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
Patient safety events and harms during medical and surgical hospitalizations for persons with serious mental illness
AbstractDaumit, G. L., McGinty, E. E., Pronovost, P., Dixon, L. B., Guallar, E., Ford, D. E., Cahoon, E. K., Boonyasai, R. T., & Thompson, D. (n.d.).Publication year
2016Journal title
Psychiatric ServicesVolume
67Issue
10Page(s)
1068-1075AbstractObjective: This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. Methods: Medical record reviewwas conducted formedicalsurgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. Results: A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (pPatient, provider, and system factors contributing to patient safety events during medical and surgical hospitalizations for persons with serious mental illness
AbstractMcGinty, 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
2017Journal title
Journal of Nervous and Mental DiseaseVolume
205Issue
6Page(s)
495-501AbstractThis 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.Patients’ and family members’ perspectives on arrhythmias and sudden death in dialysis : the HeartLink focus groups pilot study
AbstractXu, E. J., Boyer, L. P., Jaar, B. G., Ephraim, P. L., Gimenez, L., Cheng, A., Chrispin, J., Weir, M. R., Raj, D., Guallar, E., & Shafi, T. (n.d.).Publication year
2021Journal title
BMC NephrologyVolume
22Issue
1AbstractBackground: Patients receiving dialysis face a high risk of cardiovascular disease, arrhythmia and sudden cardiac death. Few patients, however, are aware of this risk. Implantable cardiac monitors are currently available for clinical use and can continuously monitor cardiac rhythms without the need for transvenous leads. Our goal was to gauge patients’ and family members’ perceptions of these risks and to identify their concerns about cardiac monitors. Methods: Two 90-minute focus groups were conducted: one with patients receiving in-center hemodialysis and one with their family members. Trained moderators assessed: (1) knowledge of cardiovascular disease; (2) cardiovascular disease risk in dialysis; (3) risk of death due to cardiovascular disease; (4) best ways to convey this risk to patients/families; and (5) concerns about cardiac monitors. The sessions were audiotaped, transcribed, and independently analyzed by two reviewers to identify core themes. Emblematic quotations were chosen to illustrate the final themes. Results: Nine adult patients and three family members participated. Patients felt education was inadequate and had little knowledge of arrhythmias. Patients’/families’ concerns regarding cardiac monitors were related to adverse effects, the notification process, and cosmetic effects. Patients/families felt that nephrologists, not dialysis staff, would be the best source for education. Conclusions: The preliminary data from this small study population suggest that patients/families are not well aware of the high risk of arrhythmia and sudden cardiac death in dialysis. Further investigation is required to gauge this awareness among patients/families and to assess their impressions of implantable cardiac monitors for arrhythmia detection and management.Patterns and Implications of Intracranial Arterial Remodeling in Stroke Patients
AbstractQiao, Y., Anwar, Z., Intrapiromkul, J., Liu, L., Zeiler, S. R., Leigh, R., Zhang, Y., Guallar, E., & Wasserman, B. A. (n.d.).Publication year
2016Journal title
StrokeVolume
47Issue
2Page(s)
434-440AbstractBackground and Purpose - Preliminary studies suggest that intracranial arteries are capable of accommodating plaque formation by remodeling. We sought to study the ability and extent of intracranial arteries to remodel using 3-dimensional high-resolution black blood magnetic resonance imaging and investigate its relation to ischemic events. Methods-Forty-two patients with cerebrovascular ischemic events underwent 3-dimensional time-of-flight magnetic resonance angiography and contrast-enhanced black blood magnetic resonance imaging examinations at 3 T for intracranial atherosclerotic disease. Each plaque was classified by location (eg, posterior versus anterior circulation) and its likelihood to have caused a stroke identified on magnetic resonance imaging (culprit, indeterminate, or nonculprit). Lumen area, outer wall area, and wall area were measured at the lesion and reference sites. Plaque burden was calculated as wall area divided by outer wall area. The arterial remodeling ratio (RR) was calculated as outer wall area at the lesion site divided by outer wall area at the reference site after adjusting for vessel tapering. Arterial remodeling was categorized as positive if RR >l 1.05, intermediate if 0.95≤RR≤1.05, and negative if RR < 0.95. Results-One hundred and thirty-seven plaques were identified in 42 patients (37% [50] posterior and 63% [87] anterior). Compared with anterior circulation plaques, posterior circulation plaques had a larger plaque burden (77.7±15.7 versus 69.0±14.0; P=0.008), higher RR (1.14±0.38 versus 0.95±0.32; P=0.002), and more often exhibited positive remodeling (54.0% versus29.9%; P=0.011). Positive remodeling was marginally associated with downstream stroke presence when adjusted for plaque burden (odds ratio 1.34, 95% confidence interval: 0.99-1.81). Conclusions-Intracranial arteries remodel in response to plaque formation, and posterior circulation arteries have a greater capacity for positive remodeling and, consequently, may more likely elude angiographic detection. Arterial remodeling may provide insight into stroke risk.PCSK9 inhibitors : A new era in lipid-lowering treatment?
