Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

Dr. Guallar is an epidemiologist whose research is focused on the study of cardiovascular disease epidemiology and prevention, with an emphasis on evaluating the role of environmental and nutritional exposures in the development of cardiovascular disease. This research has made critically important and novel contributions to our understanding of risk factors for chronic disease both in the US and globally. He has published seminal articles and is a leading figure in an emerging field highlighting the risks of exposure to levels of metals previously considered safe for cardiovascular health. In addition to his work in toxic metals, Dr. Guallar has made important contributions to understanding the effects of certain micronutrients and vitamin supplements on cardiovascular disease risk and outcomes. Publications in this area were influential in changing consumer habits and attitudes towards these products. Much of this research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, the CDC, and other funders.

Dr. Guallar was the founding director of the Center for Clinical Epidemiology at the Samsung Medical Center and a lead investigator of the Kangbuk Samsung Cohort Study at the Kangbuk Samsung Hospital since its inception in 2010. Dr. Guallar has published over 500 research papers in peer-reviewed journals. He is also a Deputy Editor for Methods at the Annals of Internal Medicine and a past member and Chair of the Cancer, Heart, and Sleep Study Section at the National Institutes of Health.

Prior to teaching at NYU, Dr. Guallar was a Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg School of Public Health and a core faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins. In the Department of Epidemiology, Dr. Guallar was the Director of the Environmental and Occupational Area of Concentration and the Co-Director of the PhD Program. Dr. Guallar was also an adjunct Professor at the Department of Clinical Research Design and Evaluation of the Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, in Seoul, Korea.

Education

Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, Spain

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

Six Honor Calls in the MD Program, University of Zaragoza School of Medicine (1981)

Fellow of Spain’s Program of Training of Graduate Research of the Ministry of Education and Science, University of Zaragoza (1988)

Fulbright Scholar, sponsored by Spain’s Ministry of Health and Consumer Affairs (1989)

Faculty Innovation Award, Johns Hopkins University Bloomberg School of Public Health (2001)

Scientist Development Award, American Heart Association (2002)

Fellow of the American Heart Association, Council on Epidemiology and Prevention (2013)

Advising, Mentoring, and Teaching Recognition Award 2014 – 2015, Johns Hopkins University Bloomberg School of Public Health (2015)

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

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

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

Publication year

2017

Journal title

BMC Cardiovascular Disorders

Volume

17

Issue

1

10.1186/s12872-017-0591-5

Abstract

Abstract

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

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

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

Publication year

2016

Journal title

Investigative Ophthalmology and Visual Science

Volume

57

Issue

6

Page(s)

2905-2913

10.1167/iovs.15-18469

Abstract

Abstract

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

Prevalence of Intracranial Atherosclerotic Stenosis Using High-Resolution Magnetic Resonance Angiography in the General Population : The Atherosclerosis Risk in Communities Study

Suri, M. F., Qiao, Y., Ma, X., Guallar, E., Zhou, J., Zhang, Y., Liu, L., Chu, H., Qureshi, A. I., Alonso, A., Folsom, A. R., & Wasserman, B. A. (n.d.).

Publication year

2016

Journal title

Stroke

Volume

47

Issue

5

Page(s)

1187-1193

10.1161/STROKEAHA.115.011292

Abstract

Abstract

Background and Purpose - Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke, but little is known about its epidemiology. We studied the prevalence of ICAS and its association with vascular risk factors using high-resolution magnetic resonance angiography in a US cardiovascular cohort. Methods - The Atherosclerosis Risk in Communities (ARIC) study recruited participants from 4 US communities from 1987 to 1989. