PRIME-CVD: A Parametrically Rendered Informatics Medical Environment for Education in Cardiovascular Risk Modelling

Synthetic healthcare data are widely proposed as privacy-preserving substitutes for real patient data, yet their evaluation remains dominated by statistical similarity and predictive performance that do not reflect clinical validity. We introduce a multi-dimensional evaluation framework grounded in epidemiology, assessing descriptive fidelity, clinical utility, and structural validity, corresponding to descriptive, predictive, and causal questions. We evaluate four representative generative paradigms - GAN-based, VAE-boosted, diffusion-based, and masked modelling - using PRIME-CVD, a 50,000-person cohort with known ground-truth structure. While all models reproduce marginal distributions, none simultaneously preserve subgroup structure, effect estimates, and dependency structure. Notably, models with strong distributional fidelity can exhibit poor calibration and distorted relationships, leading to unreliable inference. These results show that current evaluation practices can overestimate synthetic data quality and motivate domain-informed assessment based on the ability to support valid clinical and scientific conclusions.

Coronary artery disease (CAD) remains one of the leading causes of death globally, highlighting the need for reliable predictive systems to support early diagnosis and risk assessment. While traditional machine learning models perform well on structured clinical data, large language models (LLMs) present new possibilities to interpret medical information expressed in natural language. In this work, we develop a hybrid framework that bridges structured clinical data and natural-language representations for CAD prediction. Using a publicly available dataset of 1,190 patient records with 11 clinical attributes, structured variables are converted into interpretable feature representations and synthetic clinical narratives using LLMs. A validation pipeline performs reverse extraction of clinical variables and computes a consistency score with the original records, achieving an average fidelity of 94.61%. We then evaluate four conventional machine learning models and compare their performance with LLM-based classification under zero-shot and few-shot prompting settings. We use two LLMs here, GPT and Gemini. Experimental results show that Random Forest achieves the highest accuracy. Despite this advantage, LLM-based classification remains beneficial in real-world clinical settings. This is because LLMs operate directly on natural language patient descriptions, meaning that sensitive numerical patient data such as exact lab values, blood pressure readings, and diagnostic codes are kept private. Findings suggest that combining structured clinical data with LLM-generated narratives can enable new directions for hybrid clinical prediction systems.

Synthetic medical tabular data generation has become essential for developing and validating computer-based medical systems (CBMSs) when real clinical data is restricted due to privacy, ethical, or data availability limitations. Existing probabilistic and deep generative models often lack interpretability and fail to preserve clinically meaningful dependencies, limiting their suitability for safety-critical applications. This paper proposes a novel application of Fuzzy Cognitive Maps (FCMs) in a framework for synthetic medical tabular data generation with explicit causality and privacy preservation. Clinical features are described using linguistically interpretable fuzzy sets, and inter-feature dependencies are encoded as FCM edge weights computed from fuzzy set intersections. Synthetic patient records are generated by propagating randomly initialized linguistic activation vectors through the FCM until convergence, followed by defuzzification to produce clinically coherent numerical values. The approach natively handles mixed data types, and domain constraints common in health records. Experimental evaluation on UCI medical benchmark datasets demonstrates competitive performance under a Train-on-Synthetic-Test-on-Real (TSTR) protocol. The proposed method achieves accuracy of up to 0.81 and AUROC of up to 0.90 on the Heart Disease dataset, matching or exceeding TVAE and Gaussian Copula baselines while running exclusively on CPU. Fidelity metrics including KS Complement (up to 0.91) and Correlation Similarity (up to 0.95) confirm strong statistical coherence, and DCR Baseline Protection scores consistently exceed those of TVAE, confirming adequate privacy guarantees. These results demonstrate that causally grounded, interpretable fuzzy modeling offers a computationally efficient and transparent alternative to deep generative models for trustworthy synthetic data generation in CBMSs.