Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

Dr. Guallar is an epidemiologist whose research is focused on the study of cardiovascular disease epidemiology and prevention, with an emphasis on evaluating the role of environmental and nutritional exposures in the development of cardiovascular disease. This research has made critically important and novel contributions to our understanding of risk factors for chronic disease both in the US and globally. He has published seminal articles and is a leading figure in an emerging field highlighting the risks of exposure to levels of metals previously considered safe for cardiovascular health. In addition to his work in toxic metals, Dr. Guallar has made important contributions to understanding the effects of certain micronutrients and vitamin supplements on cardiovascular disease risk and outcomes. Publications in this area were influential in changing consumer habits and attitudes towards these products. Much of this research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, the CDC, and other funders.

Dr. Guallar was the founding director of the Center for Clinical Epidemiology at the Samsung Medical Center and a lead investigator of the Kangbuk Samsung Cohort Study at the Kangbuk Samsung Hospital since its inception in 2010. Dr. Guallar has published over 500 research papers in peer-reviewed journals. He is also a Deputy Editor for Methods at the Annals of Internal Medicine and a past member and Chair of the Cancer, Heart, and Sleep Study Section at the National Institutes of Health.

Prior to teaching at NYU, Dr. Guallar was a Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg School of Public Health and a core faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins. In the Department of Epidemiology, Dr. Guallar was the Director of the Environmental and Occupational Area of Concentration and the Co-Director of the PhD Program. Dr. Guallar was also an adjunct Professor at the Department of Clinical Research Design and Evaluation of the Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, in Seoul, Korea.

Education

Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, Spain

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

Six Honor Calls in the MD Program, University of Zaragoza School of Medicine (1981)

Fellow of Spain’s Program of Training of Graduate Research of the Ministry of Education and Science, University of Zaragoza (1988)

Fulbright Scholar, sponsored by Spain’s Ministry of Health and Consumer Affairs (1989)

Faculty Innovation Award, Johns Hopkins University Bloomberg School of Public Health (2001)

Scientist Development Award, American Heart Association (2002)

Fellow of the American Heart Association, Council on Epidemiology and Prevention (2013)

Advising, Mentoring, and Teaching Recognition Award 2014 – 2015, Johns Hopkins University Bloomberg School of Public Health (2015)

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

Chronic arsenic exposure and risk of carotid artery disease : The Strong Heart Study

Mateen, F. J., Grau-Perez, M., Pollak, J. S., Moon, K. A., Howard, B. V., Umans, J. G., Best, L. G., Francesconi, K. A., Goessler, W., Crainiceanu, C., Guallar, E., Devereux, R. B., Roman, M. J., & Navas-Acien, A. (n.d.).

Publication year

2017

Journal title

Environmental Research

Volume

157

Page(s)

127-134

10.1016/j.envres.2017.05.020

Abstract

Abstract

Background Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-moderate inorganic arsenic exposure with carotid arterial disease. Methods American Indians, 45–74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989–1991). Carotid artery ultrasound was performed in 1998–1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score). Results 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0 kg/m2, diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) µg/g creatinine. The mean CIMT was 0.75 mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09). Conclusions Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

Clinical decision tool for CRT-P vs. CRT-D implantation : Findings from PROSE-ICD

Nauffal, V., Zhang, Y., Tanawuttiwat, T., Blasco-Colmenares, E., Rickard, J., Marine, J. E., Butcher, B., Norgard, S., Dickfeld, T. M., Ellenbogen, K. A., Guallar, E., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

4

10.1371/journal.pone.0175205

Abstract

Abstract

Background: Cardiac resynchronization therapy (CRT) devices reduce mortality through pacing-induced cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy for ventricular arrhythmias (VAs). Whether certain factors can predict if patients will benefit more from implantation of CRT pacemakers (CRT-P) or CRT defibrillators (CRT-D) remains unclear. Methods and results: We followed 305 primary prevention CRT-D recipients for the two primary outcomes of HF hospitalization and ICD therapy for VAs. Serum biomarkers, electrocardiographic and clinical variables were collected prior to implant. Multivariable analysis using Cox-proportional hazards model was used to fit the final models. Among 282 patients with follow-up outcome data, 75 (26.6%) were hospitalized for HF and 31 (11%) received appropriate ICD therapy. Independent predictors of HF hospitalization were atrial fibrillation (HR = 1.8 (1.1,2.9)), NYHA class III/IV (HR = 2.2 (1.3,3.6)), ejection fraction 4.03pg/ml (HR = 1.7 (1.1,2.9)) and hemoglobin (20mg/dL (HR = 3.0 (1.3,7.1)), HS-CRP >9.42mg/L (HR = 2.3 (1.1,4.7)), no beta blocker therapy (HR = 3.2 (1.4,7.1)) and hematocrit ≥38% (HR = 2.7 (1.03,7.0)). Patients with 0-1 risk factors for appropriate therapy (IR 1 per 100 person-years) and ≥3 risk factors for HF hospitalization (IR 23 per 100-person-years) were more likely to die prior to receiving an appropriate ICD therapy. Conclusions: Clinical and biomarker data can risk stratify CRT patients for HF progression and VAs. These findings may help characterize subgroups of patients that may benefit more from the use of CRT-P vs. CRT-D systems.

Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988-2004

Ruiz-Hernandez, A., Navas-Acien, A., Pastor-Barriuso, R., Crainiceanu, C. M., Redon, J., Guallar, E., & Tellez-Plaza, M. (n.d.).

Publication year

2017

Journal title

International Journal of Epidemiology

Volume

46

Issue

6

Page(s)

1903-1912

10.1093/ije/dyx176

Abstract

Abstract

Background: Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Methods: Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations. Results: There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999-2004 to 1988-94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively. Conclusions: Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.

Development of chronic kidney disease in patients with non-alcoholic fatty liver disease : A cohort study

Sinn, D. H., Kang, D., Jang, H. R., Gu, S., Cho, S. J., Paik, S. W., Ryu, S., Chang, Y., Lazo, M., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2017

Journal title

Journal of Hepatology

Volume

67

Issue

6

Page(s)

1274-1280

10.1016/j.jhep.2017.08.024

Abstract

Abstract

Background & Aims Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9 y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60 ml/min/1.73 m2. During 200,790 person-years of follow-up (median follow-up of 4.15 years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04–1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS

Diabetes mellitus and the incidence of hearing loss : A cohort study

Kim, M. B., Zhang, Y., Chang, Y., Ryu, S., Choi, Y., Kwon, M. J., Moon, I. J., Deal, J. A., Lin, F. R., Guallar, E., Chung, E. C., Hong, S. H., Ban, J. H., Shin, H., & Cho, J. (n.d.).

Publication year

2017

Journal title

International Journal of Epidemiology

Volume

46

Issue

2

Page(s)

717-726

10.1093/ije/dyw243

Abstract

Abstract

Background: To evaluate the association between diabetes mellitus (DM) and the development of incident hearing loss. Methods: Prospective cohort study was performed in 253 301 adults with normal hearing tests who participated in a regular health-screening exam between 2002 and 2014. The main exposure was the presence of DM at baseline, defined as a fasting serum glucose 126 mg/dL, a self-reported history of DM or current use of anti-diabetic medications. Pre-diabetes was defined as a fasting glucose 100–125 mg/dL and no history of DM or anti-diabetic medication use. Incident hearing loss was defined as a pure-tone average of thresholds at 0.5, 1.0 and 2.0 kHz > 25 dB in both right and left ears. Results: During 1 285 704 person-years of follow-up (median follow-up of four years), 2817 participants developed incident hearing loss. The rate of hearing loss in participants with normal glucose levels, pre-diabetes and DM were 1.8, 3.1 and 9.2 per 1000 person-years, respectively (P < 0.001). The multivariable-adjusted hazard ratios for incident hearing loss for participants with pre-diabetes and DM compared with those with normal glucose levels were 1.04 (95% confidence interval 0.95–1.14) and 1.36 (1.19–1.56), respectively. In spline regression analyses, the risk of incident hearing loss increased progressively with HbA1c levels above 5%. Conclusions: In this large cohort study of young and middle-aged men and women, DM was associated with the development of bilateral hearing loss. DM patients have a moderately increased risk of future hearing loss.

Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve : The multi-ethnic study of atherosclerosis (MESA)

Tibuakuu, M., Jones, M. R., Navas-Acien, A., Zhao, D., Guallar, E., Gassett, A. J., Sheppard, L., Budoff, M. J., Kaufman, J. D., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Environmental Health: A Global Access Science Source

Volume

16

Issue

1

10.1186/s12940-017-0346-x

Abstract

Abstract

Background: Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression. Methods: We studied 6253 MESA participants aged 45-84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter

Frailty and subclinical coronary atherosclerosis : The Multicenter AIDS Cohort Study (MACS)

Korada, S. K., Zhao, D., Tibuakuu, M., Brown, T. T., Jacobson, L. P., Guallar, E., Bolan, R. K., Palella, F. J., Margolick, J. B., Martinson, J. J., Budoff, M. J., Post, W. S., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Atherosclerosis

Volume

266

Page(s)

240-247

10.1016/j.atherosclerosis.2017.08.026

Abstract

Abstract

Background and aims Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

Frequency of arrhythmia symptoms and acceptability of implantable cardiac monitors in Hemodialysis patients

El Hage, N., Jaar, B. G., Cheng, A., Knight, C., Blasco-Colmenares, E., Gimenez, L., Guallar, E., & Shafi, T. (n.d.).

