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

Ecuestas alimentarias en los niños españoles de edad escolar : Análisis del período 1984-1994

Gorgojo Jiménez, L., Guallar, E., Martín-Moreno, J. M., Löpez-Nomdedeu, C., Vázquez, C., Martí-Henneberg, C., & Serrano-Ríos, M. (n.d.).

Publication year

1999

Journal title

Medicina Clinica

Volume

112

Issue

10

Page(s)

368-374

Abstract

Abstract

OBJECTIVE: To review available data on the usual dietary intake of school-age Spanish children, by analyzing the nutritional surveys carried out during the period 1984-1994. METHODS: Systematic and comprehensive search of surveys with dietary data in Spanish children aged 6 to 16 years collected during the period 1984-1994 and published after January 1997. The search of bibliographic databases (MEDLINE, IME, ISBN and Teseo), was completed with an extensive search of the gray literature and of unpublished studies through contact with public and private institutions which may fund such studies. The quality of the original surveys was assessed, and the data of the studies fulfilling pre-established quality requirements were summarized and tabulated. RESULTS: We located 65 nutritional surveys in children and adolescents performed between 1984 and 1994, which generated 91 documents. Most surveys (76.9%) were local, while 18.5% of them studied provinces or regions and 3.1% studied more than one region. Only 4 studies (6.2%) met the quality requirements, but the methods or the presentation of the results of these surveys were too heterogeneous. In spite of that, the available data tends to show a certain lack of balance of macronutrient intakes in relation to the usual dietary recomendations. CONCLUSIONS: Available data on nutritional intake of Spanish school-age children during 1984-1994 were too heterogeneous to be comparable, even if the analysis was restricted to high-quality surveys. Furthermore, there are no repeated surveys monitoring changes in intake in representative samples of children performed during the study period. This should be taken into account in future research endeavours which should contemplate a well defined sampling framework and the appropriate methodology to assure the proper interpretation of the eventual results.

Omega-3 fatty acids in adipose tissue and risk of myocardial infarction : The EURAMIC study

Guallar, E., Aro, A., Jiménez, F. J., Martín-Moreno, J. M., Salminen, I., Van't Veer, P., Kardinaal, A. F., Gömez-Aracena, J., Martin, B. C., Kohlmeier, L., Kark, J. D., Mazaev, V. P., Ringstad, J., Guillén, J., Riemersma, R. A., Huttunen, J. K., Thamm, M., & Kok, F. J. (n.d.).

Publication year

1999

Journal title

Arteriosclerosis, Thrombosis, and Vascular Biology

Volume

19

Issue

4

Page(s)

1111-1118

10.1161/01.ATV.19.4.1111

Abstract

Abstract

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (±SD) proportion of α-linolenic acid was 0.77% (±0.19) of fatty acids in cases and 0.80% (±0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of α-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (±0.13) of fatty acids in cases and 0.25% (±0.13) of fatty acids in controls (P=0.14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of α-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

El placebo en ensayos clinicos con medicamentos

Laporte, J. R., Garcia Alonso, F., Guallar, E., Bakke, O., Carne, X., & Guallar, E. (n.d.).

Publication year

1998

Journal title

Medicina Clinica

Volume

111

Issue

14

Page(s)

558

Abstract

Abstract

~

Previous disability as a predictor of outcome in a geriatric rehabilitation unit

Valderrama-Gama, E., Damián, J., Guallar, E., & Rodríguez-Mañas, L. (n.d.).

Publication year

1998

Journal title

Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Volume

53

Issue

5

Page(s)

M405-M409

10.1093/gerona/53A.5.M405

Abstract

Abstract

Background. Functional status at admission has been shown consistently to predict rehabilitation results, but the impact of previous disability has been seldom considered. Methods. A prospective follow-up study of elderly patients admitted to a geriatric rehabilitation unit in Madrid Spain, was carried out. The study population comprised 135 subjects aged 65 years or older, who were consecutively admitted during a 7-month period. Outcome variables included the Barthel Index (BI) at discharge, the improvement in BI from admission to discharge, the achieved percentage of potential gain, and the efficiency of gains. Previous BI, admission BI, diagnosis, source (hospital/others), mental status, age, and gender were examined as explanatory variables. Results. In multiple regression analysis, previous BI was the only significant independent predictor for all the outcome variables. For each 5-point increase in previous BI, the increase in BI at discharge was 1.7 (p = .007). Corresponding values for the achieved percentage of potential gain and for the efficiency of galas were 0105 (p = .01) and 0.05 (p = .04), respectively. Except for the achieved percentage of potential gain, admission BI and source of referral were also independent significant predictors of outcome. Conclusions. Previous functional situation of elderly people is important to predict rehabilitation outcome, even after taking into account information on disability at admission. As a consequence, a measure of the achieved percentage of potential gain corrected by the preadmission functional status is proposed, especially in the case of elderly patients.

