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

Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations

Spector, J. T., Navas-Acien, A., Fadrowski, J., Guallar, E., Jaar, B., & Weaver, V. M. (n.d.).

Publication year

2011

Journal title

Nephrology Dialysis Transplantation

Volume

26

Issue

9

Page(s)

2786-2792

10.1093/ndt/gfq773

Abstract

Abstract

Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (

Blood cadmium and estimated glomerular filtration rate in Korean adults

Hwangbo, Y., Weaver, V. M., Tellez-Plaza, M., Guallar, E., Lee, B. K., & Navas-Acien, A. (n.d.).

Publication year

2011

Journal title

Environmental health perspectives

Volume

119

Issue

12

Page(s)

1800-1805

10.1289/ehp.1003054

Abstract

Abstract

Background: Cadmium is a nephrotoxicant at high exposure levels. Few studies have evaluated the role of cadmium in kidney function at low-exposure levels. Objective: We evaluated the association of blood cadmium with estimated glomerular filtration rate (eGFR) in the Korean adult population. Methods: We evaluated 1,909 adults ≥ 20 years of age who participated in the 2005 Korean National Health and Nutrition Examination Survey and had blood cadmium determinations. eGFR was calculated using the Modification of Diet in Renal Disease equation. Results: Blood cadmium geometric means were 1.57 μg/L for men and 1.49 μg/L for women. The difference in eGFR levels that compared participants in the highest versus lowest cadmium tertiles, after multivariable adjustment, was -1.85 [95% confidence interval (CI): -3.55, -0.16] mL/min per 1.73 m2 in women and 0.67 (-1.16, 2.50) mL/min per 1.73 m2 in men. Among men, the association between blood cadmium and eGFR was modified by blood lead levels (p-value for interaction = 0.048). The fully adjusted differences in eGFR levels for a 2-fold increase in blood cadmium levels were -1.14 (-3.35, 1.07) and 1.84 (0.54, 3.14) mL/min per 1.73 m2 in men with blood lead levels below and above the median (2.75 μg/dL), respectively. Conclusion: Elevated blood cadmium levels were associated with lower eGFR in women, which supports the role of cadmium as a risk factor for chronic kidney disease. In men, there was no overall association, although elevated blood cadmium levels were associated with higher eGFR levels in men with high blood lead levels and nonstatistically associated with lower eGFR levels in men with low blood lead levels.

Body fatness and sex steroid hormone concentrations in US men : Results from NHANES III

Rohrmann, S., Shiels, M. S., Lopez, D. S., Rifai, N., Nelson, W. G., Kanarek, N., Guallar, E., Menke, A., Joshu, C. E., Feinleib, M., Sutcliffe, S., & Platz, E. A. (n.d.).

Publication year

2011

Journal title

Cancer Causes and Control

Volume

22

Issue

8

Page(s)

1141-1151

10.1007/s10552-011-9790-z

Abstract

Abstract

Objective: Obesity is associated with a variety of chronic diseases, including cancer, which may partly be explained by its influence on sex steroid hormone concentrations. Whether different measures of obesity, i.e., body mass index (BMI), waist circumference, and percent body fat were differentially associated with circulating levels of sex steroid hormones was examined in 1,265 men, aged 20-90+ years old, attending the morning examination session of the Third National Health and Nutrition Examination Survey (NHANES III). Materials and methods: Serum hormones were measured by immunoassay. Weight, height, and waist circumference were measured by trained staff. Percent body fat was estimated from bioelectrical impedance. Multivariate linear regression was used to estimate associations between body fatness measures and hormone levels. Results: Total and free testosterone and sex hormone binding globulin concentrations decreased, whereas total and free estradiol increased with increasing BMI, waist circumference, and percent body fat (all p trend\0.05). The magnitude of change in these hormones was similar for a one-quartile increase in each body fatness measure. Conclusion: Measured BMI, waist circumference, and percent body fat led to similar inferences about their association with hormone levels in men.

Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)

Mata, N., Alonso, R., Badimán, L., Padrá, T., Fuentes, F., Mũiz, O., Perez-Jiménez, F., Lápez-Miranda, J., Díaz, J. L., Vidal, J. I., Barba, A., Piedecausa, M., Sanchez, J. F., Irigoyen, L., Guallar, E., Ordovas, J. M., & Mata, P. (n.d.).

Publication year

2011

Journal title

Lipids in Health and Disease

Volume

10

10.1186/1476-511X-10-94

Abstract

Abstract

Abstract. Aim. Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART. Methods and Results. A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe. Conclusion: Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.

