Eliseo Guallar
Eliseo Guallar
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Chair and Professor of the Department of Epidemiology
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Professional overview
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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.
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Education
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Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, SpainMD, University of Zaragoza, Zaragoza, SpainMPH, University of Minnesota, Minneapolis, MNDrPH, Harvard University, Boston, MA
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Honors and awards
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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)
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Publications
Publications
Guideline-concordant antipsychotic use and mortality in schizophrenia
AbstractCullen, B. A., Mcginty, E. E., Zhang, Y., Dosreis, S. C., Steinwachs, D. M., Guallar, E., & Daumit, G. L. (n.d.).Publication year
2013Journal title
Schizophrenia bulletinVolume
39Issue
5Page(s)
1159-1168AbstractObjective: To determine if care concordant with 2009 Schizophrenia Patient Outcomes Research Team (PORT) pharmacological recommendations for schizophrenia is associated with decreased mortality. Methods: We conducted a retrospective cohort study of adult Maryland Medicaid beneficiaries with schizophrenia and any antipsychotic use from 1994 to 2004 (N = 2132). We used Medicaid pharmacy data to measure annual and average antipsychotic continuity, to calculate chlorpromazine (CPZ) dosing equivalents, and to examine anti-Parkinson medication use. Cox proportional hazards regression models were used to examine the relationship between antipsychotic continuity, antipsychotic dosing, and anti-Parkinson medication use and mortality. Results: Annual antipsychotic continuity was associated with decreased mortality. Among patients with annual continuity greater than or equal to 90%, the hazard ratio [HR] for mortality was 0.75 (95% confidence interval [CI] 0.57-0.99) compared with patients with annual medication possession ratios (MPRs) of less than 10%. The HRs for mortality associated with continuous annual and average antipsychotic continuity were 0.75 (95% CI 0.58-0.98) and 0.84 (95% CI 0.58-1.21), respectively. Among users of first-generation antipsychotics, doses greater than or equal to 1500 CPZ dosing equivalents were associated with increased risk of mortality (HR 1.88, 95% CI 1.10-3.21), and use of anti-Parkinson medication was associated with decreased risk of mortality (HR 0.72, 95% CI 0.55-0.95). Mental health visits were also associated with decreased mortality (HR 0.96, 95% CI 0.93-0.98). Conclusions: Adherence to PORT pharmacological guidelines is associated with reduced mortality among patients with schizophrenia. Adoption of outcomes monitoring systems and innovative service delivery programs to improve adherence to the PORT guidelines should be considered.Heritability and preliminary genome-wide linkage analysis of arsenic metabolites in urine
AbstractTellez-Plaza, M., Gribble, M. O., Saroja Voruganti, V., Francesconi, K. A., Goessler, W., Umans, J. G., Silbergeld, E. K., Guallar, E., Franceschini, N., North, K. E., Kao, W. H., MacCluer, J. W., Cole, S. A., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
Environmental health perspectivesVolume
121Issue
3Page(s)
345-351AbstractBackground: Arsenic (III) methyltransferase (AS3MT) has been related to urine arsenic metabolites in association studies. Other genes might also play roles in arsenic metabolism and excretion. Objective: We evaluated genetic determinants of urine arsenic metabolites in American Indian adults from the Strong Heart Study (SHS). Methods: We evaluated heritability of urine arsenic metabolites [percent inorganic arsenic (%iAs), percent monomethylarsonate (%MMA), and percent dimethylarsinate (%DMA)] in 2,907 SHS participants with urine arsenic measurements and at least one relative within the cohort. We conducted a preliminary linkage analysis in a subset of 487 participants with available genotypes on approximately 400 short tandem repeat markers using a general pedigree variance component approach for localizing quantitative trait loci (QTL). Results: The medians (interquartile ranges) for %iAs, %MMA, and %DMA were 7.7% (5.4-10.7%), 13.6% (10.5-17.1%), and 78.4% (72.5-83.1%), respectively. The estimated heritability was 53% for %iAs, 50% for %MMA, and 59% for %DMA. After adjustment for sex, age, smoking, body mass index, alcohol consumption, region, and total urine arsenic concentrations, LOD [logarithm (to the base of 10) of the odds] scores indicated suggestive evidence for genetic linkage with QTLs influencing urine arsenic metabolites on chromosomes 5 (LOD = 2.03 for %iAs), 9 (LOD = 2.05 for %iAs and 2.10 for %MMA), and 11 (LOD = 1.94 for %iAs). A peak for %DMA on chromosome 10 within 2 Mb of AS3MT had an LOD of 1.80. Conclusions: This population-based family study in American Indian communities supports a genetic contribution to variation in the distribution of arsenic metabolites in urine and, potentially, the involvement of genes other than AS3MT.Heritability of myopia and ocular biometrics in Koreans : the healthy twin study.