Publication year

2017

Journal title

BMC Nephrology

Volume

18

Issue

1

10.1186/s12882-017-0740-1

Abstract

Abstract

Background: Arrhythmia-related complications and sudden death are common in dialysis patients. However, routine cardiac monitoring has so far not been feasible. Miniaturization of implantable cardiac monitors offers a new paradigm for detection and management of arrhythmias in dialysis patients. The goal of our study was to determine the frequency of arrhythmia-related symptoms in hemodialysis patients and to assess their willingness to undergo implantation of a cardiac monitor. Methods: We conducted a survey of in-center hemodialysis patients at a hemodialysis clinic in Baltimore, Maryland. We assessed the frequency of arrhythmia-related symptoms and willingness to undergo placement of an implantable cardiac monitor (LINQ, Medtronic Inc.). Results: Forty six patients completed the survey. The mean age of the survey respondents was 59 years and 65% were male. Symptoms were common with 74% (n = 34) of participants reporting at least one arrhythmia-related symptom and many [22% (n = 10)] had all 3 symptoms. Among the patients with symptoms, 57% (n = 26) reported "heart skipping beats, flopping in chest or beating very hard," 61% (n = 28) reported "heart racing (palpitations)," and 37% (n = 17) reported feeling that they "passed out or almost passed out." The majority of the patients felt that the timing of the symptoms was unrelated to dialysis treatments. The acceptability of the monitoring device implantation was high, with 59% (n = 20) of patients with symptoms and 50% (n = 6) of patients without symptoms willing to consider it. The main reason for not considering the device was not wanting to have an implanted device. Conclusion: The prevalence of arrhythmia-related symptoms is high in hemodialysis patients and the majority would consider an implantable cardiac monitor if recommended by their physicians. Routine implantation of cardiac monitoring devices to manage arrhythmias in dialysis patients may be feasible and will provide further insights on the leading causes of morbidity and mortality in dialysis patients.

Functional status and mortality prediction in community-acquired pneumonia

Jeon, K., Yoo, H., Jeong, B. H., Park, H. Y., Koh, W. J., Suh, G. Y., & Guallar, E. (n.d.).

Publication year

2017

Journal title

Respirology

Volume

22

Issue

7

Page(s)

1400-1406

10.1111/resp.13072

Abstract

Abstract

Background and objective: Poor functional status (FS) has been suggested as a poor prognostic factor in both pneumonia and severe pneumonia in elderly patients. However, it is still unclear whether FS is associated with outcomes and improves survival prediction in community-acquired pneumonia (CAP) in the general population. Methods: Data on hospitalized patients with CAP and FS, assessed by the Eastern Cooperative Oncology Group (ECOG) scale were prospectively collected between January 2008 and December 2012. The independent association of FS with 30-day mortality in CAP patients was evaluated using multivariable logistic regression. Improvement in mortality prediction when FS was added to the CRB-65 (confusion, respiratory rate, blood pressure and age 65) score was evaluated for discrimination, reclassification and calibration. Results: The 30-day mortality of study participants (n = 1526) was 10%. Mortality significantly increased with higher ECOG score (P for trend

Hepatitis B and C virus infection and diabetes mellitus : A cohort study

Hong, Y. S., Chang, Y., Ryu, S., Cainzos-Achirica, M., Kwon, M. J., Zhang, Y., Choi, Y., Ahn, J., Rampal, S., Zhao, D., Pastor-Barriuso, R., Lazo, M., Shin, H., Cho, J., & Guallar, E. (n.d.).

