Abstract
PURPOSE: Hypercholesterolemia is a major risk factor for a wide range of cardiovascular diseases. Developing countries are more susceptible to hypercholesterolemia and its complications due to the increasing prevalence and the lack of adequate resources for conducting screening and/or prevention programs. Using machine learning techniques to identify factors contributing to hypercholesterolemia and developing predictive models can help early detection of hypercholesterolemia, especially in developing countries. METHODS: Data from the nationwide 2016 STEPs study in Iran were used to identify socioeconomic, lifestyle, and metabolic risk factors associated with hypercholesterolemia. Furthermore, the predictive power of the identified risk factors was assessed using five commonly used machine learning algorithms (random forest; gradient boosting; support vector machine; logistic regression; artificial neural network) and 10-fold cross validation in terms of specificity, sensitivity, and the area under the receiver operating characteristic curve. RESULTS: A total of 14,667 individuals were included in this study, of those 12.8% (n = 1879) had (undiagnosed) hypercholesterolemia. Based on multivariate logistic regression analysis the five most important risk factors for hypercholesterolemia were: older age (for the elderly group: OR = 2.243; for the middle-aged group: OR = 1.869), obesity-related factors including high BMI status (morbidly obese: OR = 1.884; obese: OR = 1.499; overweight: OR = 1.426) and AO (OR = 1.339), raised BP (hypertension: OR = 1.729; prehypertension: OR = 1.577), consuming fish once or twice per week (OR = 1.261), and having risky diet (OR = 1.163). Furthermore, all the five hypercholesterolemia prediction models achieved AUC around 0.62, and models based on random forest (AUC = 0.6282; specificity = 65.14%; sensitivity = 60.51%) and gradient boosting (AUC = 0.6263; specificity = 64.11%; sensitivity = 61.15%) had the optimal performance. CONCLUSION: The study shows that socioeconomic inequalities, unhealthy lifestyle, and metabolic syndrome (including obesity and hypertension) are significant predictors of hypercholesterolemia. Therefore controlling these factors is necessary to reduce the burden of hypercholesterolemia. Furthermore, machine learning algorithms such as random forest and gradient boosting can be employed for hypercholesterolemia screening and its timely diagnosis. Applying deep learning algorithms as well as techniques for handling the class overlap problem seems necessary to improve the performance of the models.