AbstractCainzos-Achirica, M., Martin, S. S., Cornell, J. E., Mulrow, C. D., & Guallar, E. (n.d.).Publication year
2015Journal title
Annals of internal medicineVolume
163Issue
1Page(s)
64-65Abstract~Perceived stress and non-alcoholic fatty liver disease in apparently healthy men and women
AbstractKang, D., Zhao, D., Ryu, S., Guallar, E., Cho, J., Lazo, M., Shin, H., Chang, Y., & Sung, E. (n.d.).Publication year
2020Journal title
Scientific reportsVolume
10Issue
1AbstractPsychological stress may have adverse metabolic effects and induce unhealthy behaviors, but the role of stress in the development of non-alcoholic fatty liver disease (NAFLD) is largely unexplored. We investigated the association between perceived stress and the prevalence of NAFLD in a large sample of apparently healthy men and women. We performed a cross-sectional study of 171,321 adults who underwent health screening examination between 2011 and 2013 in one health screening center. Perceived stress was assessed using the short version of the Perceived Stress Inventory (PSI). NAFLD was assessed using ultrasonography in the absence of excessive alcohol use or any other identifiable cause of liver disease. The prevalence of NAFLD was 27.8%. In fully-adjusted multivariable models, the odds ratio (95% confidence intervals) for NAFLD comparing participants in the 5th quintile of PSI score (≥23) with those in the lowest quintile (Peripheral arterial disease and its association with arsenic exposure and metabolism in the strong heart study
AbstractNewman, J. D., Navas-Acien, A., Kuo, C. C., Guallar, E., Howard, B. V., Fabsitz, R. R., Devereux, R. B., Umans, J. G., Francesconi, K. A., Goessler, W., Best, L. T., & Tellez-Plaza, M. (n.d.).Publication year
2016Journal title
American Journal of EpidemiologyVolume
184Issue
11Page(s)
806-817AbstractAt high levels, inorganic arsenic exposure is linked to peripheral arterial disease (PAD) and cardiovascular disease. To our knowledge, no prior study has evaluated the association between low-to-moderate arsenic exposure and incident PAD by ankle brachial index (ABI). We evaluated this relationship in the Strong Heart Study, a large population-based cohort study of American Indian communities. A total of 2,977 and 2,966 PAD-free participants who were aged 45-74 years in 1989-1991 were reexamined in 1993-1995 and 1997-1999, respectively, for incident PAD defined as either ABI 1.4. A total of 286 and 206 incident PAD cases were identified for ABI 1.4, respectively. The sum of inorganic and methylated urinary arsenic species (∑As) at baseline was used as a biomarker of long-term exposure. Comparing the highest tertile of ∑As with the lowest, the adjusted hazard ratios were 0.57 (95% confidence interval (CI): 0.32, 1.01) for ABI 1.4. Increased arsenic methylation (as percent dimethylarsinate) was associated with a 2-fold increased risk of ABI >1.4 (hazard ratio = 2.04, 95% CI: 1.02, 3.41). Long-term low-to-moderate ∑As and increased arsenic methylation were associated with ABI >1.4 but not with ABIPeripheral arterial disease and metals in urine and blood (multiple letters) [3]
AbstractPlusquin, M., Nawrot, T. S., Staessen, J. A., Navas-Acien, A., Silbergeld, E. K., & Guallar, E. (n.d.).Publication year
2005Journal title
Environmental health perspectivesVolume
113Issue
8Page(s)
A510-A511Abstract~Permanent Chemotherapy-Induced Alopecia in Patients with Breast Cancer : A 3-Year Prospective Cohort Study
AbstractKang, D., Kim, I. R., Choi, E. K., Im, Y. H., Park, Y. H., Ahn, J. S., Lee, J. E., Nam, S. J., Lee, H. K., Park, J. H., Lee, D. Y., Lacouture, M. E., Guallar, E., & Cho, J. (n.d.).Publication year
2019Journal title
OncologistVolume
24Issue
3Page(s)
