Eliseo Guallar
Eliseo Guallar
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Chair and Professor of the Department of Epidemiology
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Professional overview
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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.
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Education
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Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, SpainMD, University of Zaragoza, Zaragoza, SpainMPH, University of Minnesota, Minneapolis, MNDrPH, Harvard University, Boston, MA
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Honors and awards
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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)
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Publications
Publications
Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: Findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD)
AbstractZhang, Y., Kennedy, R., Blasco-Colmenares, E., Butcher, B., Norgard, S., Eldadah, Z., Dickfeld, T., Ellenbogen, K. A., Marine, J. E., Guallar, E., Tomaselli, G. F., & Cheng, A. (n.d.).Publication year
2014Journal title
Heart RhythmVolume
11Issue
8Page(s)
1377-1383AbstractBackground Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs). Objective The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients. Methods We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality. Results There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained. Conclusion In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.Placental transfer and concentrations of cadmium, mercury, lead, and selenium in mothers, newborns, and young children
AbstractChen, Z., Myers, R., Wei, T., Bind, E., Kassim, P., Wang, G., Ji, Y., Hong, X., Caruso, D., Bartell, T., Gong, Y., Strickland, P., Navas-Acien, A., Guallar, E., & Wang, X. (n.d.).Publication year
2014Journal title
Journal of Exposure Science and Environmental EpidemiologyVolume
24Issue
5Page(s)
537-544AbstractThere is an emerging hypothesis that exposure to cadmium (Cd), mercury (Hg), lead (Pb), and selenium (Se) in utero and early childhood could have long-term health consequences. However, there are sparse data on early life exposures to these elements in US populations, particularly in urban minority samples. This study measured levels of Cd, Hg, Pb, and Se in 50 paired maternal, umbilical cord, and postnatal blood samples from the Boston Birth Cohort (BBC). Maternal exposure to Cd, Hg, Pb, and Se was 100% detectable in red blood cells (RBCs), and there was a high degree of maternal-fetal transfer of Hg, Pb, and Se. In particular, we found that Hg levels in cord RBCs were 1.5 times higher than those found in the mothers. This study also investigated changes in concentrations of Cd, Hg, Pb, and Se during the first few years of life. We found decreased levels of Hg and Se but elevated Pb levels in early childhood. Finally, this study investigated the association between metal burden and preterm birth and low birthweight. We found significantly higher levels of Hg in maternal and cord plasma and RBCs in preterm or low birthweight births, compared with term or normal birthweight births. In conclusion, this study showed that maternal exposure to these elements was widespread in the BBC, and maternal-fetal transfer was a major source of early life exposure to Hg, Pb, and Se. Our results also suggest that RBCs are better than plasma at reflecting the trans-placental transfer of Hg, Pb, and Se from the mother to the fetus. Our study findings remain to be confirmed in larger studies, and the implications for early screening and interventions of preconception and pregnant mothers and newborns warrant further investigation.Plasma selenium levels and oxidative stress biomarkers: A gene-environment interaction population-based study
AbstractGalan-Chilet, I., Tellez-Plaza, M., Guallar, E., De Marco, G., Lopez-Izquierdo, R., Gonzalez-Manzano, I., Carmen Tormos, M., Martin-Nuñez, G. M., Rojo-Martinez, G., Saez, G. T., Martín-Escudero, J. C., Redon, J., & Javier Chaves, F. (n.d.).Publication year
2014Journal title
Free Radical Biology and MedicineVolume
74Page(s)
229-236AbstractThe role of selenium exposure in preventing chronic disease is controversial, especially in selenium-repleted populations. At high concentrations, selenium exposure may increase oxidative stress. Studies evaluating the interaction of genetic variation in genes involved in oxidative stress pathways and selenium are scarce. We evaluated the cross-sectional association of plasma selenium concentrations with oxidative stress levels, measured as oxidized to reduced glutathione ratio (GSSG/GSH), malondialdehyde (MDA), and 8-oxo-7,8-dihydroguanine (8-oxo-dG) in urine, and the interacting role of genetic variation in oxidative stress candidate genes, in a representative sample of 1445 men and women aged 18-85 years from Spain. The geometric mean of plasma selenium levels in the study sample was 84.76 μg/L. In fully adjusted models the geometric mean ratios for oxidative stress biomarker levels comparing the highest to the lowest quintiles of plasma selenium levels were 0.61 (0.50-0.76) for GSSG/GSH, 0.89 (0.79-1.00) for MDA, and 1.06 (0.96-1.18) for 8-oxo-dG. We observed nonlinear dose-responses of selenium exposure and oxidative stress biomarkers, with plasma selenium concentrations above ~110 μg/L being positively associated with 8-oxo-dG, but inversely associated with GSSG/GSH and MDA. In addition, we identified potential risk genotypes associated with increased levels of oxidative stress markers with high selenium levels. Our findings support that high selenium levels increase oxidative stress in some biological processes. More studies are needed to disentangle the complexity of selenium biology and the relevance of potential gene-selenium interactions in relation to health outcomes in human populations.Protein biomarkers identify patients unlikely to benefit from primary prevention implantable cardioverter defibrillators: Findings from the prospective observational study of implantable cardioverter defibrillators (PROSE-ICD)
AbstractCheng, A., Zhang, Y., Blasco-Colmenares, E., Dalal, D., Butcher, B., Norgard, S., Eldadah, Z., Ellenbogen, K. A., Dickfeld, T., Spragg, D. D., Marine, J. E., Guallar, E., & Tomaselli, G. F. (n.d.).Publication year
2014Journal title
Circulation: Arrhythmia and ElectrophysiologyVolume
7Issue
6Page(s)
1084-1091AbstractBackground: Primary prevention implantable cardioverter defibrillators (ICDs) reduce all-cause mortality, but the benefits are heterogeneous. Current risk stratification based on left ventricular ejection fraction has limited discrimination power. We hypothesize that biomarkers for inflammation, neurohumoral activation, and cardiac injury can predict appropriate shocks and all-cause mortality in patients with primary prevention ICDs. Methods and Results: The Prospective Observational Study of Implantable Cardioverter Defibrillators (PROSe-ICD) enrolled 1189 patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end point was an ICD shock for adjudicated ventricular tachyarrhythmia. The secondary end point was all-cause mortality. After a median follow-up of 4.0 years, 137 subjects experienced an appropriate ICD shock and 343 participants died (incidence rates of 3.2 and 5.8 per 100 person-years, respectively). In multivariableadjusted models, higher interleukin-6 levels increased the risk of appropriate ICD shocks. In contrast, C-reactive protein, interleukin-6, tumor necrosis factor-α receptor II, pro-brain natriuretic peptide (pro-BNP), and cardiac troponin T showed significant linear trends for increased risk of all-cause mortality across quartiles. A score combining these 5 biomarkers identified patients who were much more likely to die than to receive an appropriate shock from the ICD. Conclusions: An increase in serum biomarkers of inflammation, neurohumoral activation, and myocardial injury increased the risk for death but poorly predicted the likelihood of an ICD shock. These findings highlight the potential importance of serum-based biomarkers in identifying patients who are unlikely to benefit from primary prevention ICDs.Race/ethnicity, residential segregation, and exposure to ambient air pollution: The Multi-Ethnic Study of Atherosclerosis (MESA)
AbstractJones, M. R., Diez-Roux, A. V., Hajat, A., Kershaw, K. N., O’Neill, M. S., Guallar, E., Post, W. S., Kaufman, J. D., & Navas-Acien, A. (n.d.).Publication year
2014Journal title
American journal of public healthVolume
104Issue
11Page(s)
2130-2137AbstractObjectives. We described the associations of ambient air pollution exposure with race/ethnicity and racial residential segregation. Methods. We studied 5921 White, Black, Hispanic, and Chinese adults across 6 US cities between 2000 and 2002. Household-level fine particulate matter (PM2.5) and nitrogen oxides (NOX) were estimated for 2000. Neighborhood racial composition and residential segregation were estimated using US census tract data for 2000. Results. Participants in neighborhoods with more than 60% Hispanic populations were exposed to 8% higher PM2.5and 31% higher NOXconcentrations compared with those in neighborhoods with less than 25% Hispanic populations. Participants in neighborhoods with more than 60% White populations were exposed to 5% lower PM2.5and 18% lower NOXconcentrations compared with those in neighborhoods with less than 25% of the population identifying as White. Neighborhoods with Whites underrepresented or with Hispanics overrepresented were exposed to higher PM2.5and NOXconcentrations. No differences were observed for other racial/ethnic groups. Conclusions. Living in majority White neighborhoods was associated with lower air pollution exposures, and living in majority Hispanic neighborhoods was associated with higher air pollution exposures. This new information highlighted the importance of measuring neighborhood-level segregation in the environmental justice literature.Random-effects meta-analysis of inconsistent effects: A time for change
AbstractCornell, J. E., Mulrow, C. D., Localio, R., Stack, C. B., Meibohm, A. R., Guallar, E., & Goodman, S. N. (n.d.).Publication year
2014Journal title
Annals of internal medicineVolume
160Issue
4Page(s)
267-270AbstractA primary goal of meta-analysis is to improve the estimation of treatment effects by pooling results of similar studies. This article explains how the most widely used method for pooling heterogeneous studies-the DerSimonian-Laird (DL) estimator-can produce biased estimates with falsely high precision. A classic example is presented to show that use of the DL estimator can lead to erroneous conclusions. Particular problems with the DL estimator are discussed, and several alternative methods for summarizing heterogeneous evidence are presented. The authors support replacing universal use of the DL estimator with analyses based on a critical synthesis that recognizes the uncertainty in the evidence, focuses on describing and explaining the probable sources of variation in the evidence, and uses random-effects estimates that provide more accurate confidence limits than the DL estimator.Reply
Zhao, D., Guallar, E., Cho, J., & Kim, M. H. (n.d.). In American Journal of Ophthalmology (1–).Publication year
2014Volume
158Issue
6Page(s)
1363Reply: How to determine a metabolically healthy body composition in cardiovascular disease
Chang, Y., Kim, B. K., Cho, J., Guallar, E., & Ryu, S. (n.d.). In Journal of the American College of Cardiology (1–).Publication year
2014Volume
64Issue
11Page(s)
1184-1185Spatial clustering of toxic trace elements in adolescents aroun. The Torreón, Mexico lead-zinc smelter
AbstractGarcia-Vargas, G. G., Rothenberg, S. J., Silbergeld, E. K., Weaver, V., Zamoiski, R., Resnick, C., Rubio-Andrade, M., Parsons, P. J., Steuerwald, A. J., Navas-Acién, A., & Guallar, E. (n.d.).Publication year
2014Journal title
Journal of Exposure Science and Environmental EpidemiologyVolume
24Issue
6Page(s)
634-642AbstractHigh blood lead (BPb) levels in children and elevated soil and dust arsenic, cadmium, and lead were previously found in Torreón, northern Mexico, host t. The world's fourth largest lead-zinc metal smelter. The objectives of this study were to determine spatial distributions of adolescents with higher BPb and creatinine-corrected urine total arsenic, cadmium, molybdenum, thallium, and uranium aroun. The smelter. Cross-sectional study of 512 male and female subjects 12-15 years of age was conducted. We measured BPb by graphite furnace atomic absorption spectrometry and urine trace elements by inductively coupled plasma-mass spectrometry, with dynamic reaction cell mode for arsenic. We constructed multiple regression models including sociodemographic variables and adjusted for subject residence spatial correlation with spatial lag or error terms. We applied local indicators of spatial association statistics to model residuals to identify hot spots of significant spatial clusters of subjects with higher trace elements. We found spatial clusters of subjects with elevated BPb (range 3.6-14.7 μg/dl) and urine cadmium (0.18-1.14 μg/g creatinine) adjacent to and downwind o. The smelter and elevated urine thallium (0.28-0.93 μg/g creatinine) and uranium (0.07-0.13 μg/g creatinine) near ore transport routes, former waste, and industrial discharge sites. The conclusion derived from this study was that spatial clustering of adolescents with high BPb and urine cadmium adjacent to and downwind o. The smelter and residual waste pile, areas identified over a decade ago with high lead and cadmium in soil and dust, suggests that past and/or present plant operations continue to present health risks to children in those neighborhoods.The association of blood pressure and primary open-angle glaucoma: A meta-analysis
AbstractZhao, D., Cho, J., Kim, M. H., & Guallar, E. (n.d.).Publication year
2014Journal title
American Journal of OphthalmologyVolume
158Issue
3Page(s)
615-627.e9AbstractPurpose To conduct a systematic review and meta-analysis of the association between blood pressure levels and hypertension with primary open-angle glaucoma and intraocular pressure endpoints. Design Systematic review with quantitative meta-analysis. Methods Studies were identified by searching the PubMed and EMBASE databases. Inverse-variance weighted random-effects models were used to summarize relative risks. Subgroup analyses and meta-regression were used to explore potential sources of heterogeneity across studies. Results Sixty observational studies were included. The pooled relative risk for primary open-angle glaucoma comparing patients with hypertension to those without hypertension was 1.16 (95% CI = 1.05-1.28), with modest heterogeneity across studies (I2 34.5%). Virtually all studies reported a positive association between blood pressure and intraocular pressure (IOP). The pooled average increase in IOP associated with a 10 mm Hg increase in systolic blood pressure was 0.26 mm Hg (95% CI 0.23-0.28, I2 30.7%), and the average increase associated with a 5 mm Hg increase in diastolic blood pressure was 0.17 mm Hg (95% CI 0.11-0.23, I2 90.5%). Conclusions In this meta-analysis, hypertension was associated with increased intraocular pressure. The association between hypertension and primary open-angle glaucoma was stronger in cross-sectional compared with case-control and longitudinal studies. Our findings support a role of increased blood pressure in elevated intraocular pressure and possibly in the development of glaucoma.The prevalence of colorectal adenomas in asymptomatic korean men and women
AbstractYang, M. H., Rampal, S., Sung, J., Choi, Y. H., Son, H. J., Lee, J. H., Kim, Y. H., Chang, D. K., Rhee, P. L., Rhee, J. C., Guallar, E., & Cho, J. (n.d.).Publication year
2014Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
23Issue
3Page(s)
499-507AbstractBackground: Colorectal cancer incidence is rapidly rising in many Asian countries, with rates approaching those of Western countries. This study aimed to evaluate the prevalence and trends of colorectal adenomas by age, sex, and risk strata in asymptomatic Koreans. Methods: Cross-sectional study of 19,372 consecutive participants aged 20 to 79 years undergoing screening colonoscopy at the Center for Health Promotion of the Samsung Medical Center in Korea from January 2006 to June 2009. Results:Among participants at average risk, those without a history of colorectal polyps or a family history of colorectal cancer, the prevalence of colorectal adenomas and advanced adenomas were 34.5% and 3.1%, respectively, in men and 20.0% and 1.6%, respectively, in women. The prevalence of adenomas increased with age in both men and women, with a more marked increase for advanced adenoma. Participants with a family history of colorectal cancer or with a history of colorectal polyps had significantly higher prevalence of adenomas compared with participants of average risk (36.9% vs. 26.9%; age-And sex-Adjusted prevalence ratio = 1.16; 95% confidence interval, 1.09-1.22). The prevalence of adenomas increased annually in both men and women. Conclusions: In this large study of asymptomatic Korean men and women participating in a colonoscopy screening program, the prevalence of colorectal adenomas was comparable and possibly higher than previously reported in Western countries. Impact: Cost-effectiveness studies investigating the optimal age for starting colonoscopy screening and etiological studies to identify the reasons for the increasing trend in colorectal adenomas in Koreans are needed.The QT interval is associated with incident cardiovascular events: The MESA Study
AbstractBeinart, R., Zhang, Y., Lima, J. A., Bluemke, D. A., Soliman, E. Z., Heckbert, S. R., Post, W. S., Guallar, E., & Nazarian, S. (n.d.).Publication year
2014Journal title
Journal of the American College of CardiologyVolume
64Issue
20Page(s)
2111-2119AbstractBACKGROUND: Prolonged heart rate-corrected QT interval on electrocardiograms (ECGs) is associated with increased risk of myocardial infarction and cardiovascular disease (CVD)-related deaths in patients with prevalent coronary heart disease. OBJECTIVES: This study sought to examine the prognostic association between the baseline QT interval and incident cardiovascular events in individuals without prior known CVD. METHODS: The corrected baseline 12-lead ECG QT interval duration (QTcorr) was determined by adjustment for age, sex, race/ethnicity, and RR interval duration in 6, 9 273 participants in MESA (Multi-Ethnic Study of Atherosclerosis). Cox proportional hazards models adjusting for demographic and clinical risk factors were used to examine the association of baseline QTcorr with incident cardiovascular events. RESULTS: The mean age at enrollment was 61.7 ± 10 years, and 53.4% of participants were women. Cardiovascular events occurred in 291 participants over a mean follow-up of 8.0 ± 1.7 years. Each 10-ms increase in the baseline QTcorr was associated with incident heart failure (hazard ratio [HR]: 1.25; 95% CI: 1.14 to 1.37), CVD events (HR: 1.12; 95% CI: 1.05 to 1.20), and stroke (HR: 1.19; 95% CI: 1.07 to 1.32) after adjustment for CVD risk factors and potential confounders. There was no evidence of interaction with sex or ethnicity. CONCLUSIONS: The QT interval was associated with incident cardiovascular events in middle-aged and older adults without prior CVD.Thyroid hormone levels and incident chronic kidney disease in euthyroid individuals: The Kangbuk Samsung Health Study
AbstractZhang, Y., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Pastor-Barriuso, R., Rampal, S., Han, W. K., Shin, H., & Guallar, E. (n.d.).Publication year
2014Journal title
International Journal of EpidemiologyVolume
43Issue
5Page(s)
1624-1632AbstractBackground: Overt and subclinical hypothyroidism are associated with higher levels of serum creatinine and with increased risk of chronic kidney disease (CKD). The prospective association between thyroid hormones and kidney function in euthyroid individuals, however, is largely unexplored. Methods: We conducted a prospective cohort study in 104 633 South Korean men and women who were free of CKD and proteinuria at baseline and had normal thyroid hormone levels and no history of thyroid disease or cancer. At each annual or biennial follow-up visit, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxin (FT4) levels were measured by radioimmunoassay. The study outcome was incident CKD, defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 based on the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Results: After a median follow-up of 3.5 years, 1032 participants developed incident CKD. There was a positive association between high-normal levels of TSH and increased risk of incident CKD. In fully-adjusted models including baseline eGFR, the hazard ratio comparing the highest vs the lowest quintiles of TSH was 1.26 [95% confidence interval (CI) 1.02 to 1.55; P for linear trend=0.03]. In spline models, FT3 levels below 3 pg/ml were also associated with increased risk of incident CKD. There was no association between FT4 levels and CKD. Conclusions: In a large cohort of euthyroid men and women, high levels of TSH and low levels of FT3, even within the normal range, were modestly associated with an increased risk of incident CKD.Thyroid hormones and coronary artery calcification in euthyroid men and women
AbstractZhang, Y., Kim, B. K., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Rampal, S., Zhao, D., Pastor-Barriuso, R., Lima, J. A., Shin, H., & Guallar, E. (n.d.).Publication year
2014Journal title
Arteriosclerosis, Thrombosis, and Vascular BiologyVolume
34Issue
9Page(s)
2128-2134AbstractOBJECTIVE - Overt and subclinical hypothyroidism are risk factors for atherosclerosis. It is unclear whether thyroid hormone levels within the normal range are also associated with atherosclerosis measured by coronary artery calcium (CAC). APPROACH AND RESULTS - We conducted a cross-sectional study of 41 403 apparently healthy young and middle-aged men and women with normal thyroid hormone levels. Free thyroxin, free triiodothyronine, and thyroid-stimulating hormone levels were measured by electrochemiluminescent immunoassay. CAC score was measured by multidetector computed tomography. The multivariable adjusted CAC ratios comparing the highest versus the lowest quartile of thyroid hormones were 0.74 (95% confidence interval, 0.60-0.91; P for trend <0.001) for free thyroxin, 0.81 (0.66-1.00; P for trend=0.05) for free triiodothyronine, and 0.78 (0.64-0.95; P for trend=0.01) for thyroid-stimulating hormone. Similarly, the odds ratios for detectable CAC (CAC >0) comparing the highest versus the lowest quartiles of thyroid hormones were 0.87 (0.79-0.96; P for linear trend <0.001) for free thyroxin, 0.90 (0.82-0.99; P for linear trend=0.02) for free triiodothyronine, and 0.91 (0.83-1.00; P for linear trend=0.03) for thyroid-stimulating hormone. CONCLUSIONS - In a large cohort of apparently healthy young and middle-aged euthyroid men and women, low-normal free thyroxin and thyroid-stimulating hormone were associated with a higher prevalence of subclinical coronary artery disease and with a greater degree of coronary calcification.Thyroid hormones and mortality risk in euthyroid individuals: The Kangbuk Samsung health study
AbstractZhang, Y., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Pastor-Barriuso, R., Rampal, S., Han, W. K., Shin, H., & Guallar, E. (n.d.).Publication year
2014Journal title
Journal of Clinical Endocrinology and MetabolismVolume
99Issue
7Page(s)
2467-2476AbstractContext: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear. Objective: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints. Setting and Design: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records. Results: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95,comparingthe highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62,95%confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints. Conclusions: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.A behavioral weight-loss intervention in persons with serious mental illness
AbstractDaumit, G. L., Dickerson, F. B., Wang, N. Y., Dalcin, A., Jerome, G. J., Anderson, C. A., Young, D. R., Frick, K. D., Yu, A., Gennusa, J. V., Oefinger, M., Crum, R. M., Charleston, J., Casagrande, S. S., Guallar, E., Goldberg, R. W., Campbell, L. M., & Appel, L. J. (n.d.).Publication year
2013Journal title
New England Journal of MedicineVolume
368Issue
17Page(s)
1594-1602AbstractBACKGROUND: Overweight and obesity are epidemic among persons with serious mental illness, yet weight-loss trials systematically exclude this vulnerable population. Lifestyle interventions require adaptation in this group because psychiatric symptoms and cognitive impairment are highly prevalent. Our objective was to determine the effectiveness of an 18-month tailored behavioral weight-loss intervention in adults with serious mental illness. METHODS: We recruited overweight or obese adults from 10 community psychiatric rehabilitation outpatient programs and randomly assigned them to an intervention or a control group. Participants in the intervention group received tailored group and individual weight-management sessions and group exercise sessions. Weight change was assessed at 6, 12, and 18 months. RESULTS: Of 291 participants who underwent randomization, 58.1% had schizophrenia or a schizoaffective disorder, 22.0% had bipolar disorder, and 12.0% had major depression. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.3, and the mean weight was 102.7 kg (225.9 lb). Data on weight at 18 months were obtained from 279 participants. Weight loss in the intervention group increased progressively over the 18-month study period and differed significantly from the control group at each follow-up visit. At 18 months, the mean between-group difference in weight (change in intervention group minus change in control group) was -3.2 kg (-7.0 lb, P = 0.002); 37.8% of the participants in the intervention group lost 5% or more of their initial weight, as compared with 22.7% of those in the control group (P = 0.009). There were no significant between-group differences in adverse events. CONCLUSIONS: A behavioral weight-loss intervention significantly reduced weight over a period of 18 months in overweight and obese adults with serious mental illness. Given the epidemic of obesity and weight-related disease among persons with serious mental illness, our findings support implementation of targeted behavioral weight-loss interventions in this high-risk population. (Funded by the National Institute of Mental Health; ACHIEVE ClinicalTrials.gov number, NCT00902694).Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. the EURIKA study
AbstractBanegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Massó-González, E. L., Sazova, O., Perk, J., Steg, P. G., De Backer, G., & Rodríguez-Artalejo, F. (n.d.).Publication year
2013Journal title
International Journal of CardiologyVolume
166Issue
1Page(s)
210-214AbstractObjective: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. Methods: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥ 50 years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥ 1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥ 2 additional major cardiovascular risk factors). Results: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol < 70 mg/dl, non-HDL-cholesterol < 100 mg/dl, and apolipoprotein B < 80 mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol < 100 mg/dl, non-HDL-cholesterol < 130 mg/dl, and apolipoprotein B < 90 mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. Conclusion: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.Anthropometric indices and selenium status in British adults: The U.K. National Diet and Nutrition Survey
AbstractSpina, A., Guallar, E., Rayman, M. P., Tigbe, W., Kandala, N. B., & Stranges, S. (n.d.).Publication year
2013Journal title
Free Radical Biology and MedicineVolume
65Page(s)
1315-1321AbstractRecent studies have raised concern over possible associations between high selenium (Se) status and excess adiposity, known to be linked to adverse cardiometabolic outcomes. Studies of Se status in relation to adiposity are scarce in the United Kingdom. This study examined cross-sectional associations of anthropometric indices with Se-status biomarkers in a nationally representative sample of 1045 (577 female, 468 male) British Caucasian adults ages 19-64 who participated in the 2000-2001 National Diet and Nutrition Survey. Median (first, third quartile) values for whole-blood glutathione peroxidase (GPx) activity and plasma and erythrocyte Se concentrations were 120.0 (103.0, 142.4) nmol mg Hb-1 min-1, 1.08 (0.98, 1.20) μmol/L, and 1.62 (1.38, 1.91) μmol/L, respectively. For males, values were 119.0 (100.0, 141.0) nmol mg Hb-1 min-1, 1.09 (0.99, 1.22) μmol/L, and 1.54 (1.34, 1.79) μmol/L, respectively; for females 121.0 (105.0, 145.0) nmol mg Hb-1 min-1, 1.07 (0.97, 1.18) μmol/L, and 1.71 (1.43, 1.99) μmol/L, respectively. Multivariate adjusted mean differences (95% CI) in whole-blood GPx between the highest (>30 kg/m2) and the lowest (<25 kg/m2) categories of body mass index and the highest (96.5-139.2 cm) and the lowest (52.2-78.1 cm) quartiles of waist circumference (WC) were -7.9 (-13.2, -2.7) and -9.7 (-16.2, -3.2) nmol mg Hb-1 min-1, respectively. Difference (95% CI) in plasma Se between the third (87.5-96.4 cm) and the lowest quartiles of WC was -0.04 (-0.08, -0.03) μmol/L. Difference (95% CI) in red blood cell (RBC) Se between the highest (0.91-1.11) and the lowest (0.53-0.76) quartiles of waist-to-hip ratio (WHR) was 0.10 (0.00, 0.20) μmol/L. Similar results were observed in gender and menopausal-status subgroup analyses. The inverse association between plasma Se and WC and the positive association between RBC Se and WHR will need confirmation. The findings suggest associations between low whole-blood GPx activity and higher measures of general and central adiposity. Further experimental and randomized studies are needed to deduce the mechanisms and infer causality.Arsenic exposure and cancer mortality in a US-based prospective cohort: The strong heart study
AbstractGarcía-Esquinas, E., Pollán, M., Umans, J. G., Francesconi, K. A., Goessler, W., Guallar, E., Howard, B., Farley, J., Best, L. G., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
Cancer Epidemiology Biomarkers and PreventionVolume
22Issue
11Page(s)
1944-1953AbstractBackground: Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. rospective studies on carcinogenic effects at low-moderate arsenic levels are lacking. Methods: We evaluated the association between baseline arsenic exposure and cancer mortality in 3,932 American Indians, 45 to 74 years of age, from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, and 40 lymphatic/ hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate, and kidney cancers. Results: Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8-15.6) μg/g creatinine. The adjusted HRs [95% confidence interval (CI)] comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92-1.41) for overall cancer, 1.56 (1.02-2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28-8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09-5.58) for pancreatic cancer, and 0.46 (0.22-0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast. Conclusions: Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate, and pancreas. Impact: These findings support the role of low-moderate arsenic exposure in development of lung, prostate, and pancreas cancer and can inform arsenic risk assessment.Association between cancer stigma and depression among cancer survivors: A nationwide survey in Korea
AbstractCho, J., Choi, E. K., Kim, S. Y., Shin, D. W., Cho, B. L., Kim, C. H., Koh, D. H., Guallar, E., Bardwell, W. A., & Park, J. H. (n.d.).Publication year
2013Journal title
Psycho-OncologyVolume
22Issue
10Page(s)
2372-2378AbstractObjective Cancer patients are more likely to experience depression than the general population. This study aims to evaluate the possible association between cancer stigma and depression among cancer patients. Methods As a part of the Korean government's program to develop comprehensive supportive care, we conducted a nationwide survey in 2010 at the National Cancer Center and in nine regional cancer centers across Korea. Cancer stigma was assessed by using a set of 12 questions grouped in three domains - impossibility of recovery, stereotypes of cancer patients, and experience of social discrimination. Depression was measured by using the Hospital Anxiety and Depression Scale. Results A total of 466 cancer patients were included in the study. Over 30% of the cancer survivors had negative attitudes toward cancer and held stereotypical views of themselves: about 10% of the participants experienced social discrimination due to cancer, and 24.5% reported clinically significant depressive symptoms. Patients who had or experienced cancer stigma were 2.5 times more likely to have depression than patients with positive attitudes. Conclusions Regardless of highly developed medical science and increased survivorship, cancer survivors had cancer stigmas, and it was significantly associated with depression. Impact Our findings emphasize the need for medical societies and health professionals to pay more attention to cancer stigma that patients are likely to experience during treatment.Association between exposure to low to moderate arsenic levels and incident cardiovascular disease
AbstractMoon, K. A., Guallar Dr., E., Umans Dr., J. G., Devereux Dr., R. B., Best Dr., L. G., Francesconi Dr., K. A., Goessler Dr., W., Pollak, J., Silbergeld Dr., E. K., Howard Dr., B. V., & Navas-Acien Dr., A. (n.d.).Publication year
2013Journal title
Annals of internal medicineVolume
159Issue
10Page(s)
649-659AbstractBackground: Long-term exposure to high levels of arsenic is associated with increased risk for cardiovascular disease, whereas risk from long-term exposure to low to moderate arsenic levels (<100 μg/L in drinking water) is unclear. Objective: To evaluate the association between long-term exposure to low to moderate arsenic levels and incident cardiovascular disease. Design: Prospective cohort study. Setting: The Strong Heart Study baseline visit between 1989 and 1991, with follow-up through 2008. Patients: 3575 American Indian men and women aged 45 to 74 years living in Arizona, Oklahoma, and North and South Dakota. Measurements: The sum of inorganic and methylated arsenic species in urine at baseline was used as a biomarker of long-term arsenic exposure. Outcomes were incident fatal and nonfatal cardiovascular disease. Results: A total of 1184 participants developed fatal and nonfatal cardiovascular disease. When the highest and lowest quartiles of arsenic concentrations (>15.7 vs. <5.8 μg/g creatinine) were compared, the hazard ratios for cardiovascular disease, coronary heart disease, and stroke mortality after adjustment for sociodemographic factors, smoking, body mass index, and lipid levels were 1.65 (95% CI, 1.20 to 2.27; P for trend < 0.001), 1.71 (CI, 1.19 to 2.44; P for trend < 0.001), and 3.03 (CI, 1.08 to 8.50; P for trend = 0.061), respectively. The corresponding hazard ratios for incident cardiovascular disease, coronary heart disease, and stroke were 1.32 (CI, 1.09 to 1.59; P for trend = 0.002), 1.30 (CI, 1.04 to 1.62; P for trend = 0.006), and 1.47 (CI, 0.97 to 2.21; P for trend = 0.032). These associations varied by study region and were attenuated after further adjustment for diabetes, hypertension, and kidney disease measures. Limitation: Direct measurement of individual arsenic levels in drinking water was unavailable. Conclusion: Long-term exposure to low to moderate arsenic levels was associated with cardiovascular disease incidence and mortality. Primary Funding Source: National Heart, Lung, and Blood Institute and National Institute of Environmental Health Sciences.Blood lead level and measured glomerular filtration rate in children with chronic kidney disease
AbstractFadrowski, J. J., Abraham, A. G., Navas-Acien, A., Guallar, E., Weaver, V. M., & Furth, S. L. (n.d.).Publication year
2013Journal title
Environmental health perspectivesVolume
121Issue
8Page(s)
965-970AbstractBackground: The role of environmental exposure to lead as a risk factor for chronic kidney disease (CKD) and its progression remains controversial, and most studies have been limited by a lack of direct glomerular filtration rate (GFR) measurement. Objective: We evaluated the association between lead exposure and GFR in children with CKD. Methods: In this cross-sectional study, we examined the association between blood lead levels (BLLs) and GFR measured by the plasma disappearance of iohexol among 391 participants in the Chronic Kidney Disease in Children (CKiD) prospective cohort study. Results: Median BLL and GFR were 1.2; μg/dL and 44.4; mL/min per 1.73; m2, respectively. The average percent change in GFR for each 1--μg/dL increase in BLL was -2.1 (95% CI: -6.0, 1.8). In analyses stratified by CKD diagnosis, the association between BLL and GFR was stronger among children with glomerular disease underlying CKD; in this group, each 1--μg/dL increase in BLL was associated with a -12.1 (95% CI: -22.2, -1.9) percent change in GFR. In analyses stratified by anemia status, each 1--μg/dL increase in BLL among those with and without anemia was associated with a -0.3 (95% CI: -7.2, 6.6) and -4.6 (95% CI: -8.9, -0.3) percent change in GFR, respectively. Conclusions: There was no significant association between BLL and directly measured GFR in this relatively large cohort of children with CKD, although associations were observed in some subgroups. Longitudinal analyses are needed to examine the temporal relationship between lead and GFR decline, and to further examine the impact of underlying cause of CKD and anemia/hemoglobin status among patients with CKD.Body composition and arsenic metabolism: A cross-sectional analysis in the Strong Heart Study
AbstractGribble, M. O., Crainiceanu, C. M., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Zhang, Y., Silbergeld, E. K., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
Environmental Health: A Global Access Science SourceVolume
12Issue
1AbstractObjective. The objective of this study was to evaluate the association between measures of body composition and patterns of urine arsenic metabolites in the 1989-1991 baseline visit of the Strong Heart Study, a cardiovascular disease cohort of adults recruited from rural communities in Arizona, Oklahoma, North Dakota and South Dakota. Methods. We evaluated 3,663 Strong Heart Study participants with urine arsenic species above the limit of detection and no missing data on body mass index, % body fat and fat free mass measured by bioelectrical impedance, waist circumference and other variables. We summarized urine arsenic species patterns as the relative contribution of inorganic (iAs), methylarsonate (MMA) and dimethylarsinate (DMA) species to their sum. We modeled the associations of % arsenic species biomarkers with body mass index, % body fat, fat free mass, and waist circumference categories in unadjusted regression models and in models including all measures of body composition. We also considered adjustment for arsenic exposure and demographics. Results: Increasing body mass index was associated with higher mean % DMA and lower mean % MMA before and after adjustment for sociodemographic variables, arsenic exposure, and for other measures of body composition. In unadjusted linear regression models, % DMA was 2.4 (2.1, 2.6) % higher per increase in body mass index category (< 25, ≥25 & <30, ≥30 & <35, ≥35 kg/m 2), and % MMA was 1.6 (1.4, 1.7) % lower. Similar patterns were observed for % body fat, fat free mass, and waist circumference measures in unadjusted models and in models adjusted for potential confounders, but the associations were largely attenuated or disappeared when adjusted for body mass index. Conclusion: Measures of body size, especially body mass index, are associated with arsenic metabolism biomarkers. The association may be related to adiposity, fat free mass or body size. Future epidemiologic studies of arsenic should consider body mass index as a potential modifier for arsenic-related health effects.Cadmium exposure and clinical cardiovascular disease: A systematic review topical collection on nutrition
AbstractTellez-Plaza, M., Jones, M. R., Dominguez-Lucas, A., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
Current atherosclerosis reportsVolume
15Issue
10AbstractMounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95 % CI: 1.11, 1.66), 1.30 (95 % CI: 1.12, 1.52), 1.18 (95 % CI: 0.86, 1.59), and 1.49 (95 % CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.Cadmium exposure and incident cardiovascular disease
AbstractTellez-Plaza, M., Guallar, E., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Devereux, R. B., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
EpidemiologyVolume
24Issue
3Page(s)
421-429AbstractBACKGROUND: Cadmium is a widespread toxic metal with potential cardiovascular effects, but no studies have evaluated cadmium and incident cardiovascular disease. We evaluated the association of urine cadmium concentration with cardiovascular disease incidence and mortality in a large population-based cohort. METHODS: We conducted a prospective cohort study of 3348 American Indian adults 45-74 years of age from Arizona, Oklahoma, and North and South Dakota, who participated in the Strong Heart Study in 1989-1991. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through 31 December 2008. RESULTS: The geometric mean cadmium level in the study population was 0.94 μg/g (95% confidence interval [CI] = 0.92-0.96). We identified 1084 cardiovascular events, including 400 deaths. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratios (HRs) (comparing the 80th to the 20th percentile of urine cadmium concentrations) was 1.43 for cardiovascular mortality (95% CI = 1.21-1.70) and 1.34 for coronary heart disease mortality (1.10-1.63). The corresponding HRs for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.24 (1.11-1.38), 1.22 (1.08-1.38), 1.75 (1.17-2.59), and 1.39 (1.01-1.94), respectively. The associations were similar in most study subgroups, including never-smokers. CONCLUSIONS: Urine cadmium, a biomarker of long-term exposure, was associated with increased cardiovascular mortality and increased incidence of cardiovascular disease. These findings support that cadmium exposure is a cardiovascular risk factor.