Coffee, alcohol, smoking, physical activity and QT interval duration : Results from the Third National Health and Nutrition examination Survey

Zhang, Y., Post, W. S., Dalal, D., Blasco-Colmenares, E., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

PloS one

Volume

6

Issue

2

10.1371/journal.pone.0017584

Abstract

Abstract

Background: Abnormalities in the electrocardiographic QT interval duration have been associated with an increased risk of ventricular arrhythmias and sudden cardiac death. However, there is substantial uncertainty about the effect of modifiable factors such as coffee intake, cigarette smoking, alcohol consumption, and physical activity on QT interval duration. Methods: We studied 7795 men and women from the Third National Health and Nutrition Survey (NHANES III, 1988-1994). Baseline QT interval was measured from the standard 12-lead electrocardiogram. Coffee and tea intake, alcohol consumption, leisure-time physical activities over the past month, and lifetime smoking habits were determined using validated questionnaires during the home interview. Results: In the fully adjusted model, the average differences in QT interval comparing participants drinking ≥6 cups/day to those who did not drink any were -1.2 ms (95% CI -4.4 to 2.0) for coffee, and -2.0 ms (-11.2 to 7.3) for tea, respectively. The average differences in QT interval duration comparing current to never smokers was 1.2 ms (-0.6 to 2.9) while the average difference in QT interval duration comparing participants drinking ≥7 drinks/week to non-drinkers was 1.8 ms (-0.5 to 4.0). The age, race/ethnicity, and RR-interval adjusted differences in average QT interval duration comparing men with binge drinking episodes to non-drinkers or drinkers without binge drinking were 2.8 ms (0.4 to 5.3) and 4.0 ms (1.6 to 6.4), respectively. The corresponding differences in women were 1.1 (-2.9 to 5.2) and 1.7 ms (-2.3 to 5.7). Finally, the average differences in QT interval comparing the highest vs. the lowest categories of total physical activity was -0.8 ms (-3.0 to 1.4). Conclusion: Binge drinking was associated with longer QT interval in men but not in women. QT interval duration was not associated with other modifiable factors including coffee and tea intake, smoking, and physical activity.

Comentarios a las guías de práctica clínica sobre manejo de las dislipemias de la Sociedad Europea de Cardiología y la Sociedad Europea de Aterosclerosis 2011. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

Anguita, M., Alegría, E., Barrios, V., Escobar, C., León, M., Luengo, E., Comín, J., Fernández-Ortiz, A., Heras, M., Pan, M., Worner, F., Barón, G., Bernal, E., Borrás, X., Civeira, F., Cordero, A., Guallar, E., Ib́ñez B., De Pablo, C., … Laclaustra, M. (n.d.).

Publication year

2011

Journal title

Revista Espanola de Cardiologia

Volume

64

Issue

12

Page(s)

1090-1095

10.1016/j.recesp.2011.10.004

Abstract

Abstract

~

Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver : A meta-analysis

Hernaez, R., Lazo, M., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., & Clark, J. M. (n.d.).

Publication year

2011

Journal title

Hepatology

Volume

54

Issue

3

Page(s)

1082-1090

10.1002/hep.24452

Abstract

Abstract

Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultrasonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Conclusion: Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings.

Discordance in perceived needs between patients and physicians in oncology practice : A nationwide survey in Korea

Shin, D. W., Kim, S. Y., Cho, J., Sanson-Fisher, R. W., Guallar, E., Chai, G. Y., Kim, H. S., Park, B. R., Park, E. C., & Park, J. H. (n.d.).

Publication year

2011

Journal title

Journal of Clinical Oncology

Volume

29

Issue

33

Page(s)

4424-4429

10.1200/JCO.2011.35.9281

Abstract

Abstract

Purpose: Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient-physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient-physician concordance. Patients and Methods: A national, multicenter, cross-sectional survey of patient-physician dyads was performed, and 97 oncologists (participation rate, 86.5%) and 495 patients (participation rate, 87.4%) were included. A short form of the Comprehensive Needs Assessment Tool for Cancer Patients was independently administered to patients and their oncologists. Concordance and agreement rates between physicians and patients were calculated. Mixed logistic regression was used to identify predictors of concordance and to explore the association of concordance with patient satisfaction and trust in physicians. Results: Physicians systematically underestimated patient needs and patient-physician concordance was generally poor, with weighted κ statistics ranging from 0.04 to 0.15 for individual items and Spearman's ρ coefficients ranging from 0.11 to 0.21 for questionnaire domains. Length of experience as oncologist was the only significant predictor of concordance (adjusted odds ratio for overall concordance [aOR] = 2.09; 95% CI, 1.02 to 4.31). Concordance was not significantly associated with overall patient satisfaction (aOR = 1.24; 95% CI, 0.74 to 2.07) or trust in physician (aOR = 1.17; 95% CI, 0.76 to 1.81). Conclusion: Our findings revealed significant underestimation of patient needs and poor concordance between patients and physicians in assessing perceived needs of supportive care. The clinical implications of this discordance warrant further investigation.

Effect of supplementation with high-selenium yeast on plasma lipids : A randomized trial

Rayman, M. P., Stranges, S., Griffin, B. A., Pastor-Barriuso, R., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Annals of internal medicine

Volume

154

Issue

10

Page(s)

656-665

10.7326/0003-4819-154-10-201105170-00005

Abstract

Abstract

Background: High selenium status has been linked to elevated blood cholesterol levels in cross-sectional studies. Objective: To investigate the effect of selenium supplementation on plasma lipids. Design: Randomized, placebo-controlled, parallel-group study stratified by age and sex. Participants, research nurses, and persons assessing outcomes were blinded to treatment assignment. (International Standard Randomised Controlled Trial Number Register registration number: ISRCTN25193534) Setting: 4 general practices in the United Kingdom. Participants: 501 volunteers aged 60 to 74 years. Intervention: Participants received selenium, 100 mcg/d (n =127), 200 mcg/d (n = 127), or 300 mcg/d (n =126), as high-selenium yeast or a yeast-based placebo (n = 121) for 6 months. Measurements: Total and high-density lipoprotein (HDL) cholesterol concentrations were measured in nonfasting plasma samples stored from participants in the UK PRECISE (United Kingdom PREvention of Cancer by Intervention with SElenium) Pilot Study at baseline (n =454) and at 6 months (n = 394). Non-HDL cholesterol levels were calculated. Results: Mean plasma selenium concentration was 88.8 ng/g (SD, 19.2) at baseline and increased statistically significantly in the treatment groups. The adjusted difference in change in total cholesterol levels for selenium compared with placebo was -0.22 mmol/L (-8.5 mg/dL) (95% CI, -0.42 to -0.03 mmol/L [-16.2 to -1.2 mg/dL]; P = 0.02) for 100 mcg of selenium per day, -0.25 mmol/L (-9.7 mg/dL) (CI, -0.44 to -0.07 mmol/L [-17.0 to-2.7 mg/dL]; P = 0.008) for 200 mcg of selenium per day, and -0.07 mmol/L (-2.7 mg/dL) (CI, -0.26 to 0.12 mmol/L [-10.1 to 4.6 mg/dL]; P =0.46) for 300 mcg of selenium per day. Similar reductions were observed for non-HDL cholesterol levels. There was no apparent difference in change in HDL cholesterol levels with 100 and 200 mcg of selenium per day, but the difference was an adjusted 0.06 mmol/L (2.3 mg/dL) (CI, 0.00 to 0.11 mmol/L [0.0 to 4.3 mg/dL]; P = 0.045) with 300 mcg of selenium per day. The total-HDL cholesterol ratio decreased progressively with increasing selenium dose (overall P = 0.01). Limitation: The duration of supplementation was limited, as was the age range of the participants. Conclusion: Selenium supplementation seemed to have modestly beneficial effects on plasma lipid levels in this sample of persons with relatively low selenium status. The clinical significance of the findings is unclear and should not be used to justify the use of selenium supplementation as additional or alternative therapy for dyslipidemia. This is particularly true for persons with higher selenium status, given the limitations of the trial and the potential additional risk in other metabolic dimensions. Primary Funding Source: The Cancer Research Campaign (now Cancer Research UK) and the University of Surrey.

Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study

Guallar, E., Banegas, J. R., Blasco-Colmenares, E., Jiménez, F. J., Dallongeville, J., Halcox, J. P., Borghi, C., Massá-González, E. L., Tafalla, M., Perk, J., De Backer, G., Steg, P. G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2011

Journal title

BMC public health

Volume

11

10.1186/1471-2458-11-704

Abstract

Abstract

Background: Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe. Methods. Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account. Results: The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27). Conclusions: Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

Knowledge, attitudes, risk perception, and cancer screening behaviors among cancer survivors

Shin, D. W., Kim, Y. W., Oh, J. H., Kim, S. W., Chung, K. W., Lee, W. Y., Lee, J. E., Lee, W. C., Guallar, E., & Cho, J. (n.d.).

Publication year

2011

Journal title

Cancer

Volume

117

Issue

16

Page(s)

3850-3859

10.1002/cncr.25951

Abstract

Abstract

BACKGROUND: Knowledge, attitudes, and risk perception in relation to second primary cancer (SPC) screening and their impact on screening practices in cancer survivors are largely unknown. METHODS: A total of 326 cancer survivors who had completed primary treatment for cancer >1 year previously were recruited from 6 oncology care outpatient clinics in the Republic of Korea. Survivors' knowledge, attitudes, perceived risk, and screening practices were assessed along with sociodemographic, behavioral, and clinical characteristics. Multivariate logistic regression was used to examine behavioral factors associated with the completion of all appropriate SPC screening according to national guidelines. RESULTS: Approximately 37.7% of survivors had undergone all appropriate SPC screening tests. Survivors were found to have a high perceived risk of SPC, high perceived benefits of screening, and positive attitudes toward cancer screening. However, they had limited knowledge regarding SPC screening tests and few had received a recommendation from a physician to undergo SPC screening. Although there was no association found between perceived risk and positive attitudes with screening behavior, higher knowledge was noted to be significantly associated with the completion of all appropriate SPC screening (adjusted odds ratio, 1.81; 95% confidence interval, 1.03-3.33). CONCLUSIONS: In the current study, cancer survivors were found to have limited knowledge regarding second cancer screening tests, which may have resulted in lower rates of completion of screening practices in this population.

Needs of women with breast cancer as communicated to physicians on the Internet

Cho, J., Smith, K. C., Roter, D., Guallar, E., Noh, D. Y., & Ford, D. E. (n.d.).

Publication year

2011

Journal title

Supportive Care in Cancer

Volume

19

Issue

1

Page(s)

113-121

10.1007/s00520-009-0794-0

Abstract

Abstract

Purpose: With improved access to health information via the Internet, an increasing number of women with breast cancer are using this venue to obtain information about their illness and treatment from physicians. This study aims to identify the needs of women with breast cancer who communicate with physicians on the Internet. Methods: From a total of 4,424 requests posted by Korean women with breast cancer to a physician run Internet Q&A board during 2003 to 2007, we sampled 1,355 representative requests according to different type of online user identification and analyzed these using a qualitative content analytic approach to identify the nature of the requests. Results: The vast majority of women (93.5%) used the online Q&A board to seek informational support from physicians. They requested information across a broad range of topics, including treatment (38.4% of requests), physical condition (31.7%), and lifestyle/self-care (24%). Women at different disease stages made requests in different informational domains. Few (

Non-alcoholic fatty liver disease and mortality among US adults : Prospective cohort study

Lazo, M., Hernaez, R., Bonekamp, S., Kamel, I. R., Brancati, F. L., Guallar, E., & Clark, J. M. (n.d.).

Publication year

2011

Journal title

BMJ (Online)

Volume

343

Issue

7836

Page(s)

1245

10.1136/bmj.d6891

Abstract

Abstract

Objective: To evaluate the association between non-alcoholic fatty liver disease and all cause and cause specific mortality in a representative sample of the US general population. Design: Prospective cohort study. Setting: US Third National Health and Nutrition Examination Survey (NHANES III: 1988-94) with follow-up of mortality to 2006. Participants: 11 371 adults aged 20-74 participating in the Third National Health and Nutrition Examination Survey, with assessment of hepatic steatosis. Main outcome measure: Mortality from all causes, cardiovascular disease, cancer, and liver disease (up to 18 years of follow-up). Results: The prevalence of non-alcoholic fatty liver disease with and without increased levels of liver enzymes in the population was 3.1% and 16.4%, respectively. Compared with participants without steatosis, those with non-alcoholic fatty liver disease but normal liver enzyme levels had multivariate adjusted hazard ratios for deaths from all causes of 0.92 (95% confidence interval 0.78 to 1.09), from cardiovascular disease of 0.86 (0.67 to 1.12), from cancer of 0.92 (0.67 to 1.27), and from liver disease of 0.64 (0.12 to 3.59). Compared with participants without steatosis, those with non-alcoholic fatty liver disease and increased liver enzyme levels had adjusted hazard ratios for deaths from all causes of 0.80 (0.52 to 1.22), from cardiovascular disease of 0.59 (0.29 to 1.20), from cancer of 0.53 (0.26 to 1.10), and from liver disease of 1.17 (0.15 to 8.93). Conclusions: Non-alcoholic fatty liver disease was not associated with an increased risk of death from all causes, cardiovascular disease, cancer, or liver disease.

QT-interval duration and mortality rate results from the third national health and nutrition examination survey

Zhang, Y., Post, W. S., Dalal, D., Blasco-Colmenares, E., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Archives of Internal Medicine

Volume

171

Issue

19

Page(s)

1727-1733

10.1001/archinternmed.2011.433

Abstract

Abstract

Background: Extreme prolongation or reduction of the QT interval predisposes patients to malignant ventricular arrhythmias and sudden cardiac death, but the association of variations in the QT interval within a reference range with mortality end points in the general population is unclear. Methods: We included 7828 men and women from the Third National Health and Nutrition Examination Survey. Baseline QT interval was measured via standard 12-lead electrocardiographic readings. Mortality end points were assessed through December 31, 2006 (2291 deaths). Results: After an average follow-up of 13.7 years, the association between QT interval and mortality end points was U-shaped. The multivariate-adjusted hazard ratios comparing participants at or above the 95th percentile of age-, sex-, race-, and R-R interval-corrected QT interval (≥439 milliseconds) with participants in the middle quintile (401 to

Seafood intake and urine concentrations of total arsenic, dimethylarsinate and arsenobetaine in the US population

Navas-Acien, A., Francesconi, K. A., Silbergeld, E. K., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Environmental Research

Volume

111

Issue

1

Page(s)

110-118

10.1016/j.envres.2010.10.009

Abstract

Abstract

Background: Seafood is the main source of organic arsenic exposure (arsenobetaine, arsenosugars and arsenolipids) in the population. Arsenosugars and arsenolipids are metabolized to several species including dimethylarsinate (DMA). Objective: Evaluate the association of seafood intake with spot urine arsenic concentrations in the 2003-2006 National Health Nutrition and Examination Survey (NHANES). Methods: We studied 4276 participants ≥6 years. Total arsenic was measured using inductively coupled plasma dynamic reaction cell mass spectrometry (ICPMS). Urine DMA and arsenobetaine were measured by high-performance liquid chromatography coupled with ICPMS. Results: Participants reporting seafood in the past 24-h had higher urine concentrations of total arsenic (median 24.5 vs. 7.3 γg/L), DMA (6.0 vs. 3.5 γg/L), arsenobetaine (10.2 vs. 0.9 γg/L) and total arsenic minus arsenobetaine (11.0 vs. 5.5 γg/L). Participants reporting seafood ≥2/wk vs. never during the past year had 2.3 (95% confidence interval 1.9, 2.7), 1.4 (1.2, 1.6), 6.0 (4.6, 7.8) and 1.7 (1.4, 2.0) times higher (p-trend

Selenium status and blood lipids : The cardiovascular risk in young finns study

Stranges, S., Tabák, A. G., Guallar, E., Rayman, M. P., Akbaraly, T. N., Laclaustra, M., Alfthan, G., Mussalo-Rauhamaa, H., Viikari, J. S., Raitakari, O. T., Kivimäki, M., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Journal of Internal Medicine

Volume

270

Issue

5

Page(s)

469-477

10.1111/j.1365-2796.2011.02398.x

Abstract

Abstract

Background. Concern has been recently raised about possible adverse cardio-metabolic effects of high selenium status, such as increased risks of diabetes and hyperlipidaemia. However, most of the evidence comes from selenium-replete populations such as that of the United States. Objectives. To examine cross-sectional and longitudinal associations of serum selenium with cardiovascular risk factors in Finland where selenium levels were amongst the lowest in the world until the early 1980s before the implementation of a nationwide selenium fertilization programme. Methods. Serum selenium was measured in 1235 young Finns aged 3-18years at baseline in 1980 (prefertilization) and in a subgroup (N=262) at the 6-year follow-up (1986, postfertilization). During the 27-year follow-up, serum lipids, blood pressure, body mass index and smoking were assessed five times (1980, 1983, 1986, 2001 and 2007). Results. Mean (±SD) serum selenium concentrations were 74.3±14.0ngmL -1 in 1980 and 106.6±12.5ngmL -1 in 1986 (average increase 32.3ngmL -1; 95% CI: 30.3 to 34.3, P

Serum 25-hydroxyvitamin D, calcium, phosphorus, and electrocardiographic QT interval duration : Findings from NHANES III and ARIC

Zhang, Y., Post, W. S., Dalal, D., Bansal, S., Blasco-Colmenares, E., Jan De Beur, S., Alonso, A., Soliman, E. Z., Whitsel, E. A., Brugada, R., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

96

Issue

6

Page(s)

1873-1882

10.1210/jc.2010-2969

Abstract

Abstract

Context: Disturbances in 25-hydroxyvitamin D, calcium, and phosphorus concentrations have been associated with increased risks of total and cardiovascular mortality. It is possible that changes in electrocardiographic QT interval duration may mediate these effects, but the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration has not been evaluated in general population samples. Objective: The objective of the study was to evaluate the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration in two large samples of the U.S. general population. Design: This study included cross-sectional analyses the Third National Health and Nutrition Survey (NHANES III) and the Atherosclerosis Risk in Communities (ARIC) study. Setting: The study was conducted in the general community. Patients or Other Participants: Patients included 7,312 men and women from NHANES III and 14,825 men and women from the ARIC study. Interventions: Serum 25-hydroxyvitamin D, total and ionized calcium, and inorganic phosphorus were measured in NHANES III, and serum total calcium and inorganic phosphorus were measured in ARIC. Main Outcome Measure: QT interval duration was obtained from standard 12-lead electrocardiograms. Results: In NHANES III, the multivariate adjusted differences in average QT interval duration comparing the highest vs. the lowest quartiles of serum total calcium, ionized calcium, and phosphorus were -3.6 msec (-5.8 to -1.3; P for trend = 0.005), -5.4 msec (-7.4 to -3.5; P for trend < 0.001), and 3.9 msec (2.0-5.9; P for trend

Serum uric acid levels predict incident nonalcoholic fatty liver disease in healthy Korean men

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

Publication year

2011

Journal title

Metabolism: Clinical and Experimental

Volume

60

Issue

6

Page(s)

860-866

10.1016/j.metabol.2010.08.005

Abstract

Abstract

The objective of the study was to assess the prospective association between serum uric acid levels and incident nonalcoholic fatty liver disease in a cohort of healthy Korean men. A cohort study was performed on 5741 Korean men, 30 to 59 years of age, with no evidence of fatty liver disease on liver ultrasound and with no major risk factors for liver disease at baseline. Study participants were followed in annual or biennial health examinations between 2002 and 2008. The presence of fatty liver was determined at each examination by ultrasound. Cox proportional hazards models were used to evaluate the association of baseline and time-dependent levels of serum uric acid with incident fatty liver, adjusted for potential confounders. During 23 995 person-years of follow-up, 1717 participants developed fatty liver on ultrasound examination. After adjustment for age, body mass index, smoking, and alcohol intake, the hazard ratios (95% confidence intervals) for incident fatty liver comparing quartiles 2 to 4 of serum uric acid to quartile 1 were 1.17 (1.01-1.37), 1.28 (1.11-1.48), and 1.51 (1.31-1.73), respectively (P for trend = .001). The adjusted hazard ratio comparing participants with hyperuricemia (serum uric acid ≥7.0 mg/dL) to those with normouricemia (

Sex-steroid hormones and electrocardiographic qt-interval duration : Findings from the third national health and nutrition examination survey and the multi-ethnic study of atherosclerosis

Zhang, Y., Ouyang, P., Post, W. S., Dalal, D., Vaidya, D., Blasco-Colmenares, E., Soliman, E. Z., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

American Journal of Epidemiology

Volume

174

Issue

4

Page(s)

403-411

10.1093/aje/kwr172

Abstract

Abstract

The association between physiologic levels of sex hormones and QT-interval duration in humans was evaluated using data from 727 men enrolled in the Third National Health and Nutrition Examination Survey and 2,942 men and 1,885 postmenopausal women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Testosterone, estradiol, and sex hormone-binding globulin levels were measured in serum and free testosterone was calculated from those values. QT interval was measured using a standard 12-lead electrocardiogram. In men from the Third National Health and Nutrition Survey, the multivariate adjusted differences in average QT-interval duration comparing the highest quartiles with the lowest quartiles of total testosterone and free testosterone were-8.5 ms (95% confidence interval (CI):-15.5,-1.4) and-8.0 ms (95% CI:-13.2,-2.8), respectively. The corresponding differences were-1.8 ms (95% CI:-3.8,-0.2), and-4.7 ms (95% CI:-6.7,-2.6), respectively, in men from MESA and-0.6 ms (95% CI:-3.0, 1.8) and 0.8 ms (95% CI:-1.6, 3.3), respectively, in postmenopausal women from MESA. Estradiol levels were not associated with QT-interval duration in men, but there was a marginally significant positive association in postmenopausal women. The findings suggest that testosterone levels may explain differences in QT-interval duration between men and women and could be a contributor to population variability in QT-interval duration among men.

Structured management strategy versus usual care for gastroesophageal reflux disease : Rationale for pooled analysis of five European cluster-randomized trials

Ponce, J., Garrigues, V., Tabaglio, E., Gschwantler, M., Güallar, E., Tafalla, M., Nuevo, J., Hatlebakk, J. G., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Therapeutic Advances in Gastroenterology

Volume

4

Issue

1

Page(s)

11-26

10.1177/1756283X10387060

Abstract

Abstract

Background: Gastroesophageal reflux disease (GERD) has a major impact at the primary care level and there is a need to evaluate whether the diagnosis and therapeutic management of GERD in Europe needs to be improved. Methods: This project was designed to test the hypothesis that a new primary care management strategy would improve outcomes for patients with GERD, compared with usual care, in Europe. The analysis pools five separate cluster-randomized studies conducted in Austria, Italy, Norway, Spain and Sweden. These studies used a strategy based on the self-administered GerdQ questionnaire to stratify adult patients with symptoms of heartburn or regurgitation according to the frequency and impact of symptoms. A score of ≥8 indicates a high probability of suffering GERD. Patients with a GerdQ impact score ≤2 were treated with generic proton-pump inhibitors according to local guidance, and patients with an impact score ≥3 were treated with esomeprazole 40 mg once daily. Results: In total, 2400 patients were enrolled across the five studies. The protocols were modified by individual countries according to their local guidelines/requirements. In Norway, the new management strategy was compared with traditional routine endoscopy and 24-hour pH-metry, and encompassed proton-pump inhibitor reimbursement restrictions. Outcome measures differed by country, but included control of GERD symptoms, self-rated health status and work productivity, treatment changes, specialist referrals and physician adherence. GERD-related use of healthcare resources was also evaluated. Conclusion: The pooled analysis will determine whether a locally adapted primary care management strategy for GERD, using GerdQ as a patient-tailored diagnostic and therapeutic evaluation tool, is beneficial compared with usual care across five countries with different standard approaches to GERD management and control.

Urine arsenic and hypertension in US adults : The 2003-2008 national health and nutrition examination survey

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

Publication year

2011

Journal title

Epidemiology

Volume

22

Issue

2

Page(s)

153-161

10.1097/EDE.0b013e318207fdf2

Abstract

Abstract

Background: High chronic exposure to inorganic arsenic may contribute to the development of hypertension. Limited information is available, however, on the association of low to moderate exposure to inorganic arsenic with blood pressure levels and hypertension. We investigated the association of exposure to inorganic arsenic (as measured in urine) with systolic and diastolic blood pressure levels and the prevalence of hypertension in US adults. Methods: We studied 4167 adults 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 through 2008 and for whom total arsenic, dimethylarsinate (DMA), and arsenobetaine had been assessed in urine. Results: The median (interquartile range) urine concentrations were 8.3 μg/L (4.2-17.1) for total arsenic, 3.6 μg/L (2.0-6.0) for DMA, and 1.4 μg/L (0.3-6.3) for arsenobetaine. The weighted prevalence of hypertension in the study population was 36%. After multivariable adjustment, a 2-fold increase in total arsenic was associated with a hypertension odds ratio of 0.98 (95% confidence interval = 0.86-1.11). A doubling of total arsenic minus arsenobetaine was associated with a hypertension OR of 1.03 (0.94-1.14) and a doubling of DMA concentrations was associated with a hypertension OR of 1.11 (0.99-1.24). Total arsenic, total arsenic minus arsenobetaine, or DMA levels were not associated with systolic or diastolic blood pressure. Conclusions: At the low to moderate levels, typical of the US population, total arsenic, total arsenic minus arsenobetaine, and DMA concentrations in urine were not associated with the prevalence of hypertension or with systolic or diastolic blood pressure levels. A weak association of DMA with hypertension could not be ruled out.

A comparison of cancer screening practices in cancer survivors and in the general population : The Korean national health and nutrition examination survey (KNHANES) 2001-2007

Cho, J., Guallar, E., Hsu, Y. J., Shin, D. W., & Lee, W. C. (n.d.).

