinations, clustering and interactivity: Reaven´s syndrom

STULONG(acronym)

• LONGitudinal twenty years lasting STUdy of risk factors of atherosclerosis

• The study was realized in the years 1975-2000 on the 2nd Dept. of Internal Medicine, 1st Faculty of Medicine of Charles University, Prague, the Czech Republic

• The data were transferred to the electronic form by the European Centre of Medical Informatics, Statistisc, and Epidemiology of Charles University and Academy of Sciences of the Czech Republic

STULONG

Main aims of the study:

• To determine prevalence of the risk factors of atherosclerosis in middle-aged men

• To follow up the development of the risk factors • To asses the possibilities and the influence of the complex

intervention on the incidence and values of the risk factors and on the cardiovascular mortality

Population:

• urban population of middle-aged men (centre of Prague)

• 2370 men have been invited

• 1417 men have been examined, the respondence was 59%

• Middle-aged men – it is the population mostly threatened by the atherosclerosis and by its consequenses

Definition of risk factors

blood pressure 160/95 mm Hg

cholesterol 260 mg% (6,7 mmol/l)

smoking 15 cigarettes/day

obesity 15% above optimal weight

positive family history prematured death on the atherosclerotic diseases (parents, siblings)

STULONG - analysis

Statistical - descriptive statistics

- logistic regression

- survival analysis

Data mining - different methods

- resulting in different conclusions

Basic characteristics of men in STULONG (risk group - at least 1 RF, without the disease))

• Prevalence of risk factors at the entry

RF n %

hypercholesterolemia 290 34.2

hypertension 287 34.0

smoking 543 63.3 !!!

obesity 196 23.0

positive family history 216 25.3

Prevalence of risk factors in risk group

63,1

34,3 34,2 25,4 23,2

36,9

65,7 65,8 74,6 76,8

0%

50%

100%

smoking(n=860)

TCH(n=851)

HT(n=848)

RA(n=855)

obesity(n=856)

yes no

Basic characteristics of men in STULONG(risk group, age 46.1±3.6)

mean s (±)

Nr of RF 1.7 2.0

cholesterol (mmol/l)

6.25 5.4

systolic blood pressure (mm

Hg)

134.4 67.3

diastolic blood pressure (mm

Hg)

85.3 47.5

Nr of cig/day 9.4 25.0

Brocca index (%) 106.8 47.4

Mortality depending on the number of RF(atherosclerotic cardiovascular diseases)

1,6

5,0

8,5

10,8

20,0

0

5

10

15

20

25

0 1 2 3 4number of RFA

per 1000

Survival analysis

  N 1 RF 2 RF 3 RF 4 RF

10. year 99 % 98 % 93 % 93 % 91 %

20. year 97 % 89 % 84 % 80 % 63 %

The relative risk of death caused by atheroslcerotic CVD

variable cathegory RR p 35 - 44 1,00 age 45 - 55 2,08 0,001

basic 1,00 vocational 0,80 0,398

middle 0,67 0,151 education university 0,36 0,003

no 1,00 smoking yes 2,36 <0,001

<=140/90 mm Hg 1,00 141/91-159/94 mm

Hg 1,36 0,301 PB

>=160/95 mmHg 2,49 <0,001

<5,2 mmol/l 1,00 5,2-6,6 mmol/l 1,50 0,154 TCH >= 6,7 mmol/l 1,87 0,034

Discovery Challenges

Atherosclerosis – growing number of the papers

• 2002 – Helsinki …….…5 papers• 2003 – Cavtat …………9 papers• 2004 – Pisa ………….. 11 papers

Four data files for

analysis – data mining

Entry - attributes obtained from entry examination – 1417 men –244 attributes of each men

Control – attributes recorded during the follow up (changing of the social and health status, values of follow risk factors, therapy …) – 10 600 investigations – each with 66 attributes

Letter – additional information collected at the end of the study by the postal questionnaire (men, who disscharged the following) - 403 men – 62 attributes of each men

Death – date and cause of death – 389 men

Four groups of analytic questions

Related to

the entry examination the long - term observation – follow-up the postal questionnaire – at the end of the study the relations concerning entry examination, control

examination, and death

Approaches to solve the analytic questions – 1:

given in the past Discovery Challenges

• Univariated and bivariated data analysis

• Assiciation rules

• SDS rules (Set Differs of Set)

• Trend analysis

• Time windows analysis

• ROC analysis

• Disciminate function

Approaches to solve the analytic questions – 2:

• Fuzzy approximate dependencies, fuzzy logic

• Functional dependencies

• Inductive logic programming technigue

• Explicit relations

• The selection of the strongest emerging patterns

• Genetic approach

• Approach to generate a mathematical algebraic model

Analytic guestions - some results

• Protective influence of number of the visits

• Protective influence of the beer drinking, but not of the wine drinking

• Correlation of Body Mass Index with the skin foldes – very good discrimination of the three basic groups of men (normal, risk, pathological)

Further use and publications of the STULONG data

are possible only under the condition of the following explicit quotation:

„The study (STULONG) was realized at the 2nd Department of Internal Medicine, 1st Faculty of Medicine of Charles University and University Hospital, Prague 2, Czech Republic (head Prof. M. Aschermann, MD, SDr, FECS), under the supervision of Prof.F. Boudík, MD, SDr, with the collaboration of M. Tomečková, MD,PhD, and Ass. Prof. J. Bultas, MD, PhD. The data were transferredto the electronic form by the European Centre of Medical Informatics,Statistisc, and Epidemiology of Charles University and Academy ofSciences of Czech Republic (head Prof. RNDr J. Zvárová, SDr).”

At present time, the data analysis is supported by the project Nr.LN 00B 107 of the Ministry of Education of the CR.

Thank youThank you

for your effort in the for your effort in the SSTULONG data set TULONG data set

analysisanalysis and for your attention and for your attention

Marie Tomečková

EuroMISE Centre – Cardio

Pod Vodárenskou věží 2

182 07 Prague, The Czech Republic

tomeckova@euromise.cz

http://www.euromise.cz