Publication year

2017

Journal title

Scientific reports

Volume

7

Issue

1

10.1038/s41598-017-04206-6

Abstract

Abstract

The role of hepatitis virus infection in glucose homeostasis is uncertain. We examined the associations between hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the development of diabetes in a cohort (N = 439,708) of asymptomatic participants in health screening examinations. In cross-sectional analyses, the multivariable-Adjusted odds ratio for prevalent diabetes comparing hepatitis B surface antigen (HBsAg) (+) to HBsAg (-) participants was 1.17 (95% CI 1.06-1.31; P = 0.003). The corresponding odds ratio comparing hepatitis C antibodies (HCV Ab) (+) to HCV Ab (-) participants was 1.43 (95% CI 1.01-2.02, P = 0.043). In prospective analyses, the multivariable-Adjusted hazard ratio for incident diabetes comparing HBsAg (+) to HbsAg (-) participants was 1.23 (95% CI 1.08-1.41; P = 0.007). The number of incident cases of diabetes among HCV Ab (+) participants (10 cases) was too small to reliably estimate the prospective association between HCV infection and diabetes. In this large population at low risk of diabetes, HBV and HCV infections were associated with diabetes prevalence and HBV infection with the risk of incident diabetes. Our studies add evidence suggesting that diabetes is an additional metabolic complication of HBV and HCV infection.

Improving consensus scoring of crowdsourced data using the rasch model : Development and refinement of a diagnostic instrument

Brady, C. J., Mudie, L. I., Wang, X., Guallar, E., & Friedman, D. S. (n.d.).

Publication year

2017

Journal title

Journal of medical Internet research

Volume

19

Issue

6

10.2196/jmir.7984

Abstract

Abstract

Background: Diabetic retinopathy (DR) is a leading cause of vision loss in working age individuals worldwide. While screening is effective and cost effective, it remains underutilized, and novel methods are needed to increase detection of DR. This clinical validation study compared diagnostic gradings of retinal fundus photographs provided by volunteers on the Amazon Mechanical Turk (AMT) crowdsourcing marketplace with expert-provided gold-standard grading and explored whether determination of the consensus of crowdsourced classifications could be improved beyond a simple majority vote (MV) using regression methods. Objective: The aim of our study was to determine whether regression methods could be used to improve the consensus grading of data collected by crowdsourcing. Methods: A total of 1200 retinal images of individuals with diabetes mellitus from the Messidor public dataset were posted to AMT. Eligible crowdsourcing workers had at least 500 previously approved tasks with an approval rating of 99% across their prior submitted work. A total of 10 workers were recruited to classify each image as normal or abnormal. If half or more workers judged the image to be abnormal, the MV consensus grade was recorded as abnormal. Rasch analysis was then used to calculate worker ability scores in a random 50% training set, which were then used as weights in a regression model in the remaining 50% test set to determine if a more accurate consensus could be devised. Outcomes of interest were the percent correctly classified images, sensitivity, specificity, and area under the receiver operating characteristic (AUROC) for the consensus grade as compared with the expert grading provided with the dataset. Results: Using MV grading, the consensus was correct in 75.5% of images (906/1200), with 75.5% sensitivity, 75.5% specificity, and an AUROC of 0.75 (95% CI 0.73-0.78). A logistic regression model using Rasch-weighted individual scores generated an AUROC of 0.91 (95% CI 0.88-0.93) compared with 0.89 (95% CI 0.86-92) for a model using unweighted scores (chi-square P value

Intracranial atherosclerosis and dementia

Dearborn, J. L., Zhang, Y., Qiao, Y., Suri, M. F., Liu, L., Gottesman, R. F., Rawlings, A. M., Mosley, T. H., Alonso, A., Knopman, D. S., Guallar, E., & Wasserman, B. A. (n.d.).

Publication year

2017

Journal title

Neurology

Volume

88

Issue

16

Page(s)

1556-1563

10.1212/WNL.0000000000003837

Abstract

Abstract

Objective: To explore the association of intracranial atherosclerotic disease (ICAD) with mild cognitive impairment (MCI) and dementia. Methods: From 2011 to 2013, 1,744 participants completed high-resolution vessel wall MRI from the population-based Atherosclerosis Risk in Communities Study by a sampling strategy that allowed weighting back to the cohort. We defined ICAD by plaque features (presence, territory, stenosis, number). Trained clinicians used an algorithm incorporating information from interviews and neuropsychological and neurologic examinations to adjudicate for MCI and dementia. We determined the relative prevalence ratio (RPR) of MCI or dementia after adjusting for risk factors at midlife using multinomial logistic regression. Results: A total of 601 (34.5%) participants had MCI (mean age ± SD, 76.6 ± 5.2 years), 83 (4.8%) had dementia (79.1 ± 5.3 years), and 857 (49.1%) were current or former smokers. Anterior cerebral artery (ACA) plaque (adjusted RPR 3.81, 95% confidence interval [CI] 1.57-9.23), >2 territories with plaque (adjusted RPR 2.12, 95% CI 1.00-4.49), and presence of stenosis >50% (adjusted RPR 1.92, 95% CI 1.01-3.65) were associated with increased prevalence of dementia in separate models. Posterior cerebral artery plaque was associated with MCI but did not reach statistical significance for dementia (adjusted RPR MCI 1.43, 95% CI 1.04-1.98; adjusted RPR dementia 1.58, 95% CI 0.79-2.85). There were no associations with middle cerebral artery atherosclerotic lesions or cognitive impairment. Many participants had plaque in >1 territory (n = 291, 46%) and participants with ACA plaques (n = 69) had the greatest number of plaques in other territories (mean 6.0, SD 4.4). Conclusions: This study demonstrates associations between ICAD and clinical MCI and dementia.