AbstractKim, M. H., Zhao, D., Kim, W., Lim, D. H., Song, Y. M., Guallar, E., Cho, J., Sung, J., Chung, E. S., & Chung, T. Y. (n.d.).Publication year
2013Journal title
Unknown JournalVolume
54Issue
5Page(s)
3644-3649AbstractTo estimate the heritabilities of myopia and ocular biometrics among different family types among a Korean population. We studied 1508 adults in the Healthy Twin Study. Spherical equivalent, axial length, anterior chamber depth, and corneal astigmatism were measured by refraction, corneal topography, and A-scan ultrasonography. To see the degree of resemblance among different types of family relationships, intraclass correlation coefficients (ICC) were calculated. Variance-component methods were applied to estimate the genetic contributions to eye phenotypes as heritability based on the maximum likelihood estimation. Narrow sense heritability was calculated as the proportion of the total phenotypic variance explained by additive genetic effects, and linear and nonlinear effects of age, sex, and interactions between age and sex were adjusted. A total of 240 monozygotic twin pairs, 45 dizygotic twin pairs, and 938 singleton adult family members who were first-degree relatives of twins in 345 families were included in the study. ICCs for spherical equivalent from monozygotic twins, pooled first-degree pairs, and spouse pairs were 0.83, 0.34, and 0.20, respectively. The ICCs of other ocular biometrics were also significantly higher in monozygotic twins compared with other relative pairs, with greater consistency and conformity. The estimated narrow sense heritability (95% confidence interval) was 0.78 (0.71-0.84) for spherical equivalent; 0.86 (0.82-0.90) for axial length; 0.83 (0.76-0.91) for anterior chamber depth; and 0.70 (0.63-0.77) for corneal astigmatism. The estimated heritability of spherical equivalent and ocular biometrics in the Korean population suggests the compelling evidence that all traits are highly heritable.Lactate and Risk of Incident Diabetes in a Case-Cohort of the Atherosclerosis Risk in Communities (ARIC) Study
AbstractJuraschek, S. P., Shantha, G. P., Chu, A. Y., Miller, E. R., Guallar, E., Hoogeveen, R. C., Ballantyne, C. M., Brancati, F. L., Schmidt, M. I., Pankow, J. S., & Young, J. H. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
1AbstractBackground: Oxidative capacity is decreased in type 2 diabetes. Whether decreased oxidative capacity is a cause or consequence of diabetes is unknown. Our purpose is to evaluate whether lactate, a marker of oxidative capacity, is associated with incident diabetes. Methods and Findings: We conducted a case-cohort study in the Atherosclerosis Risk in Communities (ARIC) study at year 9 of follow-up. We evaluated lactate's association with diabetes risk factors at baseline and estimated the hazard ratio for incident diabetes by quartiles of plasma lactate in 544 incident diabetic cases and 533 non-cases. Plasma lactate showed a graded positive relationship with fasting glucose and insulin (PLetter and reply : Reply
AbstractSpector, J. T., Navas-Acien, A., Fadrowski, J., Guallar, E., Jaar, B., & Weaver, V. (n.d.).Publication year
2013Journal title
Nephrology Dialysis TransplantationVolume
28Issue
8Page(s)
e8-e9Abstract~Letter to the editor
AbstractTellez-Plaza, M., Guallar, E., Howard, B. V., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
EpidemiologyVolume
24Issue
5Page(s)
784-785Abstract~Mercury exposure in young adulthood and incidence of diabetes later in life : The CARDIA trace element study
AbstractHe, K., Xun, P., Liu, K., Morris, S., Reis, J., & Guallar, E. (n.d.).Publication year
2013Journal title
Diabetes CareVolume
36Issue
6Page(s)
1584-1589AbstractOBJECTIVE - Laboratory studies suggest that exposure to methylmercury at a level similar to those found in fish may induce pancreatic islet β-cell dysfunction. Few, if any, human studies have examined the association between mercury exposure and diabetes incidence. We examined whether toenail mercury levels are associated with incidence of diabetes in a large prospective cohort. RESEACH DESIGN AND METHODS - A prospective cohort of 3,875 American young adults, aged 20-32 years, free of diabetes in 1987 (baseline), were enrolled and followed six times until 2005. Baseline toenail mercury levels were measured with instrumental neutron-activation analysis. Incident diabetes was identified by plasma glucose levels, oral glucose tolerance tests, hemoglobin A1C levels, and/or antidiabetes medications. RESULTS - A total of 288 incident cases of diabetes occurred over 18 years of follow-up. In multivariate analyses adjusted for age, sex, ethnicity, study center, education, smoking status, alcohol consumption, physical activity, family history of diabetes, intakes of long-chain n-3 fatty acids and magnesium, and toenail selenium, toenail mercury levels were positively associated with the incidence of diabetes. The hazard ratio (95% CI) of incident diabetes compared the highest to the lowest quintiles of mercury exposure was 1.65 (1.07 -2.56; P for trend = 0.02). Higher mercury exposure at baseline was also significantly associated with decreased homeostasis model assessment of β-cell function index (P for trend < 0.01). CONCLUSIONS - Our results are consistent with findings from laboratory studies and provide longitudinal human data suggesting that people with high mercury exposure in young adulthood may have elevated risk of diabetes later in life.Meta-analysis : Vitamin D and non-alcoholic fatty liver disease
