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

Reply : How to determine a metabolically healthy body composition in cardiovascular disease

Chang, Y., Kim, B. K., Cho, J., Guallar, E., & Ryu, S. (n.d.).

Publication year

2014

Journal title

Journal of the American College of Cardiology

Volume

64

Issue

11

Page(s)

1184-1185

10.1016/j.jacc.2014.06.1173

Abstract

Abstract

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Spatial clustering of toxic trace elements in adolescents aroun. The Torreón, Mexico lead-zinc smelter

Garcia-Vargas, G. G., Rothenberg, S. J., Silbergeld, E. K., Weaver, V., Zamoiski, R., Resnick, C., Rubio-Andrade, M., Parsons, P. J., Steuerwald, A. J., Navas-Acién, A., & Guallar, E. (n.d.).

Publication year

2014

Journal title

Journal of Exposure Science and Environmental Epidemiology

Volume

24

Issue

6

Page(s)

634-642

10.1038/jes.2014.11

Abstract

Abstract

High blood lead (BPb) levels in children and elevated soil and dust arsenic, cadmium, and lead were previously found in Torreón, northern Mexico, host t. The world's fourth largest lead-zinc metal smelter. The objectives of this study were to determine spatial distributions of adolescents with higher BPb and creatinine-corrected urine total arsenic, cadmium, molybdenum, thallium, and uranium aroun. The smelter. Cross-sectional study of 512 male and female subjects 12-15 years of age was conducted. We measured BPb by graphite furnace atomic absorption spectrometry and urine trace elements by inductively coupled plasma-mass spectrometry, with dynamic reaction cell mode for arsenic. We constructed multiple regression models including sociodemographic variables and adjusted for subject residence spatial correlation with spatial lag or error terms. We applied local indicators of spatial association statistics to model residuals to identify hot spots of significant spatial clusters of subjects with higher trace elements. We found spatial clusters of subjects with elevated BPb (range 3.6-14.7 μg/dl) and urine cadmium (0.18-1.14 μg/g creatinine) adjacent to and downwind o. The smelter and elevated urine thallium (0.28-0.93 μg/g creatinine) and uranium (0.07-0.13 μg/g creatinine) near ore transport routes, former waste, and industrial discharge sites. The conclusion derived from this study was that spatial clustering of adolescents with high BPb and urine cadmium adjacent to and downwind o. The smelter and residual waste pile, areas identified over a decade ago with high lead and cadmium in soil and dust, suggests that past and/or present plant operations continue to present health risks to children in those neighborhoods.

The association of blood pressure and primary open-angle glaucoma : A meta-analysis

Zhao, D., Cho, J., Kim, M. H., & Guallar, E. (n.d.).

Publication year

2014

Journal title

American Journal of Ophthalmology

Volume

158

Issue

3

Page(s)

615-627.e9

10.1016/j.ajo.2014.05.029

Abstract

Abstract

Purpose To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular pressure endpoints. Design Systematic review with quantitative meta-analysis. Methods Studies were identified by searching the PubMed and EMBASE databases. Inverse-variance weighted random-effects models were used to summarize relative risks. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity across studies. Results Sixty observational studies were included. The pooled relative risk for primary open-angle glaucoma comparing patients with hypertension to those without hypertension was 1.16 (95% CI = 1.05-1.28), with modest heterogeneity across studies (I2 34.5%). Virtually all studies reported a positive association between blood pressure and intraocular pressure (IOP). The pooled average increase in IOP associated with a 10 mm Hg increase in systolic blood pressure was 0.26 mm Hg (95% CI 0.23-0.28, I2 30.7%), and the average increase associated with a 5 mm Hg increase in diastolic blood pressure was 0.17 mm Hg (95% CI 0.11-0.23, I2 90.5%). Conclusions In this meta-analysis, hypertension was associated with increased intraocular pressure. The association between hypertension and primary open-angle glaucoma was stronger in cross-sectional compared with case-control and longitudinal studies. Our findings support a role of increased blood pressure in elevated intraocular pressure and possibly in the development of glaucoma.