Low-moderate urine arsenic and biomarkers of thrombosis and inflammation in the Strong Heart Study

Moon, K. A., Navas-Acien, A., Grau-Pérez, M., Francesconi, K. A., Goessler, W., Guallar, E., Umans, J. G., Best, L. G., & Newman, J. D. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

8

10.1371/journal.pone.0182435

Abstract

Abstract

The underlying pathology of arsenic-related cardiovascular disease (CVD) is unknown. Few studies have evaluated pathways through thrombosis and inflammation for arsenic-related CVD, especially at low-moderate arsenic exposure levels (

Moderate coffee intake can be part of a healthy diet

Guallar, E., Blasco-Colmenares, E., Arking, D. E., & Zhao, D. (n.d.).

Publication year

2017

Journal title

Annals of internal medicine

Volume

167

Issue

4

Page(s)

283-284

10.7326/M17-1503

Abstract

Abstract

~

Non-alcoholic fatty liver disease and progression of coronary artery calcium score : A retrospective cohort study

Sinn, D. H., Kang, D., Chang, Y., Ryu, S., Gu, S., Kim, H., Seong, D., Cho, S. J., Yi, B. K., Park, H. D., Paik, S. W., Song, Y. B., Lazo, M., Lima, J. A., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2017

Journal title

Gut

Volume

66

Issue

2

Page(s)

323-329

10.1136/gutjnl-2016-311854

Abstract

Abstract

Background and aim Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, was associated with subclinical atherosclerosis in many cross-sectional studies, but the prospective association between NAFLD and the progression of atherosclerosis has not been evaluated. This study was conducted to evaluate the association between NAFLD and the progression of coronary atherosclerosis. Methods This retrospective cohort study included 4731 adult men and women with no history of cardiovascular disease (CVD), liver disease or cancer at baseline who participated in a repeated regular health screening examination between 2004 and 2013. Fatty liver was diagnosed by ultrasound based on standard criteria, including parenchymal brightness, liver-to-kidney contrast, deep beam attenuation and bright vessel walls. Progression of coronary artery calcium (CAC) scores was measured using multidetector CT scanners. Results The average duration of follow-up was 3.9 years. During follow-up, the annual rate of CAC progression in participants with and without NAFLD were 22% (95% CI 20% to 23%) and 17% (16% to 18%), respectively ( p

Optimizing Glaucoma Screening in High-Risk Population : Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study

SToP Glaucoma Study Group, A., SToP Glaucoma Study Group, A., Zhao, D., Guallar, E., Gajwani, P., Swenor, B., Crews, J., Saaddine, J., Mudie, L., Varadaraj, V., Friedman, D. S., Kanwar, N., Sosa-Ebert, A., Dosto, N., Thompson, S., Wahl, M., Johnson, E., & Ogega, C. (n.d.).

Publication year

2017

Journal title

American Journal of Ophthalmology

Volume

180

Page(s)

18-28

10.1016/j.ajo.2017.05.017

Abstract

Abstract

Purpose To develop, implement, and evaluate a replicable community-based screening intervention designed to improve glaucoma and other eye disease detection and follow-up care in high-risk populations in the United States. We present the design of the study and describe the findings of the first year of the program. Design Prospective study to evaluate screening and follow-up. Methods This is an ongoing study to develop an eye screening program using trained personnel to identify individuals with ophthalmic needs, focusing on African Americans ≥50 years of age at multiple inner-city community sites in Baltimore, Maryland. The screening examination uses a sequential referral approach and assesses presenting visual acuity (VA), best-corrected VA, digital fundus imaging, visual field testing, and measurement of intraocular pressure. Results We screened 901 individuals between January 2015 and October 2015. Subjects were mostly African Americans (94.9%) with a mean (standard deviation) age of 64.3 (9.9) years. Among them, 356 (39.5%) participants were referred for a definitive eye examination and 107 (11.9%) only needed prescription glasses. The most common reasons for referral were ungradable fundus image (39.3% of those referred), best-corrected VA < 20/40 (14.6%), and ungradable autorefraction (11.8%). Among people referred for definitive examination, 153 (43%) people attended their scheduled examination. The most common diagnoses at the definitive examination were glaucoma and cataract (51% and 40%, respectively). Conclusions A large proportion of individuals screened required ophthalmic services, particularly those who were older and less well educated. To reach and encourage these individuals to attend screenings and follow-up examinations, programs could develop innovative strategies and approaches.

Patient, provider, and system factors contributing to patient safety events during medical and surgical hospitalizations for persons with serious mental illness

McGinty, E. E., Thompson, D. A., Pronovost, P. J., Dixon, L. B., Guallar, E., Ford, D. E., Cahoon, E. K., Boonyasai, R., & Daumit, G. L. (n.d.).

Publication year

2017

Journal title

Journal of Nervous and Mental Disease

Volume

205

Issue

6

Page(s)

495-501

10.1097/NMD.0000000000000675

Abstract

Abstract

This study aimed to explore patient-, provider-, and system-level factors that may contribute to elevated risk of patient safety events among persons with serious mental illness (SMI). We conducted a medical record review of medical/surgical admissions in Maryland hospitals from 1994 to 2004 for a community-based sample of adults with SMI (N = 790 hospitalizations). We estimated the prevalence of multiple patient, provider, and systemfactors that could influence patient safety among persons with SMI.We conducted a case crossover analysis to examine the relationship between these factors and adverse patient safety events. Patients' mental status, level of consciousness, disease severity, and providers' lack of patient monitoring, delay/failure to seek consultation, lack of trainee supervision, and delays in care were positively associated with adverse patient safety events (p < 0.05). Efforts to reduce SMI-related patient safety risks will need to be multifaceted and address both patient- and provider-level factors.

Physical activity, vitamin D, and incident atherosclerotic cardiovascular disease in whites and blacks : The ARIC study

Chin, K., Zhao, D., Tibuakuu, M., Martin, S. S., Ndumele, C. E., Florido, R., Windham, B. G., Guallar, E., Lutsey, P. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

102

Issue

4

Page(s)

1227-1236

10.1210/jc.2016-3743

Abstract

Abstract

Context: Physical activity (PA) is associated with 25-hydroxyvitamin D [25(OH)D] levels. Both are associated with atherosclerotic cardiovascular disease (ASCVD), but their joint association with ASCVD risk is unknown. Objective: To examine the relationship between PA and 25(OH)D, and assess effect modification of 25(OH)D and PA with ASCVD. Design: Cross-sectional and prospective study. Setting: Community-dwelling cohort. Participants: A total of 10,342 participants free of ASCVD, with moderate- to vigorous-intensity PA assessed (1987 to 1989) and categorized per American Heart Association (AHA) guidelines (recommended, intermediate, or poor). Main Outcome Measures: Serum 25(OH)D levels (1990 to 1992) and ASCVD events (i.e., incident myocardial infarction, fatal coronary disease, or stroke) through 2013. Results: Participants had mean age of 54 years, and were 57% women, 21% black, 30% 25(OH)D deficient [

Prevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome

Metkus, T. S., Guallar, E., Sokoll, L., Morrow, D., Tomaselli, G., Brower, R., Schulman, S., & Korley, F. K. (n.d.).

Publication year

2017

Journal title

Critical care medicine

Volume

45

Issue

10

Page(s)

1709-1717

10.1097/CCM.0000000000002641

Abstract

Abstract

Objective: Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. Design: We performed a prospective cohort study. Setting: We included patients enrolled in previously completed trials of acute respiratory distress syndrome. Patients: One thousand fifty-seven acute respiratory distress syndrome patients were included. Interventions: To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. Measurements and Main Results: Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and Pco2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). Conclusions: Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.

Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe : EURIKA, a cross-sectional observational study

Halcox, J. P., Banegas, J. R., Roy, C., Dallongeville, J., De Backer, G., Guallar, E., Perk, J., Hajage, D., Henriksson, K. M., & Borghi, C. (n.d.).

Publication year

2017

Journal title

BMC Cardiovascular Disorders

Volume

17

Issue

1

10.1186/s12872-017-0591-5

Abstract

Abstract

Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of highdensity lipoprotein cholesterol. Methods: This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Results: Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. Conclusions: A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated.

Racial differences in prevalence and risk for intracranial atherosclerosis in a us community-based population

Qiao, Y., Suri, F. K., Zhang, Y., Liu, L., Gottesman, R., Alonso, A., Guallar, E., & Wasserman, B. A. (n.d.).

