Development and validation of the Michigan Chronic Disease Simulation Model (MICROSIM)

PLoS One. 2024 May 16;19(5):e0300005. doi: 10.1371/journal.pone.0300005. eCollection 2024.

Abstract

Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease
  • Blood Pressure
  • Cardiovascular Diseases / epidemiology
  • Chronic Disease
  • Computer Simulation*
  • Dementia / epidemiology
  • Female
  • Humans
  • Male
  • Michigan / epidemiology
  • Middle Aged
  • Monte Carlo Method
  • Risk Factors

Grants and funding

This research project is supported by a grant R01 NS102715 from the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Department of Health and Human Service (DHHS). The NINDS was not involved in the design and conduct of the Study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Additional support was provided by the National Institute of Aging (NIA) grant R01 AG051827 and 1 RF1 AG068410-01 (DL), NIA Claude Pepper Center grant P30 AG024824 (AG), NIA grants K01 AG050699 (AG), and NIA Michigan Alzheimer's Disease Research Center grant P30 AG053760 (BG). Cohort Funding/Support: The Atherosclerosis Risk in Communities (ARIC) study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), NIH, DHHS, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, HHSN268201700005I,). Neurocognitive data are collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, 2U01HL096917, and R01 AG040282 from the NIH (NHLBI, NINDS, NIA, and National Institute on Deafness and Other Communication Disorders). Further information about ARIC’s funding can be found at https://sites.cscc.unc.edu/aric/desc. The authors thank the staff and participants of the ARIC study for their important contributions. The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (HHSN268201800005I & HHSN268201800007I), Northwestern University (HHSN268201800003I), University of Minnesota (HHSN268201800006I), and Kaiser Foundation Research Institute (HHSN268201800004I). A neurocognitive ancillary study is funded by the NIH (NIA, R01 AG063887). A full list of CARDIA collaborators and other cohort study information can be found at https://www.cardia.dopm.uab.edu/. This manuscript has been reviewed by CARDIA for the scientific content. The Cardiovascular Health Study (CHS) was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, 379 N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295 and U01HL130114 from the NHLBI, with additional contribution from the NINDS. Additional support was provided by R01AG023629, R01AG15928, and R01AG20098 from the NIA. A full list of principal CHS investigators and institutions can be found at https://chs-nhlbi.org/CHSOverview. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Framingham Heart Study is a project of the NHLBI of the NIH and Boston University School of Medicine. This project has been funded in whole or in part with federal funds from the NHLBI, NIH, DHHS, under contract No. HHSN268201500001I. The Northern Manhattan Stroke (NOMAS) study has been funded at least in part with federal funds from the NIH, NINDS by R01 NS29993. The Multi-Ethnic Study of Atherosclerosis (MESA) was supported by contracts 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, and N01-HC-95169 from the NHLBI, and by grants UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 from the National Center for Advancing Translational Sciences (NCATS). Cognitive testing at Exam 6 in MESA has been funded by grants R01HL127659 from the NHLBI and NIA R01AG054069 from the NIH. The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.