414-420AbstractBackground: Although chemotherapy-induced alopecia (CIA) is considered temporary, some patients report persistent alopecia several years after chemotherapy. There is, however, a paucity of long-term prospective data on the incidence and impact of permanent CIA (PCIA). The objective of our study was to estimate the long-term incidence of PCIA in a cohort of patients with breast cancer whose hair volume and density were measured prior to chemotherapy and who were followed for 3 years after chemotherapy. Materials and Methods: Prospective cohort study of consecutive patients ≥18 years of age with postoperative diagnosis of stage I–III breast cancer expected to receive adjuvant chemotherapy at the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, from February 2012 to July 2013 (n = 61). Objective hair density and thickness were measured using a noninvasive bioengineering device. Results: The proportion of participants who had PCIA at 6 months and 3 years was 39.5% and 42.3%, respectively. PCIA was characterized in most patients by incomplete hair regrowth. Patients who received a taxane-based regimen were more likely to experience PCIA compared with patients with other types of chemotherapy. At a 3-year follow-up, hair thinning was the most common problem reported by study participants (75.0%), followed by reduced hair volume (53.9%), hair loss (34.6%), and gray hair (34.6%). Conclusion: PCIA is a common adverse event of breast cancer adjuvant cytotoxic chemotherapy. Clinicians should be aware of this distressing adverse event and develop supportive care strategies to counsel patients and minimize its impact on quality of life. Implications for Practice: Knowledge of permanent chemotherapy-induced alopecia, an under-reported adverse event, should lead to optimized pretherapy counseling, anticipatory coping techniques, and potential therapeutic strategies for this sequela of treatment.Persistent Nonalcoholic Fatty Liver Disease Increases Risk for Carotid Atherosclerosis
AbstractSinn, D. H., Cho, S. J., Gu, S., Seong, D., Kang, D., Kim, H., Yi, B. K., Paik, S. W., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).Publication year
2016Journal title
GastroenterologyVolume
151Issue
3Page(s)
481-488.e1AbstractBackground & Aims Nonalcoholic fatty liver disease (NAFLD) has been associated with subclinical atherosclerosis in cross-sectional studies. We investigated the longitudinal association of NAFLD with the development of subclinical carotid atherosclerosis. Methods We performed a retrospective cohort study of 8020 adult men (average age, 49.2 y) without carotid atherosclerosis at baseline who underwent repeated health check-up examinations from January 1, 2005, through December 31, 2013. NAFLD status was diagnosed by ultrasonography and classified into 4 groups based on baseline and follow-up findings: none, developed, regressed, or persistent NAFLD. Subclinical carotid atherosclerosis was measured by ultrasound. Results The age-adjusted hazard ratio for subclinical carotid atherosclerosis development comparing participants with persistent NAFLD with those without NAFLD was 1.23 (95% confidence interval [CI], 1.13–1.35; PPhysical activity and impaired left ventricular relaxation in middle aged adults
AbstractRyu, S., Chang, Y., Kang, J., Yun, K. E., Jung, H. S., Kim, C. W., Cho, J., Lima, J. A., Sung, K. C., Shin, H., & Guallar, E. (n.d.).Publication year
2018Journal title
Scientific reportsVolume
8Issue
1AbstractThe aim of this study was to examine the relationship between physical activity level and impaired left ventricular (LV) relaxation in a large sample of apparently healthy men and women. We conducted a cross-sectional study in 57,449 adults who underwent echocardiography as part of a comprehensive health examination between March 2011 and December 2014. Physical activity level was assessed using the Korean version of the International Physical Activity Questionnaire Short Form. The presence of impaired LV relaxation was determined based on echocardiographic findings. Physical activity levels were inversely associated with the prevalence of impaired LV relaxation. The multivariable-adjusted odds ratios (95% confidence interval) for impaired LV relaxation comparing minimally active and health-enhancing physically active groups to the inactive group were 0.84 (0.77–0.91) and 0.64 (0.58–0.72), respectively (P for trend < 0.001). These associations were modified by sex (p for interactionPhysical activity and the progression of coronary artery calcification