Publication year

2017

Journal title

JAMA Cardiology

Volume

2

Issue

12

Page(s)

1341-1348

10.1001/jamacardio.2017.4041

Abstract

Abstract

IMPORTANCE Intracranial atherosclerotic disease (ICAD) is an important cause of stroke; however, little is known about racial differences in ICAD prevalence and its risk factors. OBJECTIVE To determine racial differences in ICAD prevalence and the risk factors (both midlife and concurrent) associated with its development in a large, US community-based cohort. DESIGN, SETTING, AND PARTICIPANTS Analysis of 1752 black and white participants recruited from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent 3-dimensional intracranial vessel wall magnetic resonance imaging from October 18, 2011 to December 30, 2013; data analysis was performed from October 18, 2011 toMay 13, 2015. EXPOSURES Midlife and concurrent cardiovascular risk factors. MAIN OUTCOMES AND MEASURES Intracranial plaque presence, size (maximum normalized wall index) and number were assessed by vessel wall magnetic resonance imaging. Midlife and concurrent vascular risk factor associations were determined by Poisson regression (plaque presence), negative binominal regression (plaque number), and linear regression (plaque size), and compared between races. RESULTS Of the 1752 study participants (mean [SD] age, 77.6 [5.3] years; range, 67-90 years), 1023 (58.4%) were women and 518 (29.6%) were black. Black men had the highest prevalence (50.9%vs 35.9% for black women, 35.5%for white men, and 30.2%for white women; P < .001) and the highest frequency (22.4%vs 12.1% for black women, 10.7%for white men, and 8.7%for white women; P < .01) of multiple plaques. Prevalence increased with age, reaching 50% before ages 68, 84, and 88 years in black men, white men, and white women, respectively (ICAD prevalence remained

Relation of Serum Vitamin D to Risk of Mitral Annular and Aortic Valve Calcium (from the Multi-Ethnic Study of Atherosclerosis)

Tibuakuu, M., Zhao, D., de Boer, I. H., Guallar, E., Bortnick, A. E., Lutsey, P. L., Budoff, M. J., Kizer, J. R., Kestenbaum, B. R., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

American Journal of Cardiology

Volume

120

Issue

3

Page(s)

473-478

10.1016/j.amjcard.2017.05.004

Abstract

Abstract

Serum 25-hydroxyvitamin D [25(OH)D] concentration has been identified as a possible modifiable risk factor for cardiovascular disease (CVD). We hypothesized that serum 25(OH)D concentration would be associated with calcifications of the left-sided heart valves, which are markers of CVD risk. Aortic valve calcium (AVC) and mitral annular calcium (MAC) were quantified from cardiac computed tomography scans performed on 5,530 Multi-Ethnic Study of Atherosclerosis participants at the baseline examination (2000 to 2002) and at a follow-up visit at either Examination 2 (2002 to 2004) or Examination 3 (2004 to 2005). 25(OH)D was measured from serum samples collected at the baseline examination. Using relative risk regression, we evaluated the multivariable-adjusted risk of prevalent and incident AVC and MAC in this ethnically diverse population free of clinical CVD at baseline. The mean age of participants was 62 ± 10 years; 53% were women, 40% white, 26% black, 21% Hispanic, and 12% Chinese. Prevalent AVC and MAC were observed in 12% and 9% of study sample, respectively. There were no significant associations between 25(OH)D and prevalent AVC or MAC. Over a mean follow-up of 2.5 years, 4% developed incident AVC and 5% developed incident MAC. After adjusting for demographic variables, each 10 ng/ml higher serum 25(OH)D was associated with a 15% (relative risk 0.85, 95% confidence interval 0.74 to 0.98) lower risk of incident MAC but not AVC. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors. Results suggest a possible link between serum 25(OH)D and the risk for incident MAC, but future studies with longer follow-up are needed to further test this association.