AbstractEliades, M., Spyrou, E., Agrawal, N., Lazo, M., Brancati, F. L., Potter, J. J., Koteish, A. A., Clark, J. M., Guallar, E., Hernaez, R., & Guallar, E. (n.d.).Publication year
2013Journal title
Alimentary Pharmacology and TherapeuticsVolume
38Issue
3Page(s)
246-254AbstractBackground Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition. Emerging evidence suggests that vitamin D may play a role in the pathogenesis of NAFLD. Aim To review systematically the association between vitamin D levels, measured as serum 25-hydroxy vitamin D [25(OH)D], and NAFLD. Methods We used PubMed and EMBASE databases to identify all studies that assessed the association between vitamin D and NAFLD up until 22 April 2013, without language restrictions. We included studies that compared vitamin D levels between NAFLD cases and controls and also those that compared the odds of vitamin D deficiency by NAFLD status. Pooled standardised differences and odds ratios were calculated using an inverse variance method. Results Seventeen cross-sectional and case-control studies have evaluated the association between vitamin D and NAFLD. NAFLD was diagnosed using biopsy (4 studies), ultrasound or CT (10 studies) and liver enzymes (3 studies). Nine studies provided data for a quantitative meta-analysis. Compared to controls, NAFLD patients had 0.36 ng/mL (95% CI: 0.32, 0.40 ng/mL) lower levels of 25(OH)D and were 1.26 times more likely to be vitamin D deficient (OR 1.26, 95% CI: 1.17, 1.35). Conclusions NAFLD patients have decreased serum 25(OH)D concentrations, suggesting that vitamin D may play a role in the development of NAFLD. The directionality of this association cannot be determined from cross-sectional studies. Demonstration of a causal role of hypovitaminosis D in NAFLD development in future studies could have important therapeutic implications.Past history of skin infection and risk of surgical site infection after elective surgery
AbstractFaraday, N., Rock, P., Lin, E. E., Perl, T. M., Carroll, K., Stierer, T., Robarts, P., McFillin, A., Ross, T., Shah, A. S., Riley, L. H., Tamargo, R. J., Black, J. H., Blasco-Colmenares, E., & Guallar, E. (n.d.).Publication year
2013Journal title
Annals of SurgeryVolume
257Issue
1Page(s)
150-154AbstractOBJECTIVE: To identify baseline patient characteristics associated with increased susceptibility to surgical site infection (SSI) after elective surgery. BACKGROUND: The Center for Medicare and Medicaid Services considers SSI to be preventable through adherence to current infection control practices; however, the etiology of wound infection is incompletely understood. METHODS: Prospective cohort study involving patients undergoing cardiac, vascular, craniotomy, and spinal surgery at 2 academic medical centers in Baltimore, MD. A comprehensive medical history was obtained at baseline, and participants were followed for 6 months using active inpatient and outpatient surveillance for deep SSI and infectious death. Infection control best practices were monitored perioperatively. The relative risk of SSI/infectious death was determined comparing those with versus those without a past medical history of skin infection using Cox proportional hazards models. RESULTS: Of 613 patients (mean [SD] = 62.3 [11.5] years; 42.1% women), 22.0% reported a history of skin infection. The cumulative incidence of deep SSI/infectious death was 6.7% versus 3.1% for those with and without a history of skin infection, respectively (unadjusted hazard ratio (HR) = 2.25; 95% confidence interval (95% CI), 0.98-5.14; P = 0.055). Risk estimates increased after adjustments for demographic and socioeconomic variables (HR = 2.82; 95% CI, 1.18-6.74; P = 0.019) and after propensity score adjustment for all potential confounders (HR = 3.41; 95% CI, 1.36-8.59; P = 0.009). Adjustments for intraoperative infection risk factors and adherence to infection control best practice metrics had no impact on risk estimates. CONCLUSIONS: A history of skin infection identified a state of enhanced susceptibility to SSI at baseline that is independent of traditional SSI risk factors and adherence to current infection control practices.Postmenopausal hormone therapy : The heart of the matter
AbstractGuallar, E., Manson, J. E., Laine, C., & Mulrow, C. (n.d.).Publication year
2013Journal title
Annals of internal medicineVolume
158Issue
1Page(s)
69-70Abstract~Prevalence of nonalcoholic fatty liver disease in the United States : The third national health and nutrition examination survey, 1988-1994
AbstractLazo, M., Hernaez, R., Eberhardt, M. S., Bonekamp, S., Kamel, I., Guallar, E., Koteish, A., Brancati, F. L., & Clark, J. M. (n.d.).Publication year
2013Journal title
American Journal of EpidemiologyVolume
178Issue
1Page(s)
38-45AbstractPrevious estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)2), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.Prospective observational study of implantable cardioverter-defibrillators in primary prevention of sudden cardiac death : study design and cohort description.