AbstractSung, K. C., Hong, Y. S., Lee, J. Y., Lee, S. J., Chang, Y., Ryu, S., Zhao, D., Cho, J., Guallar, E., & Lima, J. A. (n.d.).Publication year
2021Journal title
HeartVolume
107Issue
21Page(s)
1710-1716AbstractBackground The association of physical activity with the development and progression of coronary artery calcium (CAC) scores has not been studied. This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults. Methods Prospective cohort study of men and women free of overt cardiovascular disease who underwent comprehensive health screening examinations between 1 March 2011 and 31 December 2017. Baseline physical activity was measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and categorised into three groups (inactive, moderately active and health-enhancing physically active (HEPA)). The primary outcome was the difference in the 5-year change in CAC scores by physical activity category at baseline. Results We analysed 25 485 participants with at least two CAC score measurements. The proportions of participants who were inactive, moderately active and HEPA were 46.8%, 38.0% and 15.2%, respectively. The estimated adjusted average baseline CAC scores (95% confidence intervals) in participants who were inactive, moderately active and HEPA were 9.45 (8.76, 10.14), 10.20 (9.40, 11.00) and 12.04 (10.81, 13.26). Compared with participants who were inactive, the estimated adjusted 5-year average increases in CAC in moderately active and HEPA participants were 3.20 (0.72, 5.69) and 8.16 (4.80, 11.53). Higher physical activity was association with faster progression of CAC scores both in participants with CAC=0 at baseline and in those with prevalent CAC. Conclusion We found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.Physical activity and white matter lesion progression : Assessment using MRI
AbstractGuallar, E., Podewils, L. J., Guallar, E., Beauchamp, N., Lyketsos, C. G., Kuller, L. H., & Scheltens, P. (n.d.).Publication year
2007Journal title
NeurologyVolume
68Issue
15Page(s)
1223-1226AbstractWe evaluated the association between physical activity and changes in white matter lesions (WMLs) on MRI in a sample of 179 older adults comprising 59 incident cases of Alzheimer disease, 60 persons with mild cognitive impairment, and 60 persons who remained cognitively stable over a median 5-year follow-up. Physical activity was not significantly associated with a decreased rate of periventricular or deep WML progression.Physical activity, APOE genotype, and dementia risk : Findings from the Cardiovascular Health Cognition Study
AbstractPodewils, L. J., Guallar, E., Kuller, L. H., Fried, L. P., Lopez, O. L., Carlson, M., & Lyketsos, C. G. (n.d.).Publication year
2005Journal title
American Journal of EpidemiologyVolume
161Issue
7Page(s)
639-651AbstractPhysical activity may help preserve cognitive function and decrease dementia risk, but epidemiologic findings are inconsistent. The authors conducted a prospective study to determine the association between physical activity and risk of dementia, Alzheimer's disease, and vascular dementia. The US study population comprised 3,375 men and women aged 65 years or older, free of dementia at baseline, who participated in the Cardiovascular Health Cognition Study in 1992-2000. Leisure-time energy expenditure and an activity index reflecting number of different physical activities were calculated. Analyses were based on Cox proportional hazards models. There were 480 incident cases of dementia over an average of 5.4 years of follow-up. After multivariate adjustment, participants in the highest quartile of physical energy expenditure had a relative risk of dementia of 0.85 (95% confidence interval: 0.61, 1.19) compared with those in the lowest quartile, and participants engaging in ≥4 activities had a relative risk of dementia of 0.51 (95% confidence interval: 0.33, 0.79) compared with those engaging in 0-1 activity. These associations were more marked in apolipoprotein E genotype (APOE) ε4 allele noncarriers but were absent in carriers. A similar pattern was observed for Alzheimer's disease and vascular dementia. Mechanisms to explain the observed relations deserve further study.Physical Activity, Parental History of Premature Coronary Heart Disease, and Incident Atherosclerotic Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study
AbstractFlorido, R., Zhao, D., Ndumele, C. E., Lutsey, P. L., Mcevoy, J. W., Windham, B. G., Pankow, J. S., Guallar, E., & Michos, E. D. (n.d.).Publication year
2016Journal title
Journal of the American Heart AssociationVolume
5Issue
9AbstractBackground: The effects of some atherosclerotic cardiovascular disease (ASCVD) risk factors vary according to whether an individual has a family history (FHx) of premature coronary heart disease (CHD). Physical activity (PA) is associated with reduced risk of ASCVD, but whether this association varies by FHx status is not well established. Methods and Results: We evaluated 9996 participants free of ASCVD at baseline. FHx of premature CHD was defined as CHD occurring in a father before age 55 or mother before age 60. PA, assessed by a Baecke questionnaire, was converted into minutes/week of moderate or vigorous exercise and categorized per American Heart Association guidelines as recommended, intermediate, or poor. Incident ASCVD was defined as incident myocardial infarction, fatal CHD, or stroke. Multivariable-adjusted Cox hazard models were used. The mean age was 54±6 years, 56% were women, and 21% of black race. Participants with and without a FHx of premature CHD reported similar levels of PA at baseline (423 versus 409 metabolic equivalents of task×min/week, respectively, P=0.852), and ≈40% of both groups met American Heart Association recommended PA levels. Over a mean follow-up of 20.9 years, there were 1723 incident ASCVD events. Compared to those with poor PA adherence to American Heart Association guidelines, participants who reported PA at recommended levels had significantly lower risk of incident ASCVD after adjustment for demographics and lifestyle factors (hazard ratio 0.84, 95% CI 0.74-0.94), but this association was not modified by FHx status (P-interaction=0.680). Conclusions: PA was associated with a reduced risk of ASCVD among individuals with and without a FHx of premature CHD.Physical activity, vitamin D, and incident atherosclerotic cardiovascular disease in whites and blacks : The ARIC study
AbstractChin, 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
2017Journal title
Journal of Clinical Endocrinology and MetabolismVolume
102Issue
4Page(s)
1227-1236AbstractContext: 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 [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.Polyunsaturated fats, carbohydrates and carotid disease : The Atherosclerosis Risk in Communities (ARIC) Carotid MRI study
AbstractDearborn, J. L., Qiao, Y., Guallar, E., Steffen, L. M., Gottesman, R. F., Zhang, Y., & Wasserman, B. A. (n.d.).Publication year
2016Journal title
AtherosclerosisVolume
251Page(s)
361-366AbstractBackground and aims Carbohydrates and fat intake have both been linked to development of atherosclerosis. We examined associations between glycemic index (GI) and fat intake with carotid atherosclerosis. Methods The Atherosclerosis Risk in Communities (ARIC) cohort enrolled participants during the period 1987–1989 and the Carotid MRI sub-study occurred between 2004 and 2006 (1672 participants attending both visits). Measures of carbohydrate quality (usual GI), fat intake (total, polyunsaturated and saturated) and overall dietary quality index (DASH Diet Score) were derived from a 66-item food frequency questionnaire administered at baseline. Trained readers measured lipid core presence and maximum wall thickness. Using multivariate logistic regression, we determined the odds of lipid core presence by quintile (Q) of energy-adjusted dietary components. Restricted cubic spline models were used to examine non-linear associations between dietary components and maximum wall thickness. Results Mean daily polyunsaturated fat intake was 5 g (SD 1.4). GI and polyunsaturated fat intake had a nonlinear relationship with maximum wall thickness. Low (1–4 g) and high (6–12 g) polyunsaturated fat intake were associated with a statistically significant decreased odds of lipid core presence compared to intake in a majority of participants (OR Q5 vs. Q2-4: 0.64, 95% CI 0.42 to 0.98; OR Q1 vs. Q2-4: 0.64, 95% CI 0.42, 0.96), however, the association with lipid core was attenuated by adjustment for maximum wall thickness, hypertension, hyperlipidemia, and diabetes. Conclusions GI and polyunsaturated fat intake were not associated with high-risk plaque features, such as lipid core presence, independent of traditional vascular risk factors.Post-myocardial-infarction quality of care among disabled Medicaid beneficiaries with and without serious mental illness
AbstractMcGinty, E. E., Blasco-Colmenares, E., Zhang, Y., dosReis, S. C., Ford, D. E., Steinwachs, D. M., Guallar, E., & Daumit, G. L. (n.d.).Publication year
2012Journal title
General Hospital PsychiatryVolume
34Issue
5Page(s)
493-499AbstractObjective: The objective was to examine the association between serious mental illness and quality of care for myocardial infarction among disabled Maryland Medicaid beneficiaries. Methods: We conducted a retrospective cohort study of disabled Maryland Medicaid beneficiaries with myocardial infarction from 1994 to 2004. Cardiac procedures and guideline-based medication use were compared for persons with and without serious mental illness. Results: Of the 633 cohort members with myocardial infarction, 137 had serious mental illness. Serious mental illness was not associated with differences in receipt of cardiac procedures or guideline-based medications. Overall use of guideline-based medications was low; 30 days after the index hospitalization for myocardial infarction, 19%, 35% and 11% of cohort members with serious mental illness and 22%, 37% and 13% of cohort members without serious mental illness had any use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers and statins, respectively. Study participants with and without serious mental illness had similar rates of mortality. Overall, use of beta-blockers [hazard ratio 0.93, 95% confidence interval (CI) 0.90-0.97] and statins (hazard ratio 0.93, 95% CI 0.89-0.98) was associated with reduced risk of mortality. Conclusions: Quality improvement programs should consider how to increase adherence to medications of known benefit among disabled Medicaid beneficiaries with and without serious mental illness.Postmenopausal hormone therapy : The heart of the matter
AbstractGuallar, E., Manson, J. E., Laine, C., & Mulrow, C. (n.d.).Publication year
2013Journal title
Annals of internal medicineVolume
158Issue
1Page(s)
69-70Abstract~Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients : The HF-CRT score
AbstractNauffal, V., Tanawuttiwat, T., Zhang, Y., Rickard, J., Marine, J. E., Butcher, B., Norgard, S., Dickfeld, T., Ellenbogen, K. A., Guallar, E., Tomaselli, G. F., & Cheng, A. (n.d.).Publication year
2015Journal title
Heart RhythmVolume
12Issue
12Page(s)
2387-2394AbstractBackground Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among individuals with dyssynchronous systolic heart failure (HF). However, patient outcomes vary, with some at higher risk than others for HF progression and death. Objective To develop a risk prediction score incorporating variables associated with mortality, left ventricular assist device (LVAD) implant, or heart transplant in recipients of a primary prevention cardiac resynchronization therapy-defibrillator (CRT-D). Methods We followed 305 CRT-D patients from the Prospective Observational Study of Implantable Cardioverter-Defibrillators for the composite outcome of all-cause mortality, LVAD implant, or heart transplant soon after device implantation. Serum biomarkers and electrocardiographic and clinical variables were collected at implant. Multivariable analysis using the Cox proportional hazards model with stepwise selection method was used to fit the final model. Results Among 305 patients, 53 experienced the composite endpoint. In multivariable analysis, 5 independent predictors ("HF-CRT") were identified: high-sensitivity C-reactive protein >9.42 ng/L (HR = 2.5 [1.4, 4.5]), New York Heart Association functional class III/IV (HR = 2.3 [1.2, 4.5]), creatinine >1.2 mg/dL (HR = 2.7 [1.4, 5.1]), red blood cell count 28 ng/L (HR = 2.7 [1.4, 5.2]). One point was attributed to each predictor and 3 score categories were identified. Patients with scores 0-1, 2-3, and 4-5 had a 3-year cumulative event-free survival of 96.8%, 79.7%, and 35.2%, respectively (log-rank, PPreoperative acute normovolemic hemodilution : A meta-analysis
