Eliseo Guallar

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Chair and Professor of the Department of Epidemiology

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

D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study

Choi, S., Jang, W. J., Song, Y. B., Lima, J. A., Guallar, E., Choe, Y. H., Hwang, J. K., Kim, E. K., Yang, J. H., Hahn, J. Y., Choi, S. H., Lee, S. C., Lee, S. H., & Gwon, H. C. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

Issue

10.1371/journal.pone.0160955

Abstract

Abstract

Objectives: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. Methods: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low Ddimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). Results: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2-30.5] versus 18.8% [10.7-26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7-46.9] versus 35.8% [24.2-45.3]; p = 0.04) and a smaller MSI (37.7 [28.2-46.9] versus 47.1 [33.2-57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37-4.87; p<0.01) and lower MSI (OR 2.62; 95% CI 1.44-4.78; p<0.01). Conclusions: In STEMI patients undergoing primary PCI, high D-dimer levels on admission were associated with a larger myocardial infarct size, a greater extent of AAR, and lower MSI, as assessed by CMR data. Elevated initial D-dimer level may be a marker of advanced myocardial injury in patients treated with primary PCI for STEMI.

Diabetes, triglyceride levels, and other risk factors for glaucoma in the national health and nutrition examination survey 2005-2008

Ko, F., Boland, M. V., Gupta, P., Gadkaree, S. K., Vitale, S., Guallar, E., Zhao, D., & Friedman, D. S. (n.d.).

Publication year

2016

Journal title

Investigative Ophthalmology and Visual Science

Volume

Issue

Page(s)

2152-2157

10.1167/iovs.15-18373

Abstract

Abstract

PURPOSE. To determine risk factors for glaucoma in a population-based study in the United States. METHODS. Participants age 40 and older from the National Health and Nutrition Examination Survey underwent questionnaires, physical examination, laboratory tests, and vision tests including fundus imaging. Glaucoma was determined based on expert grading of fundus photographs. Regression modeling of glaucoma risk factors was performed. RESULTS. Participants with glaucoma (172) were older (mean age 68.1 [95% confidence interval (CI) 65.6-70.7] vs. 56.4 years [95% CI 55.6-57.2, P < 0.001]), likely to have less than high school education (25.1% vs. 18.1%, P = 0.05), to have diabetes (23.1% vs. 10.8%, P < 0.001), to have central obesity (72.5% vs. 60.7%, P = 0.01), to have systolic hypertension (30.3% vs. 20.1%, P = 0.01), to have diastolic hypotension (30.3% vs. 13.9%, P < 0.001), and to be nonsmokers (91.0% vs. 79.3%, P =0.002). Sex, poverty, access to health care, fasting glucose, insulin dependence, body mass index, cholesterol levels, diastolic hypertension, systolic hypotension, obstructive sleep apnea, and marijuana were not associated with glaucoma. Multivariable modeling showed associations between glaucoma and older age (odds ratio [OR] 1.09 per year, 95% CI 1.04-1.14), black race (OR 4.40, 95% CI 1.71-11.30), and poverty (OR 3.39, 95% CI 1.73-6.66). Diabetes was no longer associated with glaucoma after adjustment for triglyceride levels. Sex, education, insurance status, body mass index, blood pressure, obstructive sleep apnea, and smoking were not associated with glaucoma. CONCLUSIONS. People who are older, of black race, and with lower income levels have a higher prevalence of glaucoma. A novel association between diabetes, triglyceride levels, and glaucoma is also identified.

Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death

Demazumder, D., Limpitikul, W. B., Dorante, M., Dey, S., Mukhopadhyay, B., Zhang, Y., Randall Moorman, J., Cheng, A., Berger, R. D., Guallar, E., Jones, S. R., & Tomaselli, G. F. (n.d.).

Publication year

2016

Journal title

Europace

Volume

Issue

Page(s)

1818-1828

10.1093/europace/euv399

Abstract

Abstract

Aims: The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. Methods and results: In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60±13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29±16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45±24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. Conclusions: EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.

Estimation of Inorganic Arsenic Exposure in Populations with Frequent Seafood Intake: Evidence from MESA and NHANES

Jones, M. R., Tellez-Plaza, M., Vaidya, D., Grau, M., Francesconi, K. A., Goessler, W., Guallar, E., Post, W. S., Kaufman, J. D., & Navas-Acien, A. (n.d.).

Publication year

2016

Journal title

American Journal of Epidemiology

Volume

184

Issue

Page(s)

590-602

10.1093/aje/kww097

Abstract

Abstract

The sum of urinary inorganic arsenic (iAs) and methylated arsenic (monomethylarsonate and dimethylarsinate (DMA)) species is the main biomarker of iAs exposure. Assessing iAs exposure, however, is difficult in populations with moderate-to-high seafood intakes. In the present study, we used subsamples from the Multi-Ethnic Study of Atherosclerosis (2000-2002) (n = 310) and the 2003-2006 National Health and Nutrition Examination Survey (n = 1,175). We calibrated urinary concentrations of non-seafood-derived iAs, DMA, and methylarsonate, as well as the sum of inorganic and methylated arsenic species, in the Multi-Ethnic Study of Atherosclerosis and of DMA in the National Health and Nutrition Examination Survey by regressing their original concentrations by arsenobetaine and extracting model residuals. To confirm that calibrated biomarkers reflected iAs exposure but not seafood intake, we compared urinary arsenic concentrations by levels of seafood and rice intakes. Self-reported seafood intakes, estimated n-3 polyunsaturated fatty acid levels, and measured n-3 polyunsaturated fatty acid levels were positively associated with the original urinary arsenic biomarkers. Using the calibrated arsenic biomarkers, we found a marked attenuation of the associations with self-reported seafood intake and estimated or measured n-3 fatty acids, whereas associations with self-reported rice intake remained similar. Our residual-based method provides estimates of iAs exposure and metabolism for each participant that no longer reflect seafood intake and can facilitate research about low-to-moderate levels of iAs exposure in populations with high seafood intakes.

Evaluation of frequency-doubling technology perimetry as a means of screening for glaucoma and other eye diseases using the national health and nutrition examination survey

Boland, M. V., Gupta, P., Ko, F., Zhao, D., Guallar, E., & Friedman, D. S. (n.d.).

Publication year

2016

Journal title

JAMA ophthalmology

Volume

134

Issue

Page(s)

57-62

10.1001/jamaophthalmol.2015.4459

Abstract

Abstract

IMPORTANCE Glaucoma is a significant cause of global blindness and there are, as yet, no effective means of screening. OBJECTIVE To assess the potential role of frequency-doubling technology (FDT) perimetry in screening for glaucoma using data collected as part of the National Health and Nutrition Examination Survey (NHANES). DESIGN, SETTING, AND PARTICIPANTS Reanalysis of cross-sectional data of 6797 participants in the 2005-2008 cycles of the NHANES, which evaluated a sample of the noninstitutionalized US population with at least light-perception vision. A subset of optic nerve photographs were regraded by 3 glaucoma specialists in December 2012. Each participant underwent visual field testing, including FDT perimetry screening, and had fundus photographs taken. MAIN OUTCOMES AND MEASURES Sensitivity and specificity of FDT perimetry to detect glaucoma, macular disease, or decreased visual acuity. RESULTS A total of 5746 NHANES participants had optic images originally graded.We regraded 1201 images of 1073 eyes of 548 participants with initial cup-disc ratio (CDR) of 0.6 or greater and 423 images of 360 eyes of 180 randomly selected participants with initial CDR less than 0.6. Diagnoses of glaucoma by disc photograph were 1.6%(3 of 180) in the CDR less than 0.6 group and 31.4%(172 of 548) in the CDR of 0.6 or greater group. The sensitivity of FDT was 33%(95%CI, 0%-87%) and specificity was 77%(95%CI, 71%-84%). For the group with at least 1 CDR of 0.6 or greater, sensitivity of FDT was 66%(95%CI, 59%-73%) and specificity was 70%(95%CI, 66%-75%). When analyzed to give FDT credit for identifying glaucoma, macular disease, or decreased visual acuity, the sensitivity of the test was 80% (95%CI, 77%-83%) and the specificity was 83%(95%CI, 82%-84%). Approximately 25%of the NHANES population was not able to successfully complete FDT testing, representing screening failures and decreasing specificity. CONCLUSIONS AND RELEVANCE Using the 2005-2008 waves of the NHANES as a model of population-based screening for eye disease, FDT perimetry lacks both sensitivity and specificity as a means of screening for glaucoma, the presence of retinal disease, or decreased acuity in a population-based setting. Given that no single test of glaucoma has yet been shown to be appropriate in a screening setting, to our knowledge, investigators should consider novelmethods of detecting glaucoma or combinations of tests that might work better in a screening setting.

Factors associated with change in 25-hydroxyvitamin d levels over longitudinal follow-up in the aric study

McKibben, R. A., Zhao, D., Lutsey, P. L., Schneider, A. L., Guallar, E., Mosley, T. H., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

101

Issue

Page(s)

33-43

10.1210/jc.2015-1711

Abstract

Abstract

Context: A single measurement of 25-hydroxyVitamin D (25 [OH] D) may not accurately reflect long-term Vitamin D status. Little is known about change in 25(OH)D levels over time, particularly among blacks. Objective: The objective of the study was to determine the longitudinal changes in 25(OH)D levels among Atherosclerosis Risk in Communities (ARIC) study participants. Design: This was a longitudinal study. Setting: The study was conducted in the general community. Participants: A total of 9890 white and 3222 black participants at visit 2 (1990â€"1992), 888 whites and 876 blacks at visit 3 (1993â€"1994), and 472 blacks at the brain visit (2004â€"2006) participated in the study. Main Outcome Measure: The 25(OH)D levels were measured, and regression models were used to assess the associations between clinical factors and longitudinal changes in 25(OH)D. Results: VitaminDdeficiency (<50 nmol/L [<20 ng/mL]) was seen in23%and25%of whites at visits 2 and 3, and in 61%, 70%, and 47% of blacks at visits 2, 3, and the brain visit, respectively. The 25(OH)D levels were correlated between visits 2 and 3 (3 y interval) among whites (r = 0.73) and blacks (r = 0.66). Among blacks, the correlation between visit 2 and the brain visit (14 y interval) was 0.33. Overall, increases in 25(OH)D levels over time was associated with male gender, use of Vitamin D supplements, greater physical activity, and higher high-density lipoprotein-cholesterol (P < .001). Decreases in 25(OH)D levels over time were associated with current smoking, higher body mass index, higher education, diabetes, and hypertension (all P < .05). Conclusions: Among US blacks and whites, 25(OH)D levels remained relatively stable over time. Certain modifiable lifestyle factors were associated with change in 25(OH)D levels over time.

Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: The AWHS study

Laclaustra, M., Casasnovas, J. A., Fernández-Ortiz, A., Fuster, V., León-Latre, M., Jiménez-Borreguero, L. J., Pocovi, M., Hurtado-Roca, Y., Ordovas, J. M., Jarauta, E., Guallar, E., Ibañez, B., & Civeira, F. (n.d.).

Publication year

2016

Journal title

Journal of the American College of Cardiology

Volume

Issue

Page(s)

1263-1274

10.1016/j.jacc.2015.12.056

Abstract

Abstract

Background Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area. Objectives This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men. Methods Participants (n = 1,423) of the AWHS (Aragon Workers' Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS ≥1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS. Results Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS. Conclusions Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.

In response

Chang, Y., Ryu, S., Cho, J., Pastor-Barriuso, R., & Guallar, E. (n.d.). In Annals of internal medicine (1–).

Publication year

2016

Volume

165

Issue

Page(s)

744-745

10.7326/L16-0405

Joint effect of airflow limitation and emphysema on postoperative outcomes in early-stage nonsmall cell lung cancer

Shin, S., Park, H. Y., Kim, H., Kim, H. K., Choi, Y. S., Kim, J., Um, S. W., Chung, M. J., Kim, H., Kwon, O. J., Zo, J. I., Guallar, E., Cho, J., & Shim, Y. M. (n.d.).

Publication year

2016

Journal title

European Respiratory Journal

Volume

Issue

Page(s)

1743-1750

10.1183/13993003.01148-2016

Abstract

Abstract

This study aims to evaluate the joint effect of severity of airflow limitation and emphysema on postoperative pulmonary complications (PPCs) and overall survival after complete resection in patients with early-stage nonsmall cell lung cancer (NSCLC). We retrospectively studied 413 male patients with pathologic stage I or II NSCLC between 2007 and 2009. Severity of airflow limitation was defined based on forced expiratory volume in 1 s. Emphysema was defined by ?5% low attenuation area at -950 HU. In multivariable-Adjusted analyses, the adjusted odds ratio (aOR) for any PPC, comparing patients with moderate-To-severe airflow limitation to those without airflow limitation, was 2.23, and the aOR comparing patients with emphysema to those without emphysema was 1.77. However, the joint effect of airflow limitation and emphysema was much higher than expected from the independent effects of both factors (aOR 8.90). Moreover, patients with coexisting moderate-To-severe airflow limitation and emphysema had significantly poorer overall survival than any other group. Patients with moderate-To-severe airflow limitation and emphysema had almost nine times the risk of PPCs and poorer survival than patients with neither of these conditions. Integrated assessment of airflow limitation severity and emphysema is necessary for the optimal selection of candidates for lung resection surgery of early-stage NSCLC.

Korean national health insurance database

Shin, D. W., Cho, B., & Guallar, E. (n.d.). In JAMA internal medicine (1–).

Publication year

2016

Volume

176

Issue

Page(s)

138

10.1001/jamainternmed.2015.7163

Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study

Borghi, C., Tubach, F., De Backer, G., Dallongeville, J., Guallar, E., Medina, J., Perk, J., Roy, C., Banegas, J. R., Rodriguez-Artalejo, F., & Halcox, J. P. (n.d.).

Publication year

2016

Journal title

International Journal of Cardiology

Volume

218

Page(s)

83-88

10.1016/j.ijcard.2016.05.044

Abstract

Abstract

Background The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). Methods EURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N = 5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis. Results In the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93-2.73), body mass index (BMI; OR per kg/m2: 1.03; 95% CI: 1.01-1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m2: 1.06; 95% CI: 1.04-1.08), diabetes (OR: 1.28; 95% CI: 1.06-1.53), use of statins (OR: 1.36; 95% CI: 1.15-1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09-1.23), and geographic location. Similar results were seen in sensitivity analyses. Conclusions Over 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors.

Metabolically healthy obesity and development of chronic kidney disease: A cohort study

Chang, Y., Ryu, S., Choi, Y., Zhang, Y., Cho, J., Kwon, M. J., Hyun, Y. Y., Lee, K. B., Kim, H., Jung, H. S., Yun, K. E., Ahn, J., Rampal, S., Zhao, D., Suh, B. S., Chung, E. C., Shin, H., Pastor-Barriuso, R., & Guallar, E. (n.d.).

Publication year

2016

Journal title

Annals of internal medicine

Volume

164

Issue

Page(s)

305-312

10.7326/M15-1323

Abstract

Abstract

Background: The risk for chronic kidney disease (CKD) among obese persons without obesity-related metabolic abnormalities, called metabolically healthy obesity, is largely unexplored. Objective: To investigate the risk for incident CKD across categories of body mass index in a large cohort of metabolically healthy men and women. Design: Prospective cohort study. Setting: Kangbuk Samsung Health Study, Kangbuk Samsung Hospital, Seoul, South Korea. Participants: 62 249 metabolically healthy, young and middleaged men and women without CKD or proteinuria at baseline. Measurements: Metabolic health was defined as a homeostasis model assessment of insulin resistance less than 2.5 and absence of any component of the metabolic syndrome. Underweight, normal weight, overweight, and obesity were defined as a body mass index less than 18.5 kg/m2, 18.5 to 22.9 kg/m2, 23 to 24.9 kg/m2, and 25 kg/m2 or greater, respectively. The outcome was incident CKD, defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m2. Results: During 369 088 person-years of follow-up, 906 incident CKD cases were identified. The multivariable-adjusted differences in 5-year cumulative incidence of CKD in underweight, overweight, and obese participants compared with normalweight participants were-4.0 (95% CI,-7.8 to-0.3), 3.5 (CI, 0.9 to 6.1), and 6.7 (CI, 3.0 to 10.4) cases per 1000 persons, respectively. These associations were consistently seen in all clinically relevant subgroups. Limitation: Chronic kidney disease was identified by a single measurement at each visit. Conclusion: Overweight and obesity are associated with an increased incidence of CKD in metabolically healthy young and middle-aged participants. These findings show that metabolically healthy obesity is not a harmless condition and that the obese phenotype, regardless of metabolic abnormalities, can adversely affect renal function.

Metabolically healthy obesity and the development of nonalcoholic fatty liver disease

Chang, Y., Jung, H. S., Cho, J., Zhang, Y., Yun, K. E., Lazo, M., Pastor-Barriuso, R., Ahn, J., Kim, C. W., Rampal, S., Cainzos-Achirica, M., Zhao, D., Chung, E. C., Shin, H., Guallar, E., & Ryu, S. (n.d.).

Publication year

2016

Journal title

American Journal of Gastroenterology

Volume

111

Volume

184

Issue

Page(s)

806-817

10.1093/aje/kww002

Abstract

Abstract

At high levels, inorganic arsenic exposure is linked to peripheral arterial disease (PAD) and cardiovascular disease. To our knowledge, no prior study has evaluated the association between low-to-moderate arsenic exposure and incident PAD by ankle brachial index (ABI). We evaluated this relationship in the Strong Heart Study, a large population-based cohort study of American Indian communities. A total of 2,977 and 2,966 PAD-free participants who were aged 45-74 years in 1989-1991 were reexamined in 1993-1995 and 1997-1999, respectively, for incident PAD defined as either ABI <0.9 or ABI >1.4. A total of 286 and 206 incident PAD cases were identified for ABI <0.9 and ABI >1.4, respectively. The sum of inorganic and methylated urinary arsenic species (∑As) at baseline was used as a biomarker of long-term exposure. Comparing the highest tertile of ∑As with the lowest, the adjusted hazard ratios were 0.57 (95% confidence interval (CI): 0.32, 1.01) for ABI <0.9 and 2.24 (95% CI: 1.01, 4.32) for ABI >1.4. Increased arsenic methylation (as percent dimethylarsinate) was associated with a 2-fold increased risk of ABI >1.4 (hazard ratio = 2.04, 95% CI: 1.02, 3.41). Long-term low-to-moderate ∑As and increased arsenic methylation were associated with ABI >1.4 but not with ABI <0.9. Further studies are needed to clarify whether diabetes and enhanced arsenic metabolism increase susceptibility to the vasculotoxic effects of arsenic exposure.

Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis

Sinn, D. H., Cho, S. J., Gu, S., Seong, D., Kang, D., Kim, H., Yi, B. K., Paik, S. W., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2016

Journal title

Gastroenterology

Volume

151

Issue

Page(s)

481-488.e1

10.1053/j.gastro.2016.06.001

Abstract

Abstract

Background & Aims Nonalcoholic fatty liver disease (NAFLD) has been associated with subclinical atherosclerosis in cross-sectional studies. We investigated the longitudinal association of NAFLD with the development of subclinical carotid atherosclerosis. Methods We performed a retrospective cohort study of 8020 adult men (average age, 49.2 y) without carotid atherosclerosis at baseline who underwent repeated health check-up examinations from January 1, 2005, through December 31, 2013. NAFLD status was diagnosed by ultrasonography and classified into 4 groups based on baseline and follow-up findings: none, developed, regressed, or persistent NAFLD. Subclinical carotid atherosclerosis was measured by ultrasound. Results The age-adjusted hazard ratio for subclinical carotid atherosclerosis development comparing participants with persistent NAFLD with those without NAFLD was 1.23 (95% confidence interval [CI], 1.13–1.35; P <.001). The association persisted after adjustment for smoking, alcohol, body mass index, and weight change (hazard ratio, 1.13; 95% CI, 1.03–1.25; P =.014), but disappeared after adjustment for metabolic variables. The hazard ratio, comparing subjects with regression of NAFLD vs those with persistent NAFLD, was 0.82 (95% CI, 0.69–0.96; P =.013). The risk of subclinical carotid atherosclerosis development also was higher among participants with a high NAFLD fibrosis score, fibrosis-4 scores, or levels of γ-glutamyl transferase at baseline. Conclusions In a large cohort study, persistent NAFLD was associated with an increased risk of subclinical carotid atherosclerosis development. This association was explained by metabolic factors that could be potential mediators of the effect of NAFLD. Markers of liver fibrosis also were associated with subclinical carotid atherosclerosis development. Prospective studies are needed to determine whether treatment of NAFLD can reduce this risk.

Physical Activity, Parental History of Premature Coronary Heart Disease, and Incident Atherosclerotic Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study

Florido, R., Zhao, D., Ndumele, C. E., Lutsey, P. L., Mcevoy, J. W., Windham, B. G., Pankow, J. S., Guallar, E., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of the American Heart Association

Volume

Issue

10.1161/JAHA.116.003505

Abstract

Abstract

Background: The effects of some atherosclerotic cardiovascular disease (ASCVD) risk factors vary according to whether an individual has a family history (FHx) of premature coronary heart disease (CHD). Physical activity (PA) is associated with reduced risk of ASCVD, but whether this association varies by FHx status is not well established. Methods and Results: We evaluated 9996 participants free of ASCVD at baseline. FHx of premature CHD was defined as CHD occurring in a father before age 55 or mother before age 60. PA, assessed by a Baecke questionnaire, was converted into minutes/week of moderate or vigorous exercise and categorized per American Heart Association guidelines as recommended, intermediate, or poor. Incident ASCVD was defined as incident myocardial infarction, fatal CHD, or stroke. Multivariable-adjusted Cox hazard models were used. The mean age was 54±6 years, 56% were women, and 21% of black race. Participants with and without a FHx of premature CHD reported similar levels of PA at baseline (423 versus 409 metabolic equivalents of task×min/week, respectively, P=0.852), and ≈40% of both groups met American Heart Association recommended PA levels. Over a mean follow-up of 20.9 years, there were 1723 incident ASCVD events. Compared to those with poor PA adherence to American Heart Association guidelines, participants who reported PA at recommended levels had significantly lower risk of incident ASCVD after adjustment for demographics and lifestyle factors (hazard ratio 0.84, 95% CI 0.74-0.94), but this association was not modified by FHx status (P-interaction=0.680). Conclusions: PA was associated with a reduced risk of ASCVD among individuals with and without a FHx of premature CHD.

Polyunsaturated fats, carbohydrates and carotid disease: The Atherosclerosis Risk in Communities (ARIC) Carotid MRI study

Dearborn, J. L., Qiao, Y., Guallar, E., Steffen, L. M., Gottesman, R. F., Zhang, Y., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Atherosclerosis

Volume

251

Page(s)

361-366

10.1016/j.atherosclerosis.2016.05.024

Abstract

Abstract

Background and aims Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. Methods The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987–1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. Results Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1–4 g) and high (6–12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. Conclusions GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.

Prevalence of glaucoma in the united states: The 2005–2008 national health and nutrition examination survey

Gupta, P., Zhao, D., Guallar, E., Ko, F., Boland, M. V., & Friedman, D. S. (n.d.).

Publication year

2016

Journal title

Investigative Ophthalmology and Visual Science

Volume

Issue

Page(s)

2905-2913

10.1167/iovs.15-18469

Abstract

Abstract

PURPOSE. To estimate the prevalence of glaucoma in the US population based on optic nerve head photography, to estimate the prevalence of glaucoma awareness, and to identify demographic and ocular risk factors for being unaware of having glaucoma. METHODS. The study included 5746 men and women 40 years of age and older participating in the National Health and Nutrition Examination Survey (NHANES) 2005–2008. Each participant had 458 photographs of the macula and optic disc of both eyes. Fundus photographs were first graded by a reading center, and those with a cup-to-disc ratio (CDR) ≥ 0.6 were regraded by three glaucoma specialists to determine the presence or absence of glaucoma. Analyses were performed using NHANES weights to account for the complex multistage probability sampling design. RESULTS. The estimated overall prevalence of glaucoma in the US civilian, noninstitutionalized population 40 years of age and older was 2.1% (95% confidence interval [CI], 1.7%–2.6%). Glaucoma affected 2.9 million individuals, including 1.4 million women; 1.5 million men; 2.3 million people 60 years of age and older; and 0.9 million blacks, Mexican Americans, and people of other races. The prevalence of glaucoma was highest in non-Hispanic blacks, followed by non-Hispanic whites, Mexican Americans, and others. Over half of participants with glaucoma were unaware that they had the disease. CONCLUSIONS. The prevalence of glaucoma based on optic nerve fundus photography assessment in the general US population 40 years of age and older was 2.1%. Approximately half of glaucoma cases were previously undiagnosed. Studies to determine whether and how to identify undiagnosed glaucoma are an important next step.

Eliseo Guallar

Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

Education

Honors and awards

Publications

Publications

D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study

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Diabetes, triglyceride levels, and other risk factors for glaucoma in the national health and nutrition examination survey 2005-2008

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Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death

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Estimation of Inorganic Arsenic Exposure in Populations with Frequent Seafood Intake: Evidence from MESA and NHANES

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Evaluation of frequency-doubling technology perimetry as a means of screening for glaucoma and other eye diseases using the national health and nutrition examination survey

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Factors associated with change in 25-hydroxyvitamin d levels over longitudinal follow-up in the aric study

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Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium: The AWHS study

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In response

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Joint effect of airflow limitation and emphysema on postoperative outcomes in early-stage nonsmall cell lung cancer

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Korean national health insurance database

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Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study

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Metabolically healthy obesity and development of chronic kidney disease: A cohort study

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Metabolically healthy obesity and the development of nonalcoholic fatty liver disease

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