AbstractCheng, A., Dalal, D., Butcher, B., Norgard, S., Zhang, Y., Dickfeld, T., Eldadah, Z. A., Ellenbogen, K. A., Guallar, E., & Tomaselli, G. F. (n.d.).Publication year
2013Journal title
Unknown JournalVolume
2Issue
1Page(s)
e000083AbstractPrimary-prevention implantable cardioverter-defibrillators (ICDs) reduce total mortality in patients with severe left ventricular systolic function. However, only a minority of patients benefit from these devices. We designed the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD) to identify risk factors and enhance our understanding of the biological mechanisms that predispose to arrhythmic death in patients undergoing ICD implantation for primary prevention of sudden death. This is a multicenter prospective cohort study with a target enrollment of 1200 patients. The primary end point is ICD shocks for adjudicated ventricular tachyarrhythmias. The secondary end point is total mortality. All patients undergo a comprehensive evaluation including history and physical examination, signal-averaged electrocardiograms, and blood sampling for genomic, proteomic, and metabolomic analyses. Patients are evaluated every 6 months and after every known ICD shock for additional electrocardiographic and blood sampling. As of December 2011, a total of 1177 patients have been enrolled with more nonwhite and female patients compared to previous randomized trials. A total of 143 patients have reached the primary end point, whereas a total of 260 patients died over an average follow-up of 59 months. The PROSE-ICD study represents a real-world cohort of individuals with systolic heart failure receiving primary-prevention ICDs. Extensive electrophysiological and structural phenotyping as well as the availability of serial DNA and serum samples will be important resources for evaluating novel metrics for risk stratification and identifying patients at risk for arrhythmic sudden death. URL: http://clinicaltrials.gov/ Unique Identifier: NCT00733590.Prospective study of serum adiponectin and incident metabolic syndrome : The ARIRANG study
AbstractKim, J. Y., Ahn, S. V., Yoon, J. H., Koh, S. B., Yoon, J., Yoo, B. S., Lee, S. H., Park, J. K., Choe, K. H., & Guallar, E. (n.d.).Publication year
2013Journal title
Diabetes CareVolume
36Issue
6Page(s)
1547-1553AbstractOBJECTIVE - Increased adiponectin levels may play a protective role in the development of metabolic abnormalities, but prospective studies of the predictive value of serum adiponectin to identify individuals at high risk of new-onset metabolic syndrome are lacking. We investigated whether serum adiponectin predicts incident cases of the metabolic syndrome in a populationbased longitudinal study. RESEARCH DESIGN ANDMETHODS - A prospective cohort study was conducted of 2,044 adults (831 men and 1,213 women) aged 40-70 years without metabolic syndrome examined in 2005-2008 (baseline) and 2008 - 2011 (follow-up). Baseline serum adiponectin concentrations were measured by radioimmunoassay. RESULTS - During an average of 2.6 years of follow-up, 153 men (18.4%) and 199 women (16.4%) developed metabolic syndrome. In multivariable-adjusted models, the odds ratio for incident metabolic syndrome comparing the highest with the lowest quartiles of adiponectin levels was 0.25 (95% CI 0.14-0.47) in men and 0.45 (0.28-0.74) in women. While serum adiponectin did not improve the area under the ROC curve for predicting new-onset metabolic syndrome based on information from metabolic syndrome components, the net reclassification improvement and the integrated discrimination improvement of prediction models including adiponectin were significantly higher compared with those of models not including adiponectin among men, with a signi ficant difference between men and women (P = 0.001). CONCLUSIONS - Increased adiponectin is an independent protective factor for incident metabolic syndrome in men and women, and it may have a clinical role in predicting new-onset metabolic syndrome among men.Public attitudes toward cancer and cancer patients : A national survey in Korea
AbstractCho, J., Smith, K., Choi, E. K., Kim, I. R., Chang, Y. J., Park, H. Y., Guallar, E., & Shim, Y. M. (n.d.).Publication year
2013Journal title
Psycho-OncologyVolume
22Issue
3Page(s)