The prevalence of colorectal adenomas in asymptomatic korean men and women

Yang, M. H., Rampal, S., Sung, J., Choi, Y. H., Son, H. J., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Rhee, J. C., Guallar, E., & Cho, J. (n.d.).

Publication year

2014

Journal title

Cancer Epidemiology Biomarkers and Prevention

Volume

23

Issue

3

Page(s)

499-507

10.1158/1055-9965.EPI-13-0682

Abstract

Abstract

Background: Colorectal cancer incidence is rapidly rising in many Asian countries, with rates approaching those of Western countries. This study aimed to evaluate the prevalence and trends of colorectal adenomas by age, sex, and risk strata in asymptomatic Koreans. Methods: Cross-sectional study of 19,372 consecutive participants aged 20 to 79 years undergoing screening colonoscopy at the Center for Health Promotion of the Samsung Medical Center in Korea from January 2006 to June 2009. Results:Among participants at average risk, those without a history of colorectal polyps or a family history of colorectal cancer, the prevalence of colorectal adenomas and advanced adenomas were 34.5% and 3.1%, respectively, in men and 20.0% and 1.6%, respectively, in women. The prevalence of adenomas increased with age in both men and women, with a more marked increase for advanced adenoma. Participants with a family history of colorectal cancer or with a history of colorectal polyps had significantly higher prevalence of adenomas compared with participants of average risk (36.9% vs. 26.9%; age-And sex-Adjusted prevalence ratio = 1.16; 95% confidence interval, 1.09-1.22). The prevalence of adenomas increased annually in both men and women. Conclusions: In this large study of asymptomatic Korean men and women participating in a colonoscopy screening program, the prevalence of colorectal adenomas was comparable and possibly higher than previously reported in Western countries. Impact: Cost-effectiveness studies investigating the optimal age for starting colonoscopy screening and etiological studies to identify the reasons for the increasing trend in colorectal adenomas in Koreans are needed.

The QT interval is associated with incident cardiovascular events : The MESA Study

Beinart, R., Zhang, Y., Lima, J. A., Bluemke, D. A., Soliman, E. Z., Heckbert, S. R., Post, W. S., Guallar, E., & Nazarian, S. (n.d.).

Publication year

2014

Journal title

Journal of the American College of Cardiology

Volume

64

Issue

20

Page(s)

2111-2119

10.1016/j.jacc.2014.08.039

Abstract

Abstract

BACKGROUND: Prolonged heart rate-corrected QT interval on electrocardiograms (ECGs) is associated with increased risk of myocardial infarction and cardiovascular disease (CVD)-related deaths in patients with prevalent coronary heart disease. OBJECTIVES: This study sought to examine the prognostic association between the baseline QT interval and incident cardiovascular events in individuals without prior known CVD. METHODS: The corrected baseline 12-lead ECG QT interval duration (QTcorr) was determined by adjustment for age, sex, race/ethnicity, and RR interval duration in 6, 9 273 participants in MESA (Multi-Ethnic Study of Atherosclerosis). Cox proportional hazards models adjusting for demographic and clinical risk factors were used to examine the association of baseline QTcorr with incident cardiovascular events. RESULTS: The mean age at enrollment was 61.7 ± 10 years, and 53.4% of participants were women. Cardiovascular events occurred in 291 participants over a mean follow-up of 8.0 ± 1.7 years. Each 10-ms increase in the baseline QTcorr was associated with incident heart failure (hazard ratio [HR]: 1.25; 95% CI: 1.14 to 1.37), CVD events (HR: 1.12; 95% CI: 1.05 to 1.20), and stroke (HR: 1.19; 95% CI: 1.07 to 1.32) after adjustment for CVD risk factors and potential confounders. There was no evidence of interaction with sex or ethnicity. CONCLUSIONS: The QT interval was associated with incident cardiovascular events in middle-aged and older adults without prior CVD.

Thyroid hormone levels and incident chronic kidney disease in euthyroid individuals : The Kangbuk Samsung Health Study

Zhang, Y., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Pastor-Barriuso, R., Rampal, S., Han, W. K., Shin, H., & Guallar, E. (n.d.).

Publication year

2014

Journal title

International Journal of Epidemiology

Volume

43

Issue

5

Page(s)

1624-1632

10.1093/ije/dyu126

Abstract

Abstract

Background: Overt and subclinical hypothyroidism are associated with higher levels of serum creatinine and with increased risk of chronic kidney disease (CKD). The prospective association between thyroid hormones and kidney function in euthyroid individuals, however, is largely unexplored. Methods: We conducted a prospective cohort study in 104 633 South Korean men and women who were free of CKD and proteinuria at baseline and had normal thyroid hormone levels and no history of thyroid disease or cancer. At each annual or biennial follow-up visit, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by radioimmunoassay. The study outcome was incident CKD, defined as an estimated glomerular filtration rate (eGFR)

Thyroid hormones and coronary artery calcification in euthyroid men and women

Zhang, Y., Kim, B. K., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Rampal, S., Zhao, D., Pastor-Barriuso, R., Lima, J. A., Shin, H., & Guallar, E. (n.d.).

Publication year

2014

Journal title

Arteriosclerosis, Thrombosis, and Vascular Biology

Volume

34

Issue

9

Page(s)

2128-2134

10.1161/ATVBAHA.114.303889

Abstract

Abstract

OBJECTIVE - Overt and subclinical hypothyroidism are risk factors for atherosclerosis. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC). APPROACH AND RESULTS - We conducted a cross-sectional study of 41 403 apparently healthy young and middle-aged men and women with normal thyroid hormone levels. Free thyroxin, free triiodothyronine, and thyroid-stimulating hormone levels were measured by electrochemiluminescent immunoassay. CAC score was measured by multidetector computed tomography. The multivariable adjusted CAC ratios comparing the highest versus the lowest quartile of thyroid hormones were 0.74 (95% confidence interval, 0.60-0.91; P for trend 0) comparing the highest versus the lowest quartiles of thyroid hormones were 0.87 (0.79-0.96; P for linear trend

Thyroid hormones and mortality risk in euthyroid individuals : The Kangbuk Samsung health study

Zhang, Y., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Pastor-Barriuso, R., Rampal, S., Han, W. K., Shin, H., & Guallar, E. (n.d.).

Publication year

2014

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

99

Issue

7

Page(s)

2467-2476

10.1210/jc.2013-3832

Abstract

Abstract

Context: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear. Objective: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints. Setting and Design: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records. Results: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95,comparingthe highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62,95%confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints. Conclusions: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.

A behavioral weight-loss intervention in persons with serious mental illness

Daumit, G. L., Dickerson, F. B., Wang, N. Y., Dalcin, A., Jerome, G. J., Anderson, C. A., Young, D. R., Frick, K. D., Yu, A., Gennusa, J. V., Oefinger, M., Crum, R. M., Charleston, J., Casagrande, S. S., Guallar, E., Goldberg, R. W., Campbell, L. M., & Appel, L. J. (n.d.).

Publication year

2013

Journal title

New England Journal of Medicine

Volume

368

Issue

17

Page(s)

1594-1602

10.1056/NEJMoa1214530

Abstract

Abstract

BACKGROUND: Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness. METHODS: We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months. RESULTS: Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P = 0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P = 0.009). There were no significant between-group differences in adverse events. CONCLUSIONS: A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694).

Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. the EURIKA study

Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Massó-González, E. L., Sazova, O., Perk, J., Steg, P. G., De Backer, G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2013

Journal title

International Journal of Cardiology

Volume

166

Issue

1

Page(s)

210-214

10.1016/j.ijcard.2011.10.094

Abstract

Abstract

Objective: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. Methods: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥ 50 years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥ 1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥ 2 additional major cardiovascular risk factors). Results: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol < 70 mg/dl, non-HDL-cholesterol < 100 mg/dl, and apolipoprotein B < 80 mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol < 100 mg/dl, non-HDL-cholesterol < 130 mg/dl, and apolipoprotein B < 90 mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. Conclusion: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.

Anthropometric indices and selenium status in British adults : The U.K. National Diet and Nutrition Survey

Spina, A., Guallar, E., Rayman, M. P., Tigbe, W., Kandala, N. B., & Stranges, S. (n.d.).

