Document Detail

G-estimation of causal effects: isolated systolic hypertension and cardiovascular death in the Framingham Heart Study.
MedLine Citation:
PMID:  9717884     Owner:  NLM     Status:  MEDLINE    
Time-dependent covariates are often both confounders and intermediate variables. In the presence of such covariates, standard approaches for adjustment for confounding are biased. The method of G-estimation allows for appropriate adjustment. Previous studies applying the G-estimation method have addressed effects on all-cause mortality rather than on specific causes of death. In the present study, a method to adjust for censoring by competing risks is presented. The authors used the approach to estimate the causal effect of isolated systolic hypertension on cardiovascular mortality in the Framingham Heart Study, with a 10-year follow-up using data from 1956 to 1970. Arterial rigidity is a major determinant of isolated systolic hypertension and may be a confounder of the relation between isolated systolic hypertension and cardiovascular death. Conversely, isolated systolic hypertension may by itself contribute to stiffening of the vessel wall, and arterial rigidity may therefore also be an intermediate variable in the causal pathway from isolated systolic hypertension to cardiovascular death. While controlling for arterial rigidity and other baseline and time-dependent covariates, isolated systolic hypertension decreased the time to cardiovascular death by 45% (95% confidence interval 3-69).
J C Witteman; R B D'Agostino; T Stijnen; W B Kannel; J C Cobb; M A de Ridder; A Hofman; J M Robins
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  American journal of epidemiology     Volume:  148     ISSN:  0002-9262     ISO Abbreviation:  Am. J. Epidemiol.     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-09-10     Completed Date:  1998-09-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7910653     Medline TA:  Am J Epidemiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  390-401     Citation Subset:  IM    
Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, Netherlands.
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MeSH Terms
Cardiovascular Diseases / etiology*,  mortality
Epidemiologic Methods
Hypertension / complications*
Massachusetts / epidemiology
Middle Aged
Models, Statistical
Risk Factors
Grant Support

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