605-613AbstractBackground Regardless of improved survival rate, negative images and myths about cancer still abound. Cancer stigma may reduce patients' life opportunities resulting in social isolation, decreased level of emotional well-being, and poor health outcomes. This study was aimed to evaluate public attitudes toward cancer and cancer patients and people's willingness to disclose cancer diagnosis in South Korea. Methods A cross-sectional survey was conducted in August and September 2009. A nationally representative sample of 1011 men and women with no history of cancer was recruited. A set of 12 questions grouped into three domains (impossibility of recovery, cancer stereotypes, and discrimination) was used to assess public attitudes toward cancer. Results It was found 58.5% of study participants agreed that it is impossible to treat cancer regardless of highly developed medical science, 71.8% agreed that cancer patients would not be able to make contributions to society, and 23.5% agreed that they would avoid working with persons who have cancer. The proportions of people who said that that they would not disclose a cancer diagnosis to family, friends or neighbors, or coworkers were 30.2%, 47.0%, and 50.7%, respectively. Negative attitudes toward cancer were strongly associated with lower willingness to disclose a cancer diagnosis. Conclusions Negative attitudes, stereotypes, and discriminating attitudes toward cancer and people affected by the disease were very common in spite of clinical progress and improved survivorship. Impact Our findings emphasize the need for health policy and social changes to provide a more supportive environment for cancer survivors.Racial patterns of cardiovascular disease risk factors in serious mental illness and the overall U.S. population
AbstractKeenan, T. E., Yu, A., Cooper, L. A., Appel, L. J., Guallar, E., Gennusa, J. V., Dickerson, F. B., Crum, R. M., Anderson, C. A., Campbell, L. M., Young, D. R., & Daumit, G. L. (n.d.).Publication year
2013Journal title
Schizophrenia ResearchVolume
150Issue
1Page(s)
211-216AbstractBackground: Serious mental illness (SMI) and minority race are each associated with elevated cardiovascular disease (CVD) mortality. However, little is known about racial variation in CVD risk factors in individuals with SMI. This study aimed to determine racial patterns of CVD risk factors in individuals with SMI and to compare these patterns to those of the general population. Methods: Overweight/obese adults with SMI (163 whites; 111 African Americans) examined from 2008 to 2011 during a weight loss trial were compared at study baseline to overweight/obese adults (1103 whites; 550 African Americans) of similar age, sex, and race in the 2007 to 2010 National Health and Nutrition Examination Survey. Results: All CVD risk factors except cholesterol were higher in SMI than the overall U.S. population. After adjusting for age and sex, both racial groups with SMI had similarly high risks of smoking, obesity, diabetes, and hypertension, while African Americans with SMI had lower risks of high cholesterol (RR 0.73; 95% CI 0.57-0.94) and metabolic syndrome (RR 0.75; 95% CI 0.63-0.91) than whites with SMI. In the U.S. population sample, African Americans compared to whites had higher risks of obesity (RR 1.23; 95% CI 1.14-1.34), diabetes (RR 1.68; 95% CI 1.21-2.34), and hypertension (RR 1.44; 95% CI 1.31-1.60) but no significant difference in smoking, high cholesterol, and metabolic syndrome. Conclusions: Compared to the general population, the greater burden and dissimilar racial pattern of CVD risk factors in SMI underscore the need for CVD prevention programs targeting the SMI population.Real world impact of epidermal growth factor receptor mutation status on treatment patterns in patients with non-small cell lung cancer
AbstractSun, J. M., Rampal, S., Lee, G., Lee, J., Choi, Y. L., Parasuraman, B., Guallar, E., Cho, J., & Shim, Y. M. (n.d.).Publication year
2013Journal title
Lung CancerVolume
80Issue
2Page(s)
191-196AbstractBackground: Epidermal growth factor receptor (EGFR) mutation status is an important predictor of the efficacy of EGFR tyrosine kinase inhibitor (TKI) therapy in patients with non-small cell lung cancer (NSCLC). We evaluated the real impact of EGFR mutation status on chemotherapy patterns of NSCLC patients. Patients and methods: This is a retrospective cohort study of consecutive advanced NSCLC patients attended at the Samsung Medical Centre in Seoul, Korea, from January 2007 through July 2010. EGFR mutation was analyzed by direct sequencing testing. Results: Among 1164 patients treated during the study period, 166 (14.3%) were EGFR mutation positive, 275 (23.6%) were mutation negative, and 723 (62.1%) had mutation status unknown. Overall, 605 (52%) received TKI therapy as a first-, second-, or third-line therapy. The proportions of patients receiving TKI