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

Optimizing Glaucoma Screening in High-Risk Population : Design and 1-Year Findings of the Screening to Prevent (SToP) Glaucoma Study

SToP Glaucoma Study Group, A., SToP Glaucoma Study Group, A., Zhao, D., Guallar, E., Gajwani, P., Swenor, B., Crews, J., Saaddine, J., Mudie, L., Varadaraj, V., Friedman, D. S., Kanwar, N., Sosa-Ebert, A., Dosto, N., Thompson, S., Wahl, M., Johnson, E., & Ogega, C. (n.d.).

Publication year

2017

Journal title

American Journal of Ophthalmology

Volume

180

Page(s)

18-28

10.1016/j.ajo.2017.05.017

Abstract

Abstract

Purpose To develop, implement, and evaluate a replicable community-based screening intervention designed to improve glaucoma and other eye disease detection and follow-up care in high-risk populations in the United States. We present the design of the study and describe the findings of the first year of the program. Design Prospective study to evaluate screening and follow-up. Methods This is an ongoing study to develop an eye screening program using trained personnel to identify individuals with ophthalmic needs, focusing on African Americans ≥50 years of age at multiple inner-city community sites in Baltimore, Maryland. The screening examination uses a sequential referral approach and assesses presenting visual acuity (VA), best-corrected VA, digital fundus imaging, visual field testing, and measurement of intraocular pressure. Results We screened 901 individuals between January 2015 and October 2015. Subjects were mostly African Americans (94.9%) with a mean (standard deviation) age of 64.3 (9.9) years. Among them, 356 (39.5%) participants were referred for a definitive eye examination and 107 (11.9%) only needed prescription glasses. The most common reasons for referral were ungradable fundus image (39.3% of those referred), best-corrected VA < 20/40 (14.6%), and ungradable autorefraction (11.8%). Among people referred for definitive examination, 153 (43%) people attended their scheduled examination. The most common diagnoses at the definitive examination were glaucoma and cataract (51% and 40%, respectively). Conclusions A large proportion of individuals screened required ophthalmic services, particularly those who were older and less well educated. To reach and encourage these individuals to attend screenings and follow-up examinations, programs could develop innovative strategies and approaches.

Patient, provider, and system factors contributing to patient safety events during medical and surgical hospitalizations for persons with serious mental illness

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

Publication year

2017

Journal title

Journal of Nervous and Mental Disease

Volume

205

Issue

6

Page(s)

495-501

10.1097/NMD.0000000000000675

Abstract

Abstract

This study aimed to explore patient-, provider-, and system-level factors that may contribute to elevated risk of patient safety events among persons with serious mental illness (SMI). We conducted a medical record review of medical/surgical admissions in Maryland hospitals from 1994 to 2004 for a community-based sample of adults with SMI (N = 790 hospitalizations). We estimated the prevalence of multiple patient, provider, and systemfactors that could influence patient safety among persons with SMI.We conducted a case crossover analysis to examine the relationship between these factors and adverse patient safety events. Patients' mental status, level of consciousness, disease severity, and providers' lack of patient monitoring, delay/failure to seek consultation, lack of trainee supervision, and delays in care were positively associated with adverse patient safety events (p < 0.05). Efforts to reduce SMI-related patient safety risks will need to be multifaceted and address both patient- and provider-level factors.

Physical activity, vitamin D, and incident atherosclerotic cardiovascular disease in whites and blacks : The ARIC study

Chin, K., Zhao, D., Tibuakuu, M., Martin, S. S., Ndumele, C. E., Florido, R., Windham, B. G., Guallar, E., Lutsey, P. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

102

Issue

4

Page(s)

1227-1236

10.1210/jc.2016-3743

Abstract

Abstract

Context: Physical activity (PA) is associated with 25-hydroxyvitamin D [25(OH)D] levels. Both are associated with atherosclerotic cardiovascular disease (ASCVD), but their joint association with ASCVD risk is unknown. Objective: To examine the relationship between PA and 25(OH)D, and assess effect modification of 25(OH)D and PA with ASCVD. Design: Cross-sectional and prospective study. Setting: Community-dwelling cohort. Participants: A total of 10,342 participants free of ASCVD, with moderate- to vigorous-intensity PA assessed (1987 to 1989) and categorized per American Heart Association (AHA) guidelines (recommended, intermediate, or poor). Main Outcome Measures: Serum 25(OH)D levels (1990 to 1992) and ASCVD events (i.e., incident myocardial infarction, fatal coronary disease, or stroke) through 2013. Results: Participants had mean age of 54 years, and were 57% women, 21% black, 30% 25(OH)D deficient [

Prevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome

Metkus, T. S., Guallar, E., Sokoll, L., Morrow, D., Tomaselli, G., Brower, R., Schulman, S., & Korley, F. K. (n.d.).

Publication year

2017

Journal title

Critical care medicine

Volume

45

Issue

10

Page(s)

1709-1717

10.1097/CCM.0000000000002641

Abstract

Abstract

Objective: Circulating cardiac troponin has been associated with adverse prognosis in the acute respiratory distress syndrome in small and single-center studies; however, comprehensive studies of myocardial injury in acute respiratory distress syndrome using modern high-sensitivity troponin assays, which can detect troponin at much lower circulating concentrations, have not been performed. Design: We performed a prospective cohort study. Setting: We included patients enrolled in previously completed trials of acute respiratory distress syndrome. Patients: One thousand fifty-seven acute respiratory distress syndrome patients were included. Interventions: To determine the association of circulating high-sensitivity troponin I (Abbott ARCHITECT), with acute respiratory distress syndrome outcomes, we measured high-sensitivity troponin I within 24 hours of intubation. The primary outcome was 60-day mortality. Measurements and Main Results: Detectable high-sensitivity troponin I was present in 94% of patients; 38% of patients had detectable levels below the 99th percentile of a healthy reference population (26 ng/L), whereas 56% of patients had levels above the 99th percentile cut point. After multivariable adjustment, age, cause of acute respiratory distress syndrome, temperature, heart rate, vasopressor use, Sequential Organ Failure Assessment score, creatinine, and Pco2 were associated with higher high-sensitivity troponin I concentration. After adjustment for age, sex, and randomized trial assignment, the hazard ratio for 60-day mortality comparing the fifth to the first quintiles of high-sensitivity troponin I was 1.61 (95% CI, 1.11-2.32; p trend = 0.003). Adjusting for Sequential Organ Failure Assessment score suggested that this association was not independent of disease severity (hazard ratio, 0.95; 95% CI, 0.64-1.39; p = 0.93). Conclusions: Circulating troponin is detectable in over 90% of patients with acute respiratory distress syndrome and is associated with degree of critical illness. The magnitude of myocardial injury correlated with mortality.

Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe : EURIKA, a cross-sectional observational study

Halcox, J. P., Banegas, J. R., Roy, C., Dallongeville, J., De Backer, G., Guallar, E., Perk, J., Hajage, D., Henriksson, K. M., & Borghi, C. (n.d.).

Publication year

2017

Journal title

BMC Cardiovascular Disorders

Volume

17

Issue

1

10.1186/s12872-017-0591-5

Abstract

Abstract

Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of highdensity lipoprotein cholesterol. Methods: This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Results: Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. Conclusions: A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated.

Racial differences in prevalence and risk for intracranial atherosclerosis in a us community-based population

Qiao, Y., Suri, F. K., Zhang, Y., Liu, L., Gottesman, R., Alonso, A., Guallar, E., & Wasserman, B. A. (n.d.).

Publication year

2017

Journal title

JAMA Cardiology

Volume

2

Issue

12

Page(s)

1341-1348

10.1001/jamacardio.2017.4041

Abstract

Abstract

IMPORTANCE Intracranial atherosclerotic disease (ICAD) is an important cause of stroke; however, little is known about racial differences in ICAD prevalence and its risk factors. OBJECTIVE To determine racial differences in ICAD prevalence and the risk factors (both midlife and concurrent) associated with its development in a large, US community-based cohort. DESIGN, SETTING, AND PARTICIPANTS Analysis of 1752 black and white participants recruited from the Atherosclerosis Risk in Communities (ARIC) cohort study who underwent 3-dimensional intracranial vessel wall magnetic resonance imaging from October 18, 2011 to December 30, 2013; data analysis was performed from October 18, 2011 toMay 13, 2015. EXPOSURES Midlife and concurrent cardiovascular risk factors. MAIN OUTCOMES AND MEASURES Intracranial plaque presence, size (maximum normalized wall index) and number were assessed by vessel wall magnetic resonance imaging. Midlife and concurrent vascular risk factor associations were determined by Poisson regression (plaque presence), negative binominal regression (plaque number), and linear regression (plaque size), and compared between races. RESULTS Of the 1752 study participants (mean [SD] age, 77.6 [5.3] years; range, 67-90 years), 1023 (58.4%) were women and 518 (29.6%) were black. Black men had the highest prevalence (50.9%vs 35.9% for black women, 35.5%for white men, and 30.2%for white women; P < .001) and the highest frequency (22.4%vs 12.1% for black women, 10.7%for white men, and 8.7%for white women; P < .01) of multiple plaques. Prevalence increased with age, reaching 50% before ages 68, 84, and 88 years in black men, white men, and white women, respectively (ICAD prevalence remained

Relation of Serum Vitamin D to Risk of Mitral Annular and Aortic Valve Calcium (from the Multi-Ethnic Study of Atherosclerosis)

Tibuakuu, M., Zhao, D., de Boer, I. H., Guallar, E., Bortnick, A. E., Lutsey, P. L., Budoff, M. J., Kizer, J. R., Kestenbaum, B. R., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

American Journal of Cardiology

Volume

120

Issue

3

Page(s)

473-478

10.1016/j.amjcard.2017.05.004

Abstract

Abstract

Serum 25-hydroxyvitamin D [25(OH)D] concentration has been identified as a possible modifiable risk factor for cardiovascular disease (CVD). We hypothesized that serum 25(OH)D concentration would be associated with calcifications of the left-sided heart valves, which are markers of CVD risk. Aortic valve calcium (AVC) and mitral annular calcium (MAC) were quantified from cardiac computed tomography scans performed on 5,530 Multi-Ethnic Study of Atherosclerosis participants at the baseline examination (2000 to 2002) and at a follow-up visit at either Examination 2 (2002 to 2004) or Examination 3 (2004 to 2005). 25(OH)D was measured from serum samples collected at the baseline examination. Using relative risk regression, we evaluated the multivariable-adjusted risk of prevalent and incident AVC and MAC in this ethnically diverse population free of clinical CVD at baseline. The mean age of participants was 62 ± 10 years; 53% were women, 40% white, 26% black, 21% Hispanic, and 12% Chinese. Prevalent AVC and MAC were observed in 12% and 9% of study sample, respectively. There were no significant associations between 25(OH)D and prevalent AVC or MAC. Over a mean follow-up of 2.5 years, 4% developed incident AVC and 5% developed incident MAC. After adjusting for demographic variables, each 10 ng/ml higher serum 25(OH)D was associated with a 15% (relative risk 0.85, 95% confidence interval 0.74 to 0.98) lower risk of incident MAC but not AVC. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors. Results suggest a possible link between serum 25(OH)D and the risk for incident MAC, but future studies with longer follow-up are needed to further test this association.

Serum vitamin D and change in lipid levels over 5 y : The Atherosclerosis Risk in Communities study

Faridi, K. F., Zhao, D., Martin, S. S., Lupton, J. R., Jones, S. R., Guallar, E., Ballantyne, C. M., Lutsey, P. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Nutrition

Volume

38

Page(s)

85-93

10.1016/j.nut.2017.01.008

Abstract

Abstract

Objectives Deficiency of 25-hydroxyvitamin D (25[OH]D) is associated with increased risk for cardiovascular disease, perhaps mediated through dyslipidemia. Deficient 25(OH)D is cross-sectionally associated with dyslipidemia, but little is known about longitudinal lipid changes. The aim of this study was to determine the relationship of 25(OH)D deficiency to longitudinal lipid changes and risk for incident dyslipidemia. Methods This was a longitudinal community-based study of 13 039 participants from the ARIC (Atherosclerosis Risk in Communities) study who had 25(OH)D and lipids measured at baseline (1990–1992) and lipids remeasured in 1993 to 1994 and 1996 to 1998. Mixed-effect models were used to assess the association of 25(OH)D and lipid trends after adjusting for clinical characteristics and for baseline or incident use of lipid-lowering therapy. Risk for incident dyslipidemia was determined for those without baseline dyslipidemia. Results Baseline mean ± SD age was 57 ± 6 y and 25(OH)D was 24 ± 9 ng/mL. Participants were 57% women, 24% black. Over a mean follow-up of 5.2 y, the fully adjusted average differences (95% confidence interval [CI]) comparing deficient (

Serum vitamin D and sex hormones levels in men and women : The Multi-Ethnic Study of Atherosclerosis (MESA)

Zhao, D., Ouyang, P., de Boer, I. H., Lutsey, P. L., Farag, Y. M., Guallar, E., Siscovick, D. S., Post, W. S., Kalyani, R. R., Billups, K. L., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Maturitas

Volume

96

Page(s)

95-102

10.1016/j.maturitas.2016.11.017

Abstract

Abstract

Introduction 25-hydroxyvitamin D [25(OH)D] deficiency has been associated with low testosterone levels in men, but there are conflicting reports of its associations with sex hormones in women. Less is known about whether these associations are independent of adiposity and lifestyle factors, and whether they differ by race/ethnicity. Aim To examine associations of 25(OH)D concentrations with sex hormone levels. Methods Cross-sectional analysis of 3017 men and 2929 women in a multi-ethnic cohort. Main outcome measures Testosterone, estradiol, dehydroepiandrosterone (DHEA), sex hormone binding globulin (SHBG), and free testosterone. Results The mean (SD) levels of 25(OH)D in men and women were 25.7(10.4) and 26.1(12.0) ng/ml, respectively. In men, after adjusting for demographic and lifestyle variables, a 10 ng/ml [25 nmol/L] decrease in 25(OH)D was associated with an average difference of −0.70 nmol/L (95%CI −1.36, −0.05) in SHBG and 0.02 percent (0.01, 0.04) in free testosterone, but was not associated with low total testosterone level (

Sex-specific maximum predicted heart rate and its prognosis for mortality and myocardial infarction

Ahmed, H. M., Al-Mallah, M. H., Keteyian, S. J., Brawner, C. A., Ehrman, J. K., Zhao, D., Guallar, E., Blaha, M. J., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Medicine and Science in Sports and Exercise

Volume

49

Issue

8

Page(s)

1704-1710

10.1249/MSS.0000000000001285

Abstract

Abstract

Purpose Maximum predicted heart rate (MPHR) is traditionally calculated by (220 - age). However, this formula's validity has been questioned in women. The purpose of this study was to derive sex-specific formulas for MPHR in a clinical population and compare their prognostic significance with the traditional formula. Methods This was a retrospective cohort of adults referred for exercise treadmill testing between 1991 and 2009. Peak heart rate versus age was plotted by sex, and linear regression analysis was used to derive sex-specific MPHR formulas. Cox models were used to calculate risk of death and myocardial infarction (MI) based on attainment of 85% MPHR using both formulas. Results Of 31,090 patients (mean ± SD, age = 55 ± 10 yr), there were 2824 deaths over 11 ± 5 yr. MPHR was best estimated by 197 - 0.8 × age for women and 204 - 0.9 × age for men (P interaction < 0.001). Compared with the sex-specific formulas, the traditional formula overestimated peak heart rate by 12 ± 2 bpm in women and 11 ± 1 bpm in men. There were 1868 patients (6%) who achieved the target heart rate using the sex-specific formulas but not with the traditional formula. Achievement of ≥85% MPHR was similarly associated with lower risk of death (adjusted hazard ratio = 0.76 [95% confidence interval = 0.60-0.97] vs 0.75 [0.62-0.90]) and MI (0.71 [0.47-1.06] vs 0.79 [0.57-1.10]) for the sex-specific versus traditional formula. Conclusions In patients referred for exercise treadmill testing, sex-specific formulas more accurately estimated peak heart rate than the traditional MPHR formula, reclassified 6% of stress tests from inadequate to adequate, and were similarly associated with risk of MI and death.

A longitudinal study of association between adiposity markers and intraocular pressure : The kangbuk samsung health study

Zhao, D., Kim, M. H., Pastor-Barriuso, R., Chang, Y., Ryu, S., Zhang, Y., Rampal, S., Shin, H., Kim, J. M., Friedman, D. S., Guallar, E., & Cho, J. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

11

Issue

1

10.1371/journal.pone.0146057

Abstract

Abstract

Importance Intraocular pressure (IOP) reduction or stabilization is the only proven method for glaucoma management. Identifying risk factors for IOP is crucial to understand the pathophysiology of glaucoma. Objective To examine the associations of change in body mass index (BMI), waist circumference, and percent fat mass with change in intraocular pressure (IOP) in a large sample of Korean adults. Design, setting and participants Cohort study of 274,064 young and middle age Korean adults with normal fundoscopic findings who attended annual or biennial health exams from January 1, 2002 to Feb 28, 2010 (577,981 screening visits). Exposures BMI, waist circumference, and percent fat mass. Main Outcome Measure(s) At each visit, IOP was measured in both eyes with automated noncontact tonometers. Results In multivariable-Adjusted models, the average increase in IOP (95% confidence intervals) over time per interquartile increase in BMI (1.26 kg/m2), waist circumference (6.20 cm), and percent fat mass (3.40%) were 0.18 mmHg (0.17 to 0.19), 0.27 mmHg (0.26 to 0.29), and 0.10 mmHg (0.09 to 0.11), respectively (all P < 0.001). The association was stronger in men compared to women (P < 0.001) and it was only slightly attenuated after including diabetes and hypertension as potential mediators in the model. Conclusions and Relevance Increases in adiposity were significantly associated with an increase in IOP in a large cohort of Korean adults attending health screening visits, an association that was stronger for central obesity. Further research is needed to understand better the underlying mechanisms of this association, and to establish the role of weight gain in increasing IOP and the risk of glaucoma and its complications.

Arrhythmia risk stratification of patients after myocardial infarction using personalized heart models

Arevalo, H. J., Vadakkumpadan, F., Guallar, E., Jebb, A., Malamas, P., Wu, K. C., & Trayanova, N. A. (n.d.).

Publication year

2016

Journal title

Nature communications

Volume

7

10.1038/ncomms11437

Abstract

Abstract

Sudden cardiac death (SCD) from arrhythmias is a leading cause of mortality. For patients at high SCD risk, prophylactic insertion of implantable cardioverter defibrillators (ICDs) reduces mortality. Current approaches to identify patients at risk for arrhythmia are, however, of low sensitivity and specificity, which results in a low rate of appropriate ICD therapy. Here, we develop a personalized approach to assess SCD risk in post-infarction patients based on cardiac imaging and computational modelling. We construct personalized three-dimensional computer models of post-infarction hearts from patients' clinical magnetic resonance imaging data and assess the propensity of each model to develop arrhythmia. In a proof-of-concept retrospective study, the virtual heart test significantly outperformed several existing clinical metrics in predicting future arrhythmic events. The robust and non-invasive personalized virtual heart risk assessment may have the potential to prevent SCD and avoid unnecessary ICD implantations.

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

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

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 (

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.