Publication year

2013

Journal title

Free Radical Biology and Medicine

Volume

65

Page(s)

1315-1321

10.1016/j.freeradbiomed.2013.09.025

Abstract

Abstract

Recent studies have raised concern over possible associations between high selenium (Se) status and excess adiposity, known to be linked to adverse cardiometabolic outcomes. Studies of Se status in relation to adiposity are scarce in the United Kingdom. This study examined cross-sectional associations of anthropometric indices with Se-status biomarkers in a nationally representative sample of 1045 (577 female, 468 male) British Caucasian adults ages 19-64 who participated in the 2000-2001 National Diet and Nutrition Survey. Median (first, third quartile) values for whole-blood glutathione peroxidase (GPx) activity and plasma and erythrocyte Se concentrations were 120.0 (103.0, 142.4) nmol mg Hb-1 min-1, 1.08 (0.98, 1.20) μmol/L, and 1.62 (1.38, 1.91) μmol/L, respectively. For males, values were 119.0 (100.0, 141.0) nmol mg Hb-1 min-1, 1.09 (0.99, 1.22) μmol/L, and 1.54 (1.34, 1.79) μmol/L, respectively; for females 121.0 (105.0, 145.0) nmol mg Hb-1 min-1, 1.07 (0.97, 1.18) μmol/L, and 1.71 (1.43, 1.99) μmol/L, respectively. Multivariate adjusted mean differences (95% CI) in whole-blood GPx between the highest (>30 kg/m2) and the lowest (

Arsenic exposure and cancer mortality in a US-based prospective cohort : The strong heart study

García-Esquinas, E., Pollán, M., Umans, J. G., Francesconi, K. A., Goessler, W., Guallar, E., Howard, B., Farley, J., Best, L. G., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Cancer Epidemiology Biomarkers and Prevention

Volume

22

Issue

11

Page(s)

1944-1953

10.1158/1055-9965.EPI-13-0234-T

Abstract

Abstract

Background: Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. rospective studies on carcinogenic effects at low-moderate arsenic levels are lacking. Methods: We evaluated the association between baseline arsenic exposure and cancer mortality in 3,932 American Indians, 45 to 74 years of age, from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, and 40 lymphatic/ hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate, and kidney cancers. Results: Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8-15.6) μg/g creatinine. The adjusted HRs [95% confidence interval (CI)] comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92-1.41) for overall cancer, 1.56 (1.02-2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28-8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09-5.58) for pancreatic cancer, and 0.46 (0.22-0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast. Conclusions: Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate, and pancreas. Impact: These findings support the role of low-moderate arsenic exposure in development of lung, prostate, and pancreas cancer and can inform arsenic risk assessment.

Association between cancer stigma and depression among cancer survivors : A nationwide survey in Korea

Cho, J., Choi, E. K., Kim, S. Y., Shin, D. W., Cho, B. L., Kim, C. H., Koh, D. H., Guallar, E., Bardwell, W. A., & Park, J. H. (n.d.).

Publication year

2013

Journal title

Psycho-Oncology

Volume

22

Issue

10

Page(s)

2372-2378

10.1002/pon.3302

Abstract

Abstract

Objective Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. Methods As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains - impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. Results A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. Conclusions Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. Impact Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment.

Association between exposure to low to moderate arsenic levels and incident cardiovascular disease

Moon, K. A., Guallar Dr., E., Umans Dr., J. G., Devereux Dr., R. B., Best Dr., L. G., Francesconi Dr., K. A., Goessler Dr., W., Pollak, J., Silbergeld Dr., E. K., Howard Dr., B. V., Navas-Acien Dr., A., & Guallar, E. (n.d.).

Publication year

2013

Journal title

Annals of internal medicine

Volume

159

Issue

10

Page(s)

649-659

10.7326/0003-4819-159-10-201311190-00719

Abstract

Abstract

Background: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (15.7 vs.

Blood lead level and measured glomerular filtration rate in children with chronic kidney disease

Fadrowski, J. J., Abraham, A. G., Navas-Acien, A., Guallar, E., Weaver, V. M., & Furth, S. L. (n.d.).

Publication year

2013

Journal title

Environmental health perspectives

Volume

121

Issue

8

Page(s)

965-970

10.1289/ehp.1205164

Abstract

Abstract

Background: The role of environmental exposure to lead as a risk factor for chronic kidney disease (CKD) and its progression remains controversial, and most studies have been limited by a lack of direct glomerular filtration rate (GFR) measurement. Objective: We evaluated the association between lead exposure and GFR in children with CKD. Methods: In this cross-sectional study, we examined the association between blood lead levels (BLLs) and GFR measured by the plasma disappearance of iohexol among 391 participants in the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Results: Median BLL and GFR were 1.2; μg/dL and 44.4; mL/min per 1.73; m2, respectively. The average percent change in GFR for each 1--μg/dL increase in BLL was -2.1 (95% CI: -6.0, 1.8). In analyses stratified by CKD diagnosis, the association between BLL and GFR was stronger among children with glomerular disease underlying CKD; in this group, each 1--μg/dL increase in BLL was associated with a -12.1 (95% CI: -22.2, -1.9) percent change in GFR. In analyses stratified by anemia status, each 1--μg/dL increase in BLL among those with and without anemia was associated with a -0.3 (95% CI: -7.2, 6.6) and -4.6 (95% CI: -8.9, -0.3) percent change in GFR, respectively. Conclusions: There was no significant association between BLL and directly measured GFR in this relatively large cohort of children with CKD, although associations were observed in some subgroups. Longitudinal analyses are needed to examine the temporal relationship between lead and GFR decline, and to further examine the impact of underlying cause of CKD and anemia/hemoglobin status among patients with CKD.

Body composition and arsenic metabolism : A cross-sectional analysis in the Strong Heart Study

Gribble, M. O., Crainiceanu, C. M., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Zhang, Y., Silbergeld, E. K., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Environmental Health: A Global Access Science Source

Volume

12

Issue

1

10.1186/1476-069X-12-107

Abstract

Abstract

Objective. The objective of this study was to evaluate the association between measures of body composition and patterns of urine arsenic metabolites in the 1989-1991 baseline visit of the Strong Heart Study, a cardiovascular disease cohort of adults recruited from rural communities in Arizona, Oklahoma, North Dakota and South Dakota. Methods. We evaluated 3,663 Strong Heart Study participants with urine arsenic species above the limit of detection and no missing data on body mass index, % body fat and fat free mass measured by bioelectrical impedance, waist circumference and other variables. We summarized urine arsenic species patterns as the relative contribution of inorganic (iAs), methylarsonate (MMA) and dimethylarsinate (DMA) species to their sum. We modeled the associations of % arsenic species biomarkers with body mass index, % body fat, fat free mass, and waist circumference categories in unadjusted regression models and in models including all measures of body composition. We also considered adjustment for arsenic exposure and demographics. Results: Increasing body mass index was associated with higher mean % DMA and lower mean % MMA before and after adjustment for sociodemographic variables, arsenic exposure, and for other measures of body composition. In unadjusted linear regression models, % DMA was 2.4 (2.1, 2.6) % higher per increase in body mass index category (< 25, ≥25 &

Cadmium exposure and clinical cardiovascular disease : A systematic review topical collection on nutrition

Tellez-Plaza, M., Jones, M. R., Dominguez-Lucas, A., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Current atherosclerosis reports

Volume

15

Issue

10

10.1007/s11883-013-0356-2

Abstract

Abstract

Mounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95 % CI: 1.11, 1.66), 1.30 (95 % CI: 1.12, 1.52), 1.18 (95 % CI: 0.86, 1.59), and 1.49 (95 % CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.

Cadmium exposure and incident cardiovascular disease

Tellez-Plaza, M., Guallar, E., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Devereux, R. B., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Epidemiology

Volume

24

Issue

3

Page(s)