therapy among those with positive, negative and unknown EGFR mutation status were 88.0, 46.5, and 45.8%, respectively. After adjustment for other factors, patients with a positive EGFR mutation status (odds ratio [OR] 7.88, 95% CI 4.58, 13.57), and those who were female (OR 2.83, 95% CI 2.04, 3.92) or had poor performance status (OR 1.58, 95% CI 1.13, 2.22) were significantly more likely to receive TKI treatment. Furthermore, the temporal relationship between EGFR mutation reporting and initiation of TKI therapy significantly differed by EGFR mutation status. Conclusion: EGFR mutation status significantly affected the chemotherapy patterns in advanced NSCLC. More widespread EGFR testing and the use of faster and more sensitive mutation tests will result in more timely and appropriate use of TKI therapy in advanced NSCLC.Response to comment on : Kim et al. Prospective study of serum adiponectin and incident metabolic syndrome: The ARIRANG Study. Diabetes Care 2013; 36:1547-1553
AbstractKim, J. Y., Ahn, S. V., & Guallar, E. (n.d.).Publication year
2013Journal title
Diabetes CareVolume
36Issue
9Page(s)
e168Abstract~Selenium and hypertension : Do we need to reconsider selenium supplementation in cancer patients?
AbstractGouni-Berthold, I., Michalke, B., Krone, W., Guallar, E., & Berthold, H. K. (n.d.).Publication year
2013Journal title
Journal of HypertensionVolume
31Issue
5Page(s)
1050-1052Abstract~Systematic review of three decades of Spanish cardiovascular epidemiology : Improving translation for a future of prevention
AbstractFranco, M., Bilal, U., Guallar, E., Sanz, G., Gómez, A. F., Fuster, V., & Cooper, R. (n.d.).Publication year
2013Journal title
European Journal of Preventive CardiologyVolume
20Issue
4Page(s)
565-576AbstractBackground: In order to improve national cardiovascular disease (CVD) epidemiology and prevention, we systematically reviewed and analyzed the relevant literature produced in the last three decades for Spain. Design: Systematic Review. Methods: We searched for all the articles aiming to monitor CVD clinical endpoints and risk factors in the Spanish general population that were indexed in MEDLINE and EMBASE. Based on international recommendations, we analyzed each article with a three-level scoring system (low to high) for the following criteria: data quality, representativeness and translation of results into preventive interventions. Results: We reviewed 2565 articles, selecting 314 for in-depth analysis. Articles about diet, blood pressure, obesity and smoking represented 53% of all published CVD studies, whereas those about physical activity or psychosocial factors represented only 5%. Low data quality was found in 67% and 60% of the articles about physical activity and smoking, respectively. High data quality was found in 77% and 61% of the articles dedicated to diet and blood pressure, respectively. Representativeness was low for 41%, 31% and 25% of the studies focusing on diet, smoking and diabetes, respectively. Translation of research results into prevention scored lowest of all three criteria, as 41% of all 314 articles scored low. None of the articles on obesity, diabetes, lipids, physical activity or psychosocial factors identified any specific preventive intervention. Conclusion: Future Spanish CVD epidemiology research will benefit from improving not just the quality and representativeness of the data measured, but drastically improving the translation of research results into future preventive interventions. The lack of a translational focus remains the fundamental gap in CVD research.The association between cecal insertion time and colorectal neoplasm detection
AbstractYang, M. H., Cho, J., Rampal, S., Choi, E. K., Choi, Y. H., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Kim, J. J., Guallar, E., Rhee, J. C., & Son, H. J. (n.d.).Publication year
2013Journal title
BMC GastroenterologyVolume
13Issue
1AbstractBackground: Information on the impact of cecal insertion time on colorectal neoplasm detection is limited. Our objective was to determine the association between cecal insertion time and colorectal neoplasm detection rate in colonoscopy screening.Methods: We performed a cross-sectional study of 12,679 consecutive subjects aged 40-79 years undergoing screening colonoscopy in routine health check-ups at the Center for Health Promotion of the Samsung Medical Center from December 2007 to June 2009. Fixed effects logistic regression conditioning on colonoscopist was used to eliminate confounding due to differences in technical ability and other characteristics across colonoscopists.Results: The mean cecal insertion time was 5.9 (SD, 4.4 minutes). We identified 4,249 (33.5%) participants with colorectal neoplasms, of whom 1,956 had small single adenomas (The association of serum lipids with colorectal adenomas
