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

Arsenic exposure and predicted 10-year atherosclerotic cardiovascular risk using the pooled cohort equations in U.S. hypertensive adults

Nong, Q., Zhang, Y., Guallar, E., & Zhong, Q. (n.d.).

Publication year

2016

Journal title

International journal of environmental research and public health

Volume

13

Issue

11

10.3390/ijerph13111093

Abstract

Abstract

This study was to evaluate the association of urine arsenic with predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk in U.S. adults with hypertension. Cross-sectional analysis was conducted in 1570 hypertensive adults aged 40–79 years in the 2003–2012 National Health and Nutrition Examination Survey (NHANES) with determinations of urine arsenic. Predicted 10-year ASCVD risk was estimated by the Pooled Cohort Equations, developed by the American College of Cardiology/American Heart Association in 2013. For men, after adjustment for sociodemographic factors, urine dilution, ASCVD risk factors and organic arsenic intake from seafood, participants in the highest quartiles of urine arsenic had higher 10-year predicted ASCVD risk than in the lowest quartiles; the increases were 24% (95% confidence interval (CI): 2%, 53%) for total arsenic, 13% (95% CI: 2%, 25%) for dimethylarsinate and 22% (95% CI: 5%, 40%) for total arsenic minus arsenobetaine separately. For women, the corresponding increases were 5% (95% CI: −15%, 29%), 10% (95% CI: −8%, 30%) and 0% (95% CI: −15%, 19%), respectively. Arsenic exposure, even at low levels, may contribute to increased ASCVD risk in men with hypertension. Furthermore, our findings suggest that particular circumstances need urgently to be considered while elucidating cardiovascular effects of low inorganic arsenic levels. View Full-Text.

Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis

Peñalvo, J. L., Fernández-Friera, L., López-Melgar, B., Uzhova, I., Oliva, B., Fernández-Alvira, J. M., Laclaustra, M., Pocock, S., Mocoroa, A., Mendiguren, J. M., Sanz, G., Guallar, E., Bansilal, S., Vedanthan, R., Jiménez-Borreguero, L. J., Ibañez, B., Ordovás, J. M., Fernández-Ortiz, A., Bueno, H., & Fuster, V. (n.d.).

Publication year

2016

Journal title

Journal of the American College of Cardiology

Volume

68

Issue

8

Page(s)

805-814

10.1016/j.jacc.2016.05.080

Abstract

Abstract

Background The importance of a healthy diet in relation to cardiovascular health promotion is widely recognized. Identifying specific dietary patterns related to early atherosclerosis would contribute greatly to inform effective primary prevention strategies. Objectives This study sought to quantify the association between specific dietary patterns and presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults. Methods The PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082 asymptomatic participants 40 to 54 years of age (mean age 45.8 years; 63% male) to evaluate the presence of subclinical atherosclerosis in multiple vascular territories. A fundamental objective of this cohort study was to evaluate the life-style–related determinants, including diet, on atherosclerosis onset and development. We conducted a cross-sectional analysis of baseline data, including detailed information on dietary habits obtained as part of the overall life-style and risk factor assessment, as well as a complete vascular imaging study that was performed blinded to the clinical information. Results Most PESA participants follow a Mediterranean (40% of participants) or a Western (41%) dietary pattern. A new pattern, identified among 19% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Participants following this pattern presented a significantly worse cardiovascular risk profile and, after adjustment for risk factors, increased odds of presenting subclinical atherosclerosis (odds ratio: 1.31; 95% confidence interval: 1.06 to 1.63) compared with participants following a Mediterranean diet. Conclusions A new social-business eating pattern, characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and eating out as part of an overall unhealthy life-style, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis.

Association of geography and ambient air pollution with urine metal concentrations in six us cities: The multi-ethnic study of atherosclerosis

Pang, Y., Jones, M. R., Tellez-Plaza, M., Guallar, E., Vaidya, D., Post, W. S., Kaufman, J. D., Delaney, J. A., & Navas-Acien, A. (n.d.).