Publication year

2010

Journal title

Cancer Causes and Control

Volume

21

Issue

12

Page(s)

2203-2212

10.1007/s10552-010-9640-4

Abstract

Abstract

Objective: This study aimed to describe cancer screening rates for second primary cancer among cancer survivors in Korea, and to compare these rates with those of two control groups: individuals without a history of cancer but with other chronic diseases, and individuals without a history of cancer and without other chronic diseases. Methods: The study is a cross-sectional analysis of 15,556 adults ≥30 years old who participated in the 2001, 2005, and 2007 Korean National Health and Nutrition Examination Surveys (KNHANES). The prevalence of breast, cervical, gastric, and colorectal cancer screening examinations according to national guidelines was assessed and compared to two control groups. Results: Screening rates among cancer survivors were 48.5, 54.7, 34.7, and 28.6% for breast, cervical, gastric, and colorectal cancer screening, respectively. Cancer survivors showed higher screening rates for all four cancer sites compared with both control groups, but breast cancer screening was only statistically significant after adjusting gender, age, marital status, education, income, working status, health insurance, smoking and drinking status, and self-reported health status. Conclusions: Cancer survivors were more likely than individuals without a cancer history to obtain screening examinations according to recommended guidelines. Still, screening rates even among survivors were suboptimal, emphasizing the need for a more systematic approach to second primary cancer screening and prevention.

A prospective study of dietary selenium intake and risk of type 2 diabetes

Stranges, S., Sieri, S., Vinceti, M., Grioni, S., Guallar, E., Laclaustra, M., Muti, P., Berrino, F., & Krogh, V. (n.d.).

Publication year

2010

Journal title

BMC public health

Volume

10

10.1186/1471-2458-10-564

Abstract

Abstract

Background: Growing evidence raises concern about possible associations of high selenium exposure with diabetes in selenium-replete populations such as the US. In countries with lower selenium status, such as Italy, there is little epidemiological evidence on the association between selenium and diabetes. This study examined the prospective association between dietary selenium intake and risk of type 2 diabetes. Methods: The ORDET cohort study comprised a large sample of women from Northern Italy (n = 7,182). Incident type 2 diabetes was defined as a self-report of a physician diagnosis, use of antidiabetic medication, or a hospitalization discharge. Dietary selenium intake was measured by a semi-quantitative food-frequency questionnaire at the baseline examination (1987-1992). Participants were divided in quintiles based on their baseline dietary selenium intake. Results: Average selenium intake at baseline was 55.7 μg/day. After a median follow-up of 16 years, 253 women developed diabetes. In multivariate logistic regression analyses, the odds ratio for diabetes comparing the highest to the lowest quintile of selenium intake was 2.39, (95% CI: 1.32, 4.32; P for linear trend = 0.005). The odds ratio for diabetes associated with a 10 μg/d increase in selenium intake was 1.29 (95% CI: 1.10, 1.52). Conclusions: In this population, increased dietary selenium intake was associated with an increased risk of type 2 diabetes. These findings raise additional concerns about the association of selenium intake above the Recommended Dietary Allowance (55 μg/day) with diabetes risk.

Blood lead level and kidney function in US adolescents : The third national health and nutrition examination survey

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

Publication year

2010

Journal title

Archives of Internal Medicine

Volume

170

Issue

1

Page(s)

75-82

10.1001/archinternmed.2009.417

Abstract

Abstract

Background: Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents. Methods: Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988-1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C-based and creatinine-based estimating equations, was examined. Results: Median whole blood lead level was 1.5 μg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C-estimated GFR was 112.9 mL/min/ 1.73 m2. Participants with lead levels in the highest quartile (≥3.0 μg/dL) had 6.6 mL/min/1.73 m2-lower estimated GFR (95% confidence interval, -0.7 to -12.6 mL/min/1.73m2) compared with those in the first quartile (

Cadmium and peripheral arterial disease : Gender differences in the 1999-2004 US national health and nutrition examination survey

Tellez-Plaza, M., Navas-Acien, A., Crainiceanu, C. M., Sharrett, A. R., & Guallar, E. (n.d.).

Publication year

2010

Journal title

American Journal of Epidemiology

Volume

172

Issue

6

Page(s)

671-681

10.1093/aje/kwq172

Abstract

Abstract

Gender differences in the association of blood and urine cadmium concentrations with peripheral arterial disease (PAD) were evaluated by using data from 6,456 US adults aged ≥40 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial blood pressure index of