AbstractYang, M. H., Rampal, S., Sung, J., Choi, Y. H., Son, H. J., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Kim, J. J., Rhee, J. C., Chun, H. K., Guallar, E., & Cho, J. (n.d.).Publication year
2013Journal title
American Journal of GastroenterologyVolume
108Issue
5Page(s)
833-841AbstractObjectives: There is suggestive but sparse evidence that dyslipidemia is associated with colorectal neoplasms. We investigated the association of serum lipid and apolipoprotein concentrations with the prevalence of colorectal adenomas. Methods: Cross-sectional study of 19,281 consecutive participants aged 40-79 years undergoing screening colonoscopy at the Center for Health Promotion of the Samsung Medical Center in Korea from January 2006 to June 2009. Results: We identified 5,958 participants with colorectal adenomas (30.9%), including 5,504 (28.5%) with non-advanced adenomas and 454 (2.4%) with advanced adenomas. The adjusted relative prevalence ratios (aRPRs) comparing the fourth with the first quartiles of serum triglycerides were 1.35 (95% confidence interval (CI) 1.20-1.52; P trendThe effects of n-3 long-chain polyunsaturated fatty acid supplementation on biomarkers of kidney injury in adults with diabetes : Results of the GO-FISH trial
AbstractMiller, E. R., Juraschek, S. P., Anderson, C. A., Guallar, E., Henoch-Ryugo, K., Charleston, J., Turban, S., Bennett, M. R., & Appel, L. J. (n.d.).Publication year
2013Journal title
Diabetes CareVolume
36Issue
6Page(s)
1462-1469AbstractOBJECTIVE - Long-chain n-3 polyunsaturated fatty acid (n-3 PUFA) supplements may have renoprotective effects in patients with diabetes, but previous trials have been inconsistent. We performed a randomized controlled trial of n-3 PUFA supplementation on urine albumin excretion and markers of kidney injury in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS - We conducted a randomized, placebo-controlled, two-period crossover trial to test the effects of 4 g/day of n-3 PUFA supplementation on markers of glomerular filtration and kidney injury in adults with adult-onset diabetes and greater than or equal to trace amounts of proteinuria. Each period lasted 6weeks andwas separated by a 2-week washout. The main outcome was urine albumin excretion and, secondarily, markers of kidney injury (kidney injury molecule-1, N-acetyl β-D-glucosaminidase [NAG], neutrophil gelatinase-associated lipocalin [NGAL], and liver fatty acid-binding protein [LFABP]), serum markers of kidney function (cystatin C, β2-microglobulin, and creatinine), and estimated glomerular filtration rate (eGFR). RESULTS - Of the 31 participants, 29 finished both periods. A total of 55% were male, and 61% were African American; mean age was 67 years. At baseline, mean BMI was 31.6 kg/m 2, median eGFR was 76.9 mL/min/1.73 m2, and median 24-h urine albumin excretion was 161 mg/day. Compared with placebo, n-3 PUFA had nonsignificant effects on urine albumin excretion (-7.2%; 95% CI -20.6 to 8.5; P = 0.35) and significant effects on urine NGAL excretion (-16% [-29.1 to -0.5%]; P = 0.04). There was no effect on serum markers of kidney function or eGFR. In subgroup analyses, there were significant decreases in 24-h urinary excretion of albumin, NGAL, LFABP, and NAG among participants taking medications that block the renin-angiotensin-aldosterone system (RAAS). CONCLUSIONS - These results suggest a potential effect of n-3 PUFA supplementation on markers of kidney injury in patients with diabetes and early evidence of kidney disease. In the context of prior studies, these results provide a strong rationale for long-term trials of n-3 PUFA on chronic kidney disease progression.The progression and early detection of subclinical atherosclerosis (PESA) study : Rationale and design
AbstractFernández-Ortiz, A., Jiménez-Borreguero, L. J., Peñalvo, J. L., Ordovás, J. M., Mocoroa, A., Fernández-Friera, L., Laclaustra, M., García, L., Molina, J., Mendiguren, J. M., López-Melgar, B., De Vega, V. M., Alonso-Farto, J. C., Guallar, E., Sillesen, H., Rudd, J. H., Fayad, Z. A., Ibañez, B., Sanz, G., & Fuster, V. (n.d.).Publication year
2013Journal title
American Heart JournalVolume
166Issue
6Page(s)