Publication year

2016

Journal title

International journal of environmental research and public health

Volume

13

Issue

3

10.3390/ijerph13030324

Abstract

Abstract

We investigated the associations of urinary concentrations of antimony, cadmium, tungsten and uranium with geographic locations and with ambient air pollution in 304 adults in the Multi-Ethnic Study of Atherosclerosis from six US cities. After adjustment for sociodemographics, body mass index, and smoking status, urinary cadmium was the highest in Winston-Salem among all study sites (the geometric mean [GM] in Winston-Salem was 0.84 µg/L [95% confidence interval (CI) 0.57–1.22]). The adjusted GMs of urinary tungsten and uranium were highest in Los Angeles (0.11 µg/L [95% CI 0.08–0.16] and 0.019 µg/L [95% CI 0.016–0.023], respectively). The adjusted GM ratio comparing fine particulate matter (PM2.5) tertiles 2 and 3 with the lowest tertile were 1.64 (95% CI 1.05–2.56) and 3.55 (95% CI 2.24–5.63) for tungsten, and 1.18 (95% CI 0.94–1.48) and 1.70 (95% CI 1.34–2.14) for uranium. The results for tungsten remained similar after adjustment for study site. Urinary cadmium, tungsten and uranium concentrations differed by geographic locations in MESA (Multi-Ethnic Study of Atherosclerosis) communities. PM2.5 levels could contribute to geographic differences in tungsten exposure. These findings highlight the need to implement preventive strategies to decrease toxic metal exposure and to evaluate the health effects of chronic exposure to those metals.

Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

Zhang, Y., Guallar, E., Weiss, R. G., Stillabower, M., Gerstenblith, G., Tomaselli, G. F., & Wu, K. C. (n.d.).

Publication year

2016

Journal title

Heart Rhythm

Volume

13

Issue

8

Page(s)

1661-1666

10.1016/j.hrthm.2016.04.013

Abstract

Abstract

Background Left ventricular ejection fraction (LVEF) improves over time in 25%–40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.

Cadmium exposure and age-related macular degeneration

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

Publication year

2016

Journal title

Journal of Exposure Science and Environmental Epidemiology

Volume

26

Issue

2

Page(s)

214-218

10.1038/jes.2014.75

Abstract

Abstract

Cadmium (Cd) has been proposed as a risk factor for age-related macular degeneration (AMD), but the association between Cd exposure and AMD risk in large population studies is unknown. This study evaluated the association of Cd exposure with AMD in a large representative sample of Korean men and women. This was a cross-sectional study of 3865 Korean adults ≥40 years of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) during 2008-2011. Cd concentrations in whole blood were measured by graphite-furnace atomic absorption spectrometry. The presence of AMD was determined in digital non-mydriatic fundus photographs. Cd levels were higher in participants with AMD compared with those without AMD (1.3 vs 1.1 μg/l, respectively, P<0.001). In fully adjusted models, the odds ratio for AMD comparing the highest with the lowest Cd quartiles was 1.92 (95% CI=1.08-3.39; P for trend 0.029). In restricted cubic spline models, the association between Cd and AMD was approximately linear, with no evidence of threshold effects. Blood Cd concentrations were independently associated with the prevalence of AMD. If the association is proven causal, population-based preventive strategies to decrease Cd exposure could reduce the population burden of AMD.

Coronary artery calcium is associated with cortical thinning in cognitively normal individuals

Lee, J. S., Kang, D., Jang, Y. K., Kim, H. J., Na, D. L., Shin, H. Y., Kang, M., Yang, J. J., Lee, J. M., Lee, J., Kim, Y. J., Park, K. C., Guallar, E., Seo, S. W., & Cho, J. (n.d.).

Publication year

2016

Journal title

Scientific reports

Volume

6

10.1038/srep34722

Abstract

Abstract

To evaluate the association between coronary artery calcium (CAC) and cortical thickness in a large sample of cognitively normal individuals, with special emphasis in determining if the association thickness has regional brain specificity and if it is mediated by white matter hyperintensities (WMH). A total of 512 participants were included in this study. CAC scores were assessed by multi-detector computed tomography. Cortical thickness was measured using a surface-based method. Linear mixed models were used to assess the association between CAC scores and cortical thickness. In fully adjusted models, increased CAC scores were associated with cortical thinning across several brain regions, which generally overlapped with the distribution of default mode network. The association between CAC scores and cortical thickness was significantly stronger in participants with moderate or severe WMH compared to those with none or mild WMH, even though CAC scores were not associated with WMH. In cognitively normal adults, CAC was associated with cortical thinning in areas related to cognitive function. This association was evident after adjusting for multiple coronary artery disease risk factors and for WMH, suggesting that CAC may be more closely related to Alzheimer's Disease-type disease rather than to cerebral small vessel disease.