421-429

10.1097/EDE.0b013e31828b0631

Abstract

Abstract

BACKGROUND: Cadmium is a widespread toxic metal with potential cardiovascular effects, but no studies have evaluated cadmium and incident cardiovascular disease. We evaluated the association of urine cadmium concentration with cardiovascular disease incidence and mortality in a large population-based cohort. METHODS: We conducted a prospective cohort study of 3348 American Indian adults 45-74 years of age from Arizona, Oklahoma, and North and South Dakota, who participated in the Strong Heart Study in 1989-1991. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through 31 December 2008. RESULTS: The geometric mean cadmium level in the study population was 0.94 μg/g (95% confidence interval [CI] = 0.92-0.96). We identified 1084 cardiovascular events, including 400 deaths. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratios (HRs) (comparing the 80th to the 20th percentile of urine cadmium concentrations) was 1.43 for cardiovascular mortality (95% CI = 1.21-1.70) and 1.34 for coronary heart disease mortality (1.10-1.63). The corresponding HRs for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.24 (1.11-1.38), 1.22 (1.08-1.38), 1.75 (1.17-2.59), and 1.39 (1.01-1.94), respectively. The associations were similar in most study subgroups, including never-smokers. CONCLUSIONS: Urine cadmium, a biomarker of long-term exposure, was associated with increased cardiovascular mortality and increased incidence of cardiovascular disease. These findings support that cadmium exposure is a cardiovascular risk factor.

Cadmium exposure and incident peripheral arterial disease

Tellez-Plaza, M., Guallar, E., Fabsitz, R. R., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Devereux, R. B., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Circulation: Cardiovascular Quality and Outcomes

Volume

6

Issue

6

Page(s)

626-633

10.1161/CIRCOUTCOMES.112.000663

Abstract

Abstract

Background-Cadmium has been associated with peripheral arterial disease (PAD) in cross-sectional studies, but prospective evidence is lacking. Our goal was to evaluate the association of urine cadmium concentrations with incident PAD in a large population-based cohort. Methods and Results-A prospective cohort study was performed with 2864 adult American Indians 45 to 74 years of age from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2 follow-up examination visits in 1993 to 1995 and 1997 to 1999. Participants were free of PAD, defined as an ankle brachial index lt;0.9 or >1.4 at baseline, and had complete baseline information on urine cadmium, potential confounders, and ankle brachial index determinations in the follow-up examinations. Urine cadmium was measured using inductively coupled plasma mass spectrometry and corrected for urinary dilution by normalization to urine creatinine. Multivariable-adjusted hazard ratios were computed using Cox-proportional hazards models for interval-censored data. A total of 470 cases of incident PAD, defined as an ankle brachial index 1.4, were identified. After adjustment for cardiovascular disease risk factors including smoking status and pack-years, the hazard ratio comparing the 80th to the 20th percentile of urine cadmium concentrations was 1.41 (1.05-1.81). The hazard ratio comparing the highest to the lowest tertile was 1.96 (1.32-2.81). The association persisted after excluding participants with ankle brachial index >1.4 only as well as in subgroups defined by sex and smoking status. Conclusions-Urine cadmium, a biomarker of long-term cadmium exposure, was independently associated with incident PAD, providing further support for cadmium as a cardiovascular disease risk factor.

Closing in on the truth about recombinant human bone morphogenetic protein-2 : Evidence synthesis, data sharing, peer review, and reproducible research

Laine, C., Guallar, E., Mulrow, C., Taichman, D. B., Cornell, J. E., Cotton, D., Griswold, M. E., Russell Localio, A., Meibohm, A. R., Stack, C. B., Williams, S. V., & Goodman, S. N. (n.d.).

Publication year

2013

Journal title

Annals of internal medicine

Volume

158

Issue

12

Page(s)

916-918

10.7326/0003-4819-158-12-201306180-00012

Abstract

Abstract

~

Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer

Shin, D. W., Cho, J., Kim, S. Y., Guallar, E., Hwang, S. S., Cho, B., Oh, J. H., Jung, K. W., Seo, H. G., & Park, J. H. (n.d.).

Publication year

2013

Journal title

Annals of Surgical Oncology

Volume

20

Issue

8

Page(s)

2468-2476

10.1245/s10434-013-2957-y

Abstract

Abstract

Background: Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival. Methods: Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years. Results: For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1-4 after diagnosis were 2.65 (1.50-4.70) and 1.91 (1.06-3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient's residence and the hospital performing surgery, and the patient's income status were associated with delayed surgery. Conclusions: Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care.

Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias

De Mazumder, D., Lake, D. E., Cheng, A., Moss, T. J., Guallar, E., Weiss, R. G., Jones, S. R., Tomaselli, G. F., & Moorman, J. R. (n.d.).

Publication year

2013

Journal title

Circulation: Arrhythmia and Electrophysiology

Volume

6

Issue

3

Page(s)

555-561

10.1161/CIRCEP.113.000034

Abstract

Abstract

Background-Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. Methods and Results-In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. Conclusions-This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.

EGFR Mutation Testing in Patients with Advanced Non-Small Cell Lung Cancer : A Comprehensive Evaluation of Real-World Practice in an East Asian Tertiary Hospital

Choi, Y. L., Sun, J. M., Cho, J., Rampal, S., Han, J., Parasuraman, B., Guallar, E., Lee, G., Lee, J., & Shim, Y. M. (n.d.).

Publication year

2013

Journal title

PloS one

Volume

8

Issue

2

10.1371/journal.pone.0056011

Abstract

Abstract

Introduction: Guidelines for management of non-small cell lung cancer (NSCLC) strongly recommend EGFR mutation testing. These recommendations are particularly relevant in Asians that have higher EGFR mutation prevalence. This study aims to explore current testing practices, logistics of testing, types of EGFR mutation, and prevalence of EGFR mutations in patients with advanced NSCLC in a large comprehensive cancer center in Korea. Methods: Our retrospective cohort included 1,503 NSCLC patients aged ≥18 years, with stage IIIB/IV disease, who attended the Samsung Medical Center in Seoul, Korea, from January 2007 through July 2010. Trained oncology nurses reviewed and abstracted data from electronic medical records. Results: This cohort had a mean age (SD) of 59.6 (11.1) years, 62.7% were males, and 52.9% never-smokers. The most common NSCLC histological types were adenocarcinoma (70.5%) and squamous cell carcinoma (18.0%). Overall, 39.5% of patients were tested for EGFR mutations. The proportion of patients undergoing EGFR testing during January 2007 through July 2008, August 2008 through September 2009, and October 2009 through July 2010 were 23.3%, 38.3%, and 63.5%, respectively (P

Enough is enough : Stop wasting money on vitamin and mineral supplements.

Guallar, E., Stranges, S., Mulrow, C., Appel, L. J., & Miller, E. R. (n.d.).

Publication year

2013

Journal title

Annals of internal medicine

Volume

159

Issue

12

Page(s)

850-851

Abstract

Abstract

~

Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases

Park, C., Guallar, E., Linton, J. A., Lee, D. C., Jang, Y., Son, D. K., Han, E. J., Baek, S. J., Yun, Y. D., Jee, S. H., & Samet, J. M. (n.d.).

Publication year

2013

Journal title

Diabetes Care

Volume

36

Issue

7

Page(s)

1988-1993

10.2337/dc12-1577

Abstract

Abstract

Objective-Although diabetes increases the risk of cardiovascular disease (CVD) and mortality, the dose-response relationship between fasting glucose levels below those diagnostic of diabetes with cardiovascular events has not been well characterized. Research design and methods-A prospective cohort study of more than one million Koreans was conducted with a mean follow-up of 16 years. A total of 1,197,384 Korean adults with no specific medical conditions diagnosed were classified by baseline fasting serum glucose level. Associations of fasting glucose level with CVD incidence and mortality, stroke incidence and mortality, and all-cause mortality were analyzed using multivariate proportional hazards regression. ResultsThe relationships between fasting glucose levels and CVD risks generally followed J-shape curves, with lowest risk in the glucose range of 85-99 mg/dL. As fasting glucose levels increased to .100 mg/dL, risks for CVD, ischemic heart disease, myocardial infarction, and thrombotic stroke progressively increased, but risk for hemorrhagic stroke did not. Fasting glucose levels ,70 mg/dL were associated with increased risk of all stroke (hazard ratio 1.06, 95% CI 1.01-1.11) in men and (hazard ratio 1.11, 1.05-1.17) in women. Conclusions-Both low glucose level and impaired fasting glucose should be considered as predictors of risk for stroke and coronary heart disease. The fasting glucose level associated with the lowest cardiovascular risk may be in a narrow range.