Use and abuse of placebo in phase III trials

García-Alonso, F., Guallar, E., Bakke, O. M., Carné, X., & Guallar, E. (n.d.).

Publication year

1998

Journal title

European Journal of Clinical Pharmacology

Volume

54

Issue

2

Page(s)

101-105

10.1007/s002280050429

Abstract

Abstract

~

Use of two-segmented logistic regression to estimate change-points in epidemiologic studies

Pastor, R., & Guallar, E. (n.d.).

Publication year

1998

Journal title

American Journal of Epidemiology

Volume

148

Issue

7

Page(s)

631-642

10.1093/aje/148.7.631

Abstract

Abstract

In many epidemiologic data, the dose-response relation between a continuous exposure and the risk of disease abruptly changes when the exposure variable reaches an unknown threshold level, the so-called change- point. Although several methods are available for dose-response assessment with dichotomous outcomes, none of them provide inferential procedures to estimate change-points. In this paper, we describe a two-segmented logistic regression model, in which the linear term associated with a continuous exposure in standard logistic regression is replaced by a two-segmented polynomial function with unknown change-point, which is also estimated. A modified, iteratively reweighted least squares algorithm is presented to obtain parameter estimates and confidence intervals, and the performance of this model is explored through simulation. Finally, a two-segmented logistic regression model is applied to a case-control study of the association of alcohol intake with the risk of myocardial infarction and compared with alternative analyses. The ability of two-segmented logistic regression to estimate and provide inferences for the location of change-points and for the magnitude of other parameters of effect will make this model a useful complement to other methods of dose-response analysis in epidemiologic studies.

A graphical display useful for meta-analysis

Jiménez, F. J., Guallar, E., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

European Journal of Public Health

Volume

7

Issue

1

Page(s)

101-105

10.1093/eurpub/7.1.101

Abstract

Abstract

Graphical methods are frequently used in meta-analysis to summarize their results and to explore potential sources of heterogeneity across studies. In this paper, we illustrate a graphical method for meta-analysis of studies with dichotomous exposures and outcomes that complements other graphical and analytical approaches to meta-analysis. In prospective studies, the proportion of cases among the unexposed is plotted on the horizontal axis versus the proportion of cases among the exposed on the vertical axis. Contour lines for equal values of relative risk, odds ratio or risk difference and for the combined estimate of effect and its confidence interval are then superimposed on the graph. In case-control studies, the proportion of exposed controls is plotted on the horizontal axis versus the proportion of exposed cases on the vertical axis, although only the contour lines of equal odds ratios yield direct epidemiological interpretation. In these graphs, the distribution of the individual estimates of effect with respect to the contour lines offers a clue as to the adequacy of the scale of measurement used (additive or multiplicative). This graphical method also permits direct inspection of the range of disease frequency in follow-up studies and of the range of exposure in case-control studies. Its use is illustrated with the aid of 3 examples derived from the literature.

Alcohol intake and risk of breast cancer : The euramic study

Royo-Bordonada, M. A., Martín-Moreno, J. M., Guallar, E., Gorgojo, L., Van't Veer, P., Mendez, M., Huttunen, J. K., Martin, B. C., Kardinaal, A. F., Fernández-Crehuet, J., Thamm, M., Strain, J. J., Kok, F. J., Kohlmeier, L., & Guallar, E. (n.d.).

Publication year

1997

Journal title

Neoplasma

Volume

44

Issue

3

Page(s)

150-156

Abstract

Abstract

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.

Cerebrovascular disease mortality in Spain, 1955-1992 : An age-period-cohort analysis

Castillón, P. G., Artalejo, F. R., Banegas Banegas, J. R., Guallar, E., & del Rey Calero, J. (n.d.).

Publication year

1997

Journal title

Neuroepidemiology

Volume

16

Issue

3

Page(s)

116-123

10.1159/000109680

Abstract

Abstract

The purpose of this study was to assess the contributions of period and birth cohort effects to changes in cerebrovascular disease (CVD) mortality in Spain over the period 1955–1992. Poisson regression models were fitted to age- and sex-specific CVD mortality rates obtained from National Vital Statistics. In the period 1955–1975, CVD mortality remained stable. In the period 1975–1992, CVD mortality declined by 54% (rate ratio, RR: 0.46; 95% confidence interval, Cl: 0.43–0.49) in males and 62% (RR: 0.38; 95% Cl: 0.34–0.42) in females. The cohort effect was very small up to the generation born in 1905, moving clearly downward thereafter. CVD mortality for subjects born in the period 1945–1949 was lower than for those born in the period 1905–1909 by 68% (RR: 0.32; 95% Cl: 0.16–0.63) in males and 82% (RR: 0.18; 95% Cl: 0.07–0.45) in females. Among the possible partial explanations for these effects are the decline in ischemic heart disease and rheumatic fever mortality, the drop in salt and alcohol intake, the reduction in smoking among males and blood pressure among females, and the widespread use of antihypertensive treatments in Spain over the last 20 years.

DDT (dicophane) and postmenopausal breast cancer in Europe : Case-control study

Van 'T Veer, P., Lobbezoo, I. E., Martín-Moreno, J. M., Guallar, E., Gómez-Aracena, J., Kardinaal, A. F., Kohlmeier, L., Martin, B. C., Strain, J. J., Thamm, M., Van Zoonen, P., Baumann, B. A., Huttunen, J. K., & Kok, F. J. (n.d.).

Publication year

1997

Journal title

British Medical Journal

Volume

315

Issue

7100

Page(s)

81-85

10.1136/bmj.315.7100.81

Abstract

Abstract

Objective: To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane DDT), and breast cancer. Design: Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. Setting: Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. Subjects: 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. Main outcome measure: Adipose DDE concentration. Results: Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentration. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. Conclusions: The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.

Drug and alcohol use in Spain : Consumption habits, attitudes and opinions

Royo-Bordonada, M. A., Cid-Ruzafa, J., Martin-Moreno, J. M., Guallar, E., & Guallar, E. (n.d.).

Publication year

1997

Journal title

Public Health

Volume

111

Issue

5

Page(s)

277-284

10.1016/S0033-3506(97)00054-1

Abstract

Abstract

To estimate the lifetime prevalence of drug and alcohol use and its sociodemographic determinants and to investigate opinions towards drug use in Spain, we examined a representative nation-wide sample of 2495 adult Spaniards, males and females, aged 18 y or older, selected by a multistaged random strategy during 1989. Information was obtained by at-home interviews using a structured closed questionnaire. Participants were asked for their lifetime prevalence of use of cannabis, sedatives and sleeping pills, alcohol, amphetamines, inhalants, cocaine and heroin, as well as for their sociodemographic characteristics and their opinions towards drug use. Alcohol had the highest lifetime prevalence of consumption (55.7%), followed by cannabis (12.3%), sedatives and sleeping pills (12.0%), amphetamines (4.3%), cocaine (3.0%), inhalants (0.8%) and heroin (0.6%). Being male, young, separated or divorced, and unemployed were the main determinants of alcohol and drug use. A higher use of illicit drugs was also observed in the higher socioeconomic groups. Regular use of any drug was considered a risky health habit by more than 80% of the sample. We conclude that the consumption of drugs and alcohol is a rather extended habit in Spain. Drug users tend to share some common sociodemographic characteristics (being male, young, separated or divorced, and unemployed) which may help target intervention programs.

El placebo en ensayos clínicos con medicamentos

García-Alonso, F., Guallar, E., Bakke, O. M., & Carné, X. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

109

Issue

20

Page(s)

797-801

Abstract

Abstract

~

Guía para la evaluación de proyectos de investigación en ciencias de la salud

Guallar, E., Conde, J., De La Cal, M. A., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

108

Issue

12

Page(s)

460-471

Abstract

Abstract

~

La regresión a la media en la investigación y práctica clínica

Guallar, E., Jiménez, F. J., García-Alonso, F., & Bakke, O. M. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

109

Issue

1

Page(s)

23-26

Abstract

Abstract

~

Metaanálisis y revisiones sistemáticas en cardiología

Guallar, E., Damián, J., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

Revista Espanola de Cardiologia

Volume

50

Issue

5

Page(s)

345-354

10.1016/S0300-8932(97)73232-9

Abstract

Abstract

Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selection, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.

Revision de los datos de incidencia de enfermedad invasiva y de meningitis por haemophilus influenzae en ninos menores de 5 anos en Espana

Guallar-Castillón, P., Jiménez, F. J., Rubio Terrés, C., Guallar, E., & Guallar, E. (n.d.).

Publication year

1997

Journal title

Anales Espanoles de Pediatria

Volume

47

Issue

3

Page(s)

263-268

Abstract

Abstract

Objective: The object of this study was to summarize the available information on the incidence of invasive disease and meningitis caused by Haemophilus influenzae in Spain from 1985 to 1995, evaluating potential geographic differences. Methods: Systematic and exhaustive literature searches of computerized databases, manual review of obtained references, revision of relevant Spanish journals and proceedings of congresses and direct consultation with experts were carried out. Yearly incidence rates were estimated per 100,000 children less than 5 years of age, by year and geographical region. Results: We encountered 16 studies, one coveting the entire Spanish population and the rest limited to Catalonia, the Basque Country, the Valencian Community, Andalucia, Navarra or the Community of Madrid. In 1994, the incidence of invasive H, influenzae disease varied from 8.4 cases per 100,000 children under 5 years of age in Navarra to 26.3 cases per 100,000 children under 5 years of age in the Basque Country. Conclusions: Available data do not permit the nationwide estimation of the incidence rate, although it is possible to appreciate thai important geographic differences exist. It is remarkable the lack of specific information for the majority of Spanish regions, as well as the lack of data to assess temporal trends.

Age-period-cohort analysis of suicide mortality rates in Spain, 1959-1991

Granizo, J. J., Guallar, E., & Rodríguez-Artalejo, F. (n.d.).

Publication year

1996

Journal title

International Journal of Epidemiology

Volume

25

Issue

4

Page(s)

814-820

10.1093/ije/25.4.814

Abstract

Abstract

Background. Although there is evidence that suicide rates may be increasing in Spain, formal epidemiological studies have been limited to specific cities or counties. The objective of this study was to investigate nationwide trends in suicide mortality from 1959 to 1991 in Spain, with emphasis on age, period, and cohort effects. Methods. Age- and sex-specific suicide mortality rates from 1959 until 1991 were obtained from official vital statistics tables from the Institute Nacional de Estadistica, the official registry of vital statistics in Spain. Poisson regression and graphical methods were used to model and estimate age, period and cohort effects. Results. Suicide mortality rates increased with age, with a proportional increment for each decade of life of 45% (95% confidence interval: 45-46%). In both males and females, age-adjusted suicide mortality rates decreased from 1959 until the late 1970s and early 1980s. In 1982, trends started to increase, returning to the levels of 1959 in less than 6 years. Cohort effects were small for cohorts born prior to 1940. For cohorts born after 1950, suicide rates increased markedly. Conclusions. The increase in suicide mortality in younger cohorts and the high rates of suicide in the elderly demand further investigation to establish causal mechanisms and preventive strategies.

Cost-effectiveness analysis of pneumococcal vaccination in the elderly Spanish population

Jimenez, F. J., Guallar, P., Rubio, C., Villasante, P., Guallar, E., & Guallar, E. (n.d.).

Publication year

1996

Journal title

British Journal of Medical Economics

Volume

10

Issue

3

Page(s)

193-202

Abstract

Abstract

The high morbidity and mortality associated with pneumococcal pneumonia in subjects over 60 years old, the emergence of bacterial strains resistant to standard antimicrobial therapy and the availability of an anti-pneumococcal vaccine suggest the need to perform an economic study to evaluate the suitability of vaccination as a preventive strategy in those aged 60 years and over in Spain. The introduction of the Vaccination programme would cost US$ 97,593,663. Over the subsequent five years - with a basal rate of three pneumococcal pneumonias per 1000 person-years and a 66% vaccine efficacy - the programme would result in a net benefit of US$ 127,142,481, a benefit/cost ratio of 2.30 and a benefit per case prevented of US$ 2,656. Benefit/cost ratios above 1 would be obtained for incidences above 1.5 cases per 1000 person-years. Introduction of a universal vaccination programme in those over 60 years of age in Spain would be cost-effective over a wide range of incidence rates of pneumococcal pneumonia.

A prospective study of plasma fish oil levels and incidence of myocardial infarction in U.S. male physicians

Guallar, E., Hennekens, C. H., Sacks, F. M., Willett, W. C., & Stampfer, M. J. (n.d.).

Publication year

1995

Journal title

Journal of the American College of Cardiology

Volume

25

Issue

2

Page(s)

387-394

10.1016/0735-1097(94)00370-6

Abstract

Abstract

Objectives. This study evaluated whether increased intake of fish oils (eicosapentaenoic and docosahexaenoic acids) might reduce the risk of coronary heart disease. Background. Observational and clinical studies have suggested that increased intake of fish oils, as reflected in plasma levels of fish oils, may reduce the risk of myocardial infarction. Methods. A nested case-control study was conducted among the 14,916 participants in the Physicians' Health Study with a sample of plasma before randomization. Each participant with myocardial infarction occurring during the first 5 years of follow-up was matched by smoking status and age with a randomly chosen control participant who had not developed coronary heart disease. Results. Mean levels of fish oils (with 95% confidence interval [CI] for paired differences and p values) in case and control participants, expressed as present of total fatty acids, were, for eicosapentaenoic acid, 0.26 versus 0.25 (95% CI - 0.03 to 0.05, p = 0.70) in cholesterol esters and 0.56 versus 0.54 (95% CI -0.04 to 0.09, p = 0.44) in phospholipids, and for docosahexaenoic acid, 0.23 versus 0.24 (95% CI -0.07 to 0.04, p = 0.64) in cholesterol esters and 2.22 versus 2.14 (95% CI -0.10 to 0.27, p = 0.36) in phospholipids. Results adjusted for major cardiovascular risk factors showed a very similar lack of association between fish oil levels and the incidence of myocardial infarction. Conclusions. These results indicate no beneficial effect of increased fish oil consumption on the incidence of a first myocardial infarction. However, the effect of very high levels of fish oils could not be evaluated.

METAANALISIS : SU IMPORTANCIA EN LA TOMA DE DECISIONES CLINICAS EN CARDIOLOGIA

Guallar, E., Banegas, J. R., Martin-Moreno, J. M., Del Rio, A., & Guallar, E. (n.d.).

Publication year

1994

Journal title

Revista Espanola de Cardiologia

Volume

47

Issue

8

Page(s)

509-517

Abstract

Abstract

Clinical decision-making in cardiology requires accurate estimates of the efficacy of diagnostic and therapeutic procedures. Defined as the quantitative integration of results from different studies on the same scientific question, meta-analyses are well-suited to summarize the evidence on the efficacy of clinical interventions. Meta-analyses aim at obtaining combined estimates of effect using all relevant information in a systematic fashion, complementing narrative reviews and expert committee reports. In this paper, the advantages and limitations of meta-analyses and their usefulness in clinical decision making in cardiology are illustrated using three recent examples in the literature - i.e. use of β-blockers in secondary prevention of ischemic heart disease, intravenous streptokinase in acute myocardial infarction and fish intake in primary prevention of cardiovascular mortality. The steps to follow when conducting a meta-analysis are also discussed. Finally, a list of the most important meta-analyses in cardiology published to date is included for easy reference.

Consumo de pescado y mortalidad coronaria en la población general : meta-análisis de estudios de cohorte

Guallar Castillón, E., Javier Jiménez Jiménez, F., Tafalla García, M., Martín-Moreno, J. M., & Guallar, E. (n.d.).

Publication year

1993

Journal title

Gaceta Sanitaria

Volume

7

Issue

38

Page(s)

228-236

10.1016/S0213-9111(93)71155-3

Abstract

Abstract

Con objeto de estimar el efecto del consumo de pescado sobre la mortalidad por cardiopatía isquémica en la población general, se ha realizado un meta-análisis de los estudios epidemiológicos publicados sobre el tema que incluían individuos inicialmente as intomáticos. De los siete estudios publicados hasta la fecha, todos ellos de cohorte, sólo cinco presentaban los resultados con el detalle suficiente como para poder ser utilizados en un meta-análisis formal. En éstos, participaron un total de 27.656 personas, con un seguimiento medio que varió de 7,5 a 25 años, y un número total de muertes por cardiopatía isquémica de 1.731. El estimador combinado del riesgo relativo para un consumo de 30 g/día de pescado frente al no consumo fue de 0,96 (IC al 95%: 0,93–1,00; P=0,058). Dada la presencia de heterogeneidad significativa entre los estudios, no explicada por factores a priori, se procedió a combinar los estudios utilizando un modelo de efectos aleatorios, obteniendo un estimador combinado de riesgo relativo de 0,92 (IC al 95%: 0,84–1,01; P=0,090). Estos resultados, considerados junto con los del único ensayo clínico realizado de consumo de pescado en pacientes que se habían recuperado de un infarto de miocardio, en el que el consumo de 200 a 400 g/semana de pescado graso redujo la mortalidad subsiguiente en un 29% (riesgo relativo del consumo frente al no consumo de 0,71; IC al 95%; 0,54–0,93), sugieren un moderado efecto protector del consumo de pescado en relación a la cardiopatía isquémica.

Utilización de los años potenciales de vida perdidos entre las edades de 1 y 64 años como un indicador de mortalidad prematura ocurrida en Aragón.

Guallar, E., Rué, M., Borrell, C., & Guallar, E. (n.d.).

Publication year

1993

Journal title

Medicina Clinica

Volume

100

Issue

3

Page(s)

115

Abstract

Abstract

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