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

11

Issue

8

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

57

Issue

4

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

18

Issue

12

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

8

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

1

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

1

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

67

Issue

11

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

10

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

48

Issue

6

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

1

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

5

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

Issue

8

Page(s)

1133-1140

10.1038/ajg.2016.178

Abstract

Abstract

OBJECTIVES: The risk of nonalcoholic fatty liver disease (NAFLD) among obese individuals without obesity-related metabolic abnormalities, a condition referred to as metabolically healthy obese (MHO), is largely unexplored. Therefore, we examined the association between body mass index (BMI) categories and the development of NAFLD in a large cohort of metabolically healthy men and women. METHODS: A cohort study was conducted in 77,425 men and women free of NAFLD and metabolic abnormalities at baseline, who were followed-up annually or biennially for an average of 4.5 years. Being metabolically healthy was defined as not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5. The presence of fatty liver was determined using ultrasound. RESULTS: During 348,193.5 person-years of follow-up, 10,340 participants developed NAFLD (incidence rate, 29.7 per 1,000 person-years). The multivariable adjusted hazard ratios (95% confidence intervals) for incident NAFLD comparing overweight and obese with normal-weight participants were 2.15 (2.06-2.26) and 3.55 (3.37-3.74), respectively. In detailed dose-response analyses, increasing baseline BMI showed a strong and approximately linear relationship with the incidence of NAFLD, with no threshold at no risk. This association was present in both men and women, although it was stronger in women (P for interaction <0.001), and it was evident in all clinically relevant subgroups evaluated, including participants with low inflammation status. CONCLUSIONS: In a large cohort of strictly defined metabolically healthy men and women, overweight and obesity were strongly and progressively associated with an increased incidence of NAFLD, suggesting that the obese phenotype per se, regardless of metabolic abnormalities, can increase the risk of NAFLD.

Metal mixtures in urban and rural populations in the US: The Multi-Ethnic Study of Atherosclerosis and the Strong Heart Study

Pang, Y., Peng, R. D., Jones, M. R., Francesconi, K. A., Goessler, W., Howard, B. V., Umans, J. G., Best, L. G., Guallar, E., Post, W. S., Kaufman, J. D., Vaidya, D., & Navas-Acien, A. (n.d.).

Publication year

2016

Journal title

Environmental Research

Volume

147

Page(s)

356-364

10.1016/j.envres.2016.02.032

Abstract

Abstract

Background: Natural and anthropogenic sources of metal exposure differ for urban and rural residents. We searched to identify patterns of metal mixtures which could suggest common environmental sources and/or metabolic pathways of different urinary metals, and compared metal-mixtures in two population-based studies from urban/sub-urban and rural/town areas in the US: the Multi-Ethnic Study of Atherosclerosis (MESA) and the Strong Heart Study (SHS). Methods: We studied a random sample of 308 White, Black, Chinese-American, and Hispanic participants in MESA (2000-2002) and 277 American Indian participants in SHS (1998-2003). We used principal component analysis (PCA), cluster analysis (CA), and linear discriminant analysis (LDA) to evaluate nine urinary metals (antimony [Sb], arsenic [As], cadmium [Cd], lead [Pb], molybdenum [Mo], selenium [Se], tungsten [W], uranium [U] and zinc [Zn]). For arsenic, we used the sum of inorganic and methylated species (∑As). Results: All nine urinary metals were higher in SHS compared to MESA participants. PCA and CA revealed the same patterns in SHS, suggesting 4 distinct principal components (PC) or clusters (∑As-U-W, Pb-Sb, Cd-Zn, Mo-Se). In MESA, CA showed 2 large clusters (∑As-Mo-Sb-U-W, Cd-Pb-Se-Zn), while PCA showed 4 PCs (Sb-U-W, Pb-Se-Zn, Cd-Mo, ∑As). LDA indicated that ∑As, U, W, and Zn were the most discriminant variables distinguishing MESA and SHS participants. Conclusions: In SHS, the ∑As-U-W cluster and PC might reflect groundwater contamination in rural areas, and the Cd-Zn cluster and PC could reflect common sources from meat products or metabolic interactions. Among the metals assayed, ∑As, U, W and Zn differed the most between MESA and SHS, possibly reflecting disproportionate exposure from drinking water and perhaps food in rural Native communities compared to urban communities around the US.

Metals in urine and diabetes in U.S. adults

Menke, A., Guallar, E., & Cowie, C. C. (n.d.).