AbstractSegal, J. B., Blasco-Colmenares, E., Norris, E. J., & Guallar, E. (n.d.).Publication year
2004Journal title
TransfusionVolume
44Issue
5Page(s)
632-644AbstractBACKGROUND: Acute normovolemic hemodilution (ANH) involves withdrawal of whole blood with concurrent infusion of fluids to maintain normovolemia. The aim of this study was to quantify the efficacy and safety of preoperative ANH with a systematic review and meta-analysis. STUDY DESIGN AND METHODS: Randomized controlled trials were identified through MEDLINE (1966-2002) and the Cochrane Controlled Trials Database and with hand searching of journals. All trials of preoperative ANH reporting on allogeneic transfusion, bleeding, or adverse outcomes were included. Paired reviewers independently abstracted data. Outcomes were pooled using random-effects models. RESULTS: A total of 42 trials compared hemodilution to usual care or to another blood conservation method. The risk of allogeneic transfusion was similar among patients receiving ANH and those receiving usual care (relative risk [RR], 0.96; 95% Cl, 0.90-1.01), or another blood conservation method (RR, 1.11; 95% Cl, 0.96-1.28). Hemodiluted patients, however, were transfused from 1 to 2 fewer units of allogeneic blood. They had less total bleeding than patients receiving usual care (91 mL; 95% Cl, 25-158 mL), although more intraoperative bleeding. Only one-third of studies reported on adverse events. CONCLUSIONS: The literature supports only modest benefits from preoperative ANH. The safety of the procedure is unproven. Widespread adoption of ANH cannot be encouraged.Prevalence and Persistence of Uremic Symptoms in Incident Dialysis Patients
AbstractRhee, E. P., Guallar, E., Hwang, S., Kim, N., Tonelli, M., Moe, S. M., Himmelfarb, J., Thadhani, R. I., Powe, N. R., & Shafi, T. (n.d.).Publication year
2020Journal title
Kidney360Volume
1Issue
2Page(s)
86-92AbstractBackground Uremic symptoms are major contributors to the poor quality of life among patients on dialysis, but whether their prevalence or intensity has changed over time is unknown. Methods We examined responses to validated questionnaires in two incident dialysis cohort studies, the Choices for Health Outcomes in Caring for ESRD (CHOICE) study (N926, 1995-1998) and the Longitudinal United States/Canada Incident Dialysis (LUCID) study (N428, 2011-2017). We determined the prevalence and severity of uremic symptoms - anorexia, nausea/vomiting, pruritus, sleepiness, difficulty concentrating, fatigue, and pain - in both cohorts. Results In CHOICE and LUCID, respectively, mean age of the participants was 58 and 60 years, 53% and 60% were male, and 28% and 32% were black. In both cohorts, 54% of the participants had diabetes. Median time from dialysis initiation to the symptoms questionnaires was 45 days for CHOICE and 77 days for LUCID. Uremic symptom prevalence in CHOICE did not change from baseline to 1-year follow-up and was similar across CHOICE and LUCID. Baseline symptom prevalence in CHOICE and LUCID was as follows: anorexia (44%, 44%, respectively), nausea/vomiting (36%, 43%), pruritus (72%, 63%), sleepiness (86%, 68%), difficulty concentrating (55%, 57%), fatigue (89%, 77%), and pain (82%, 79%). In both cohorts, >80% of patients had three or more symptoms and >50% had five or more symptoms. The correlation between individual symptoms was low (ρPrevalence and prognostic association of circulating troponin in the acute respiratory distress syndrome
AbstractMetkus, T. S., Guallar, E., Sokoll, L., Morrow, D., Tomaselli, G., Brower, R., Schulman, S., & Korley, F. K. (n.d.).Publication year
2017Journal title
Critical care medicineVolume
45Issue
10Page(s)
1709-1717AbstractObjective: 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.