990-998AbstractBackground The presence of subclinical atherosclerosis is a likely predictor of cardiovascular events; however, factors associated with the early stages and progression of atherosclerosis are poorly defined. Objective The PESA study examines the presence of subclinical atherosclerosis by means of noninvasive imaging and prospectively analyzes the determinants associated with its development and progression in a middle-aged population. Methods The PESA study is an observational, longitudinal and prospective cohort study in a target population of 4000 healthy subjects (40-54 years old, 35% women) based in Madrid (Spain). Recruitment began in June 2010 and will be completed by the end of 2013. Baseline examination consists of (1) assessment for cardiovascular risk factors (including lifestyle and psychosocial factors); (2) screening for subclinical atherosclerosis using 2D/3D ultrasound in carotid, abdominal aorta and iliofemoral arteries, and coronary artery calcium score (CACS) by computed tomography; and (3) blood sampling for determination of traditional risk factors, advanced "omics" and biobanking. In addition, a subgroup of 1300 participants with evidence of atherosclerosis on 2D/3D ultrasound or CACS will undergo a combined 18F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (18FDG PET/MRI) study of carotid and iliofemoral arteries. Follow-up at 3 and 6 years will include a repetition of baseline measurements, except for the 18FDG PET/MRI study, which will be repeated at 6 years. Conclusions The PESA study is expected to identify new imaging and biological factors associated with the presence and progression of atherosclerosis in asymptomatic people and will help to establish a more personalized management of medical care.Thromboxane A2 generation, in the absence of platelet COX-1 activity, in patients with and without atherothrombotic myocardial infarction
AbstractDeFilippis, A. P., Oloyede, O. S., Andrikopoulou, E., Saenger, A. K., Palachuvattil, J. M., Fasoro, Y. A., Guallar, E., Blumenthal, R. S., Kickler, T. S., Jaffe, A. S., Gerstenblith, G., Schulman, S. P., & Rade, J. J. (n.d.).Publication year
2013Journal title
Circulation JournalVolume
77Issue
11Page(s)
2786-2792AbstractBackground: Aspirin's therapeutic action is via inhibition of platelet cyclooxygenase 1 (COX-1) thromboxane A2 (TxA2) production. The aim of this study was to evaluate TxA2 production, in the absence of platelet COX-1 activity, in coronary atherosclerotic heart disease patients with and without atherothrombotic myocardial infarction (MI). Methods and Results: TxA2 production, in the absence of platelet COX-1 activity, was evaluated in 44 patients taking aspirin on 3 commercially available assays that detect metabolites of TxA2 in the urine. Two assays measure urine 11-dehydro-thromboxane B2 (TxB2) alone and 1 measures urine 11-dehydro-TxB2 plus 11-dehydro-2,3-dinor- TxB2. Platelet COX-1 inhibition was confirmed onThyroid Hormones and Electrocardiographic Parameters : Findings from the Third National Health and Nutrition Examination Survey
AbstractZhang, Y., Post, W. S., Cheng, A., Blasco-Colmenares, E., Tomaselli, G. F., & Guallar, E. (n.d.).Publication year
2013Journal title
PloS oneVolume
8Issue
4AbstractIntroduction: Altered thyroid status exerts a major effect on the heart. Individuals with hypo- or hyperthyroidism showed various changes in electrocardiograms. However, little is known about how variations in thyroid hormone levels within the normal range affect electrical activities of the heart in the general population. Methods and Results: We conducted a cross-sectional analysis of 5,990 men and women from the Third National Health and Nutrition Examination Survey. Serum total T4 was measured by immunoassay and TSH was measured by chemiluminescent assay. We categorized T4 and TSH into 7 groups with cut-offs at the 5th, 20th, 40th, 60th, 80th, and 95th percentiles of the weighted population distribution. Electrocardiographic parameters were measured from the standard 12-lead electrocardiogram. We found a positive linear association between serum total T4 level and heart rate in men, and a U-shape association between T4 and PR interval in men and women. TSH level was positively associated with QRS interval in men, while a U-shape association between TSH and QRS was observed in women. No clear graded association between thyroid hormones and corrected QT or JT was found, except that men in the highest category of T4 levels appeared to have longer corrected QT and JT, and men in the lowest category of T4 appeared to have shorter corrected QT and JT. Conclusions: Variation in thyroid hormone levels in the general population, even within the normal range, was associated with various ECG changes.