Publication year

2016

Journal title

Diabetes

Volume

65

Issue

1

Page(s)

164-171

10.2337/db15-0316

Abstract

Abstract

Our objective was to evaluate the relationship of urine metals including barium, cadmium, cobalt, cesium, molybdenum, lead, antimony, thallium, tungsten, and uranium with diabetes prevalence. Data were from a cross-sectional study of 9,447 participants of the 1999-2010 National Health and Nutrition Examination Survey, a representative sample of the U.S. civilian noninstitutionalized population. Metals were measured in a spot urine sample, and diabetes status was determined based on a previous diagnosis or an A1C ≥6.5% (48 mmol/mol). After multivariable adjustment, the odds ratios of diabetes associated with the highest quartile of metal, compared with the lowest quartile, were 0.86 (95% CI 0.66-1.12) for barium (Ptrend = 0.13), 0.74 (0.51-1.09) for cadmium (Ptrend = 0.35), 1.21 (0.85-1.72) for cobalt (Ptrend = 0.59), 1.31 (0.90-1.91) for cesium (Ptrend = 0.29), 1.76 (1.24-2.50) for molybdenum (Ptrend = 0.01), 0.79 (0.56-1.13) for lead (Ptrend = 0.10), 1.72 (1.27-2.33) for antimony (Ptrend < 0.01), 0.76 (0.51-1.13) for thallium (Ptrend = 0.13), 2.18 (1.51-3.15) for tungsten (Ptrend < 0.01), and 1.46 (1.09-1.96) for uranium (Ptrend = 0.02). Higher quartiles of barium, molybdenum, and antimony were associated with greater HOMA of insulin resistance after adjustment. Molybdenum, antimony, tungsten, and uranium were positively associated with diabetes, even at the relatively low levels seen in the U.S. population. Prospective studies should further evaluate metals as risk factors for diabetes.

MR imaging measures of intracranial atherosclerosis in a population-based study

Qiao, Y., Guallar, E., Suri, F. K., Liu, L., Zhang, Y., Anwar, Z., Mirbagheri, S., Xie, Y. Y. J., Nezami, N., Intrapiromkul, J., Zhang, S., Alonso, A., Chu, H., Couper, D., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Radiology

Volume

280

Issue

3

Page(s)

860-868

10.1148/radiol.2016151124

Abstract

Abstract

Purpose: To implement a magnetic resonance (MR) imaging protocol to measure intracranial atherosclerotic disease (ICAD) in a population-based multicenter study and report examination and reader reliability of these MR imaging measurements and descriptive statistics representative of the general population. Materials and Methods: This prospective study was approved by the institutional review boards and compliant with HIPAA. Atherosclerosis Risk in Communities (ARIC) study participants (n = 1980) underwent brain MR imaging from 2011 to 2013 at four ARIC sites. Imaging included three-dimensional blackblood MR imaging and time-of-flight MR angiography. One hundred two participants returned for repeat MR imaging to estimate examination and reader variability. Plaque presence according to vessel segment was recorded. Quantitative measurements included lumen size and degree of stenosis, wall and/or plaque thickness, area and volume, and normalized wall index for each vessel segment. Reliability was assessed with percentage agreement, k statistics, and intraclass correlation coefficients. Results: Of the 1980 participants, 1755 (mean age, 77.6 years; 1026 women [59%]; 1234 white [70%]) completed examinations with adequate to excellent image quality. The weighted ICAD prevalence was 34.4% (637 of 1755 participants) and was higher in men than women (38.5% [302 of 729 participants] vs 31.7% [335 of 1026 participants], respectively; P = .012) and in African Americans compared with whites (41.1% [215 of 518 participants] vs 32.4% [422 of 1234 participants], respectively; P = .002). Percentage agreement of plaque identification per participant was 87.0% (interreader estimate), 89.2% (intrareader estimate), and 89.9% (examination estimate). Examination and reader reliability ranged from fair to good (k, 0.50-0.78) for plaque presence and from good to excellent (intraclass correlation coefficient, 0.69-0.99) for quantitative vessel wall measurements. Conclusion: Vessel wall MR imaging is a reliable tool for identifying and measuring ICAD and provided insight into ICAD distribution across a U.S. community-based population.

Nonalcoholic fatty liver disease is associated with cognitive function in adults

Seo, S. W., Gottesman, R. F., Clark, J. M., Hernaez, R., Chang, Y., Kim, C., Ha, K. H., Guallar, E., & Lazo, M. (n.d.).

