Selection of 51 predictors from 13,782 candidate multimodal features using machine learning improves coronary artery disease prediction.

Agrawal, Saaket; Klarqvist, Marcus D R; Emdin, Connor; Patel, Aniruddh P; Paranjpe, Manish D; Ellinor, Patrick T; Philippakis, Anthony; Ng, Kenney et al. · Patterns (N Y) · 2021

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Abstract

Current cardiovascular risk assessment tools use a small number of predictors. Here, we study how machine learning might: (1) enable principled selection from a large multimodal set of candidate variables and (2) improve prediction of incident coronary artery disease (CAD) events. An elastic net-based Cox model (ML4H<sub>EN-COX</sub>) trained and evaluated in 173,274 UK Biobank participants selected 51 predictors from 13,782 candidates. Beyond most traditional risk factors, ML4H<sub>EN-COX</sub> selected a polygenic score, waist circumference, socioeconomic deprivation, and several hematologic indices. A more than 30-fold gradient in 10-year risk estimates was noted across ML4H<sub>EN-COX</sub> quintiles, ranging from 0.25% to 7.8%. ML4H<sub>EN-COX</sub> improved discrimination of incident CAD (C-statistic = 0.796) compared with the Framingham risk score, pooled cohort equations, and QRISK3 (range 0.754-0.761). This approach to variable selection and model assessment is readily generalizable to a broad range of complex datasets and disease endpoints.