Serum vitamin D and change in lipid levels over 5 y : The Atherosclerosis Risk in Communities study

Faridi, K. F., Zhao, D., Martin, S. S., Lupton, J. R., Jones, S. R., Guallar, E., Ballantyne, C. M., Lutsey, P. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Nutrition

Volume

38

Page(s)

85-93

10.1016/j.nut.2017.01.008

Abstract

Abstract

Objectives Deficiency of 25-hydroxyvitamin D (25[OH]D) is associated with increased risk for cardiovascular disease, perhaps mediated through dyslipidemia. Deficient 25(OH)D is cross-sectionally associated with dyslipidemia, but little is known about longitudinal lipid changes. The aim of this study was to determine the relationship of 25(OH)D deficiency to longitudinal lipid changes and risk for incident dyslipidemia. Methods This was a longitudinal community-based study of 13 039 participants from the ARIC (Atherosclerosis Risk in Communities) study who had 25(OH)D and lipids measured at baseline (1990–1992) and lipids remeasured in 1993 to 1994 and 1996 to 1998. Mixed-effect models were used to assess the association of 25(OH)D and lipid trends after adjusting for clinical characteristics and for baseline or incident use of lipid-lowering therapy. Risk for incident dyslipidemia was determined for those without baseline dyslipidemia. Results Baseline mean ± SD age was 57 ± 6 y and 25(OH)D was 24 ± 9 ng/mL. Participants were 57% women, 24% black. Over a mean follow-up of 5.2 y, the fully adjusted average differences (95% confidence interval [CI]) comparing deficient (

Serum vitamin D and sex hormones levels in men and women : The Multi-Ethnic Study of Atherosclerosis (MESA)

Zhao, D., Ouyang, P., de Boer, I. H., Lutsey, P. L., Farag, Y. M., Guallar, E., Siscovick, D. S., Post, W. S., Kalyani, R. R., Billups, K. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Maturitas

Volume

96

Page(s)

95-102

10.1016/j.maturitas.2016.11.017

Abstract

Abstract

Introduction 25-hydroxyvitamin D [25(OH)D] deficiency has been associated with low testosterone levels in men, but there are conflicting reports of its associations with sex hormones in women. Less is known about whether these associations are independent of adiposity and lifestyle factors, and whether they differ by race/ethnicity. Aim To examine associations of 25(OH)D concentrations with sex hormone levels. Methods Cross-sectional analysis of 3017 men and 2929 women in a multi-ethnic cohort. Main outcome measures Testosterone, estradiol, dehydroepiandrosterone (DHEA), sex hormone binding globulin (SHBG), and free testosterone. Results The mean (SD) levels of 25(OH)D in men and women were 25.7(10.4) and 26.1(12.0) ng/ml, respectively. In men, after adjusting for demographic and lifestyle variables, a 10 ng/ml [25 nmol/L] decrease in 25(OH)D was associated with an average difference of −0.70 nmol/L (95%CI −1.36, −0.05) in SHBG and 0.02 percent (0.01, 0.04) in free testosterone, but was not associated with low total testosterone level (

Sex-specific maximum predicted heart rate and its prognosis for mortality and myocardial infarction

Ahmed, H. M., Al-Mallah, M. H., Keteyian, S. J., Brawner, C. A., Ehrman, J. K., Zhao, D., Guallar, E., Blaha, M. J., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Medicine and Science in Sports and Exercise

Volume

49

Issue

8

Page(s)

1704-1710

10.1249/MSS.0000000000001285

Abstract

Abstract

Purpose Maximum predicted heart rate (MPHR) is traditionally calculated by (220 - age). However, this formula's validity has been questioned in women. The purpose of this study was to derive sex-specific formulas for MPHR in a clinical population and compare their prognostic significance with the traditional formula. Methods This was a retrospective cohort of adults referred for exercise treadmill testing between 1991 and 2009. Peak heart rate versus age was plotted by sex, and linear regression analysis was used to derive sex-specific MPHR formulas. Cox models were used to calculate risk of death and myocardial infarction (MI) based on attainment of 85% MPHR using both formulas. Results Of 31,090 patients (mean ± SD, age = 55 ± 10 yr), there were 2824 deaths over 11 ± 5 yr. MPHR was best estimated by 197 - 0.8 × age for women and 204 - 0.9 × age for men (P interaction < 0.001). Compared with the sex-specific formulas, the traditional formula overestimated peak heart rate by 12 ± 2 bpm in women and 11 ± 1 bpm in men. There were 1868 patients (6%) who achieved the target heart rate using the sex-specific formulas but not with the traditional formula. Achievement of ≥85% MPHR was similarly associated with lower risk of death (adjusted hazard ratio = 0.76 [95% confidence interval = 0.60-0.97] vs 0.75 [0.62-0.90]) and MI (0.71 [0.47-1.06] vs 0.79 [0.57-1.10]) for the sex-specific versus traditional formula. Conclusions In patients referred for exercise treadmill testing, sex-specific formulas more accurately estimated peak heart rate than the traditional MPHR formula, reclassified 6% of stress tests from inadequate to adequate, and were similarly associated with risk of MI and death.