Publication year

2016

Journal title

Neurology

Volume

86

Issue

12

Page(s)

1136-1142

10.1212/WNL.0000000000002498

Abstract

Abstract

Objective: We hypothesized that nonalcoholic fatty liver disease (NAFLD) is independently associated with cognitive impairment in a representative sample of the general US population regardless of the presence of cardiovascular disease (CVD) or its risk factors. Methods: This was a cross-sectional study of 4,472 adults aged 20-59 years who participated in the Third National Health and Nutritional Examination Survey. The participants underwent assessment of liver enzyme activity and hepatic steatosis by ultrasound, and underwent cognitive evaluation using the following computer-administered tests: the Simple Reaction Time Test (SRTT), the Symbol-Digit Substitution Test (SDST), and the Serial Digit Learning Test (SDLT). We defined NAFLD as moderate/severe steatosis as determined by ultrasound in the absence of hepatitis B or C or excessive alcohol consumption. We used multiple linear regression models to examine the association between NAFLD and cognitive function while controlling for potential confounders. Results: Participants with NAFLD showed lower overall performance on the SDLT (β 0.726, 95% confidence interval [CI] 0.105-1.347), while associations with SRTT and SDST did not reach significance. Increased activity of the liver enzymes alanine aminotransferase (β 0.018, 95% CI 0.006-0.030) and aspartate aminotransferase (β 0.021, 95% CI 0.005-0.037) correlated with lower performance on the SDLT, while increased alanine aminotransferase was also correlated with lower performance in the SDST (β 0.002, 95% CI 0.0001-0.004). Conclusions: NAFLD was independently associated with lower cognitive performance independent of CVD and its risk factors. Given the scarcity of risk factors associated with age-related cognitive decline, these findings may have significant implications.

Parathyroid Hormone and Subclinical Cerebrovascular Disease: The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study

Korada, S. K. C., Zhao, D., Gottesman, R. F., Guallar, E., Lutsey, P. L., Alonso, A., Sharrett, A. R., Post, W. S., Reis, J. P., Mosley, T. H., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of Stroke and Cerebrovascular Diseases

Volume

25

Issue

4

Page(s)

883-893

10.1016/j.jstrokecerebrovasdis.2015.12.029

Abstract

Abstract

Background Elevated parathyroid hormone (PTH) levels have been associated with cardiovascular disease risk factors and events. We hypothesized that elevated PTH levels would also be associated with subclinical cerebrovascular disease. We examined the relationship between elevated PTH level and white matter hyperintensities (WMHs) and subclinical infarcts measured on brain magnetic resonance imaging (MRI). Methods PTH was measured at baseline (1993-1994) among participants free of prior clinical stroke who underwent a brain MRI at baseline (n = 1703) and a second brain MRI 10 years later (n = 948). PTH levels of 65 pg/mL or higher were considered elevated (n = 204). Participants who did not return for a follow-up MRI had, at baseline, higher PTH and a greater prevalence of cardiovascular risk factors (P <.05 for all); therefore, multiple imputation was used. The cross-sectional and prospective associations of PTH levels with WMH and MRI-defined infarcts (and their progression) were investigated using multivariable regression models. Results At baseline, the participants had a mean age of 62 years and were 60% female and 49% black. Cross-sectionally, after adjusting for demographic and lifestyle factors, elevated PTH level was associated with higher WMH score (β =.19, 95% confidence interval [CI].04-.35) and increased odds of prevalent infarcts (odds ratio 1.56, 95% CI 1.02-2.36). Results were attenuated after adjustment for potential mediators of this association (i.e., hypertension). No prospective associations were found between PTH and incident infarcts or change in estimated WMH volume, although estimates were imprecise. Conclusions Although associated cross-sectionally, we did not confirm any association between elevated PTH level and progression of cerebrovascular changes on brain MRIs obtained 10 years apart. The relationship of PTH with subclinical brain disease warrants further study.

Patient safety events and harms during medical and surgical hospitalizations for persons with serious mental illness

Daumit, G. L., McGinty, E. E., Pronovost, P., Dixon, L. B., Guallar, E., Ford, D. E., Cahoon, E. K., Boonyasai, R. T., & Thompson, D. (n.d.).

Publication year

2016

Journal title

Psychiatric Services

Volume

67

Issue

10

Page(s)

1068-1075

10.1176/appi.ps.201500415

Abstract

Abstract

Objective: This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. Methods: Medical record reviewwas conducted formedicalsurgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. Results: A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3-1.7) and procedure-related events (OR=1.6, CI=1.2-2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4-10.3). Conclusions: Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness.