Alternative Graphical Causal Models and the Identification of Direct Effects

Author(s):  
James M. Robins ◽  
Thomas S. Richardson

The subject-specific data from either an observational or experimental study consist of a string of numbers. These numbers represent a series of empirical measurements. Calculations are performed on these strings and causal inferences are drawn. For example, an investigator might conclude that the analysis provides strong evidence for ‘‘both an indirect effect of cigarette smoking on coronary artery disease through its effect on blood pressure and a direct effect not mediated by blood pressure.’’ The nature of the relationship between the sentence expressing these causal conclusions and the statistical computer calculations performed on the strings of numbers has been obscure. Since the computer algorithms are well-defined mathematical objects, it is crucial to provide formal causal models for the English sentences expressing the investigator’s causal inferences. In this chapter we restrict ourselves to causal models that can be represented by a directed acyclic graph. There are two common approaches to the construction of causal models. The first approach posits unobserved fixed ‘potential’ or ‘counterfactual’ outcomes for each unit under different possible joint treatments or exposures. The second approach posits relationships between the population distribution of outcomes under experimental interventions (with full compliance) to the set of (conditional) distributions that would be observed under passive observation (i.e., from observational data). We will refer to the former as ‘counterfactual’ causal models and the latter as ‘agnostic’ causal models (Spirtes, Glymour, & Scheines, 1993) as the second approach is agnostic as to whether unit-specific counterfactual outcomes exist, be they fixed or stochastic. The primary difference between the two approaches is ontological: The counterfactual approach assumes that counterfactual variables exist, while the agnostic approach does not require this. In fact, the counterfactual theory logically subsumes the agnostic theory in the sense that the counterfactual approach is logically an extension of the latter approach. In particular, for a given graph the causal contrasts (i.e. parameters) that are well-defined under the agnostic approach are also well-defined under the counterfactual approach.

Cardiology ◽  
2021 ◽  
pp. 1-6
Author(s):  
John Michael Cochran ◽  
Vincent R. Siebert ◽  
Jeffrey Bates ◽  
Djenita Butulija ◽  
Anna Kolpakchi ◽  
...  

Background: Identification and modification of cardiovascular risk factors is paramount to reducing cardiovascular disease morbidity and mortality. Hypertension is a major risk factor for cardiovascular disease, but its association with height remains largely underrecognized. Objectives: The objective of this manuscript is to review the evidence examining the association between blood pressure and human stature and to summarize the plausible pathophysiological mechanisms behind such an association. Methods: A systematic review of adult human height and its association with hypertension and coronary artery disease was undertaken. The literature evidence is summarized and tabulated, and an overview of the pathophysiological basis for this association is presented. Results: Shorter arterial lengths found in shorter individuals may predispose to hypertension in a complex hemodynamic interplay, which is explained predominantly by summated arterial wave reflections and an elevated augmentation index. Our systemic review suggests that an inverse relationship between adult height and blood pressure exists. However, differences in the studied populations and heterogeneity in the methods applied across the various studies limit the generalizability of these findings and their clinical application. Conclusion: Physiological studies and epidemiological data suggest a potential inverse association between adult height and blood pressure. Further research is required to define the relationship more clearly between adult height and blood pressure and to assess whether antihypertensive therapeutic approaches and goals should be modified according to patients’ heights.


2013 ◽  
Vol 84 (11) ◽  
pp. 1226-1232 ◽  
Author(s):  
Hiroshi Yamauchi ◽  
Tatsuya Higashi ◽  
Shinya Kagawa ◽  
Yoshihiko Kishibe ◽  
Masaaki Takahashi

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Gündüz Durmuş ◽  
Erdal Belen ◽  
Akif Bayyigit ◽  
Muhsin Kalyoncuoğlu ◽  
Mehmet Mustafa Can

Objectives. The inter-arm systolic blood pressure difference (IASBPD) is closely related to cardiovascular mortality and morbidity. The SYNTAX score indicates the extent and complexity of coronary artery disease, which are determined by coronary angiography. The aim of our study is to examine the relationship between the IASBPD (which is easily calculated in routine practice) and the SYNTAX score. Methods. 104 patients were included in this cross-sectional study. The IASBPD was calculated by blood pressure measurements obtained simultaneously from both arms. The SYNTAX score was calculated by coronary angiography. Results. Patients were divided into two groups: those with a high SYNTAX score (≥20) and those with a low SYNTAX score (<20). The mean IASBPD values were significantly higher in the group with a high SYNTAX score (≥20) (p<0.001). The patients with IASBPD≥10 were more likely to have a high SYNTAX score compared to the patients with IASBPD<10 (p<0.001). Multiple logistic regression analysis revealed that only the IASBPD values were found to be independently associated with high SYNTAX score (OR: 1.717 (CI: 1.307-2.257), p<0.001). Conclusion. The IASBPD values obtained by only blood pressure measurements are closely related to the extent of coronary artery disease.


2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Mohammad Hosein Mohamadi ◽  
Alireza Rai ◽  
Mansour Rezaei ◽  
Alireza Khatony

Aim. Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods. The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results. There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion. The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
Bruce Ovbiagele ◽  
Rebecca F Gottesman ◽  
Nerses Sanossian ◽  
Daniela Markovic ◽  
...  

Introduction: Long-term variability in systolic blood pressure (SBP) is associated with higher risk of cardiovascular events. Little is known about the association between within-visit SBP variability and stroke. Hypothesis: Higher within-visit SBP variability is associated with higher odds of stroke. Methods: Participants included adults ≥18 years who participated in the US National Health and Nutrition Examination Surveys from 1999 to 2010. Stroke was self-reported. SBP was obtained up to four times by a physician, using a manual sphygmomanometer according standardized procedures. Within-visit SBP variability was defined as standard deviation of the BP measurements, stratified into quartiles. We evaluated the relationship between within-visit SBP variability and odds of having had a stroke using multivariable logistic regression. Results: Of the 27,987 adults, 16.4% were aged ≥ 65 years, 51.3% were female, 71.2% were White, 10.7% were Black and 7.9% were Mexican American. Factors associated with higher mean SBP variability included older age, hypertension, chronic kidney disease, peripheral artery disease, and smoking (all P<0.05). The prevalence of stroke significantly increased across SBP variability quartiles from 2.1% for quartile 1 to 3.7% for quartile 4. High SBP variability was associated with higher odds of stroke (OR 1.8, 95% CI 1.4-2.2). After adjustment for covariates, the odds ratio of stroke comparing highest vs. lowest quartile of SBP variability was 0.9 (p=0.400). Conclusions: Within-visit variability in SBP is associated with increased odds of stroke but the relationship is confounded by age and covariates.


2021 ◽  
Vol 38 (3) ◽  
pp. 246-250
Author(s):  
Pınar AYDIN OZTURK ◽  
UNAL OZTURK ◽  
Onder OZTURK

Stroke is a multifactorial disease. Arylesterase (ARE) activities have been considered as an anti-atherosclerosis factor. Increased pulse pressure (PP) may lead to a high risk of coronary artery disease and neurovascular morbidity and mortality. Nevertheless, there are limitations for PP as an evaluation index. In order to overcome the defects of PP, there is a novel parameter, “pulse pressure/systolic pressure” named “pulse pressure index (PPI)” for evaluation of cardiovascular effect. We researched the relationship between ARE activities and pulse pressure index (PPI) in acute ischemic stroke patients. We evaluated and compared the ARE activity and PPI in 87 ischemic stroke patients and 48 control patients. ARE activity was measured with the ultraviolet (UV) spectrophotometric method by using “Rel Assay Diagnostic” kits. Pulse pressure was measured by subtraction of diastolic blood pressure from systolic blood pressure. PPI was calculated as “pulse pressure / systolic pressure”. Hypertension, age, diabetes mellitus, dyslipidemia importantly higher in ischemic stroke patients than the control group (p<0.05). PPI was significantly higher in ischemic stroke patients than the control group (0.486±0.075 and 0.417±0.051, p<0.05). ARE activity was significantly lower in ischemic stroke patients than in the control group (511.59 ± 68.51 and 584.16 ± 81.74 p=0.019). This study demonstrated that ARE activity is lower and PPI is higher in acute ischemic stroke patients than control subjects. Our results suggested that, ARE activity and PPI are important risk factors in acute ischemic stroke patients.


1994 ◽  
Vol 72 (01) ◽  
pp. 058-064 ◽  
Author(s):  
Goya Wannamethee ◽  
A Gerald Shaper

SummaryThe relationship between haematocrit and cardiovascular risk factors, particularly blood pressure and blood lipids, has been examined in detail in a large prospective study of 7735 middle-aged men drawn from general practices in 24 British towns. The analyses are restricted to the 5494 men free of any evidence of ischaemic heart disease at screening.Smoking, body mass index, physical activity, alcohol intake and lung function (FEV1) were factors strongly associated with haematocrit levels independent of each other. Age showed a significant but small independent association with haematocrit. Non-manual workers had slightly higher haematocrit levels than manual workers; this difference increased considerably and became significant after adjustment for the other risk factors. Diabetics showed significantly lower levels of haematocrit than non-diabetics. In the univariate analysis, haematocrit was significantly associated with total serum protein (r = 0*18), cholesterol (r = 0.16), triglyceride (r = 0.15), diastolic blood pressure (r = 0.17) and heart rate (r = 0.14); all at p <0.0001. A weaker but significant association was seen with systolic blood pressure (r = 0.09, p <0.001). These relationships remained significant even after adjustment for age, smoking, body mass index, physical activity, alcohol intake, lung function, presence of diabetes, social class and for each of the other biological variables; the relationship with systolic blood pressure was considerably weakened. No association was seen with blood glucose and HDL-cholesterol. This study has shown significant associations between several lifestyle characteristics and the haematocrit and supports the findings of a significant relationship between the haematocrit and blood lipids and blood pressure. It emphasises the role of the haematocrit in assessing the risk of ischaemic heart disease and stroke in individuals, and the need to take haematocrit levels into account in determining the importance of other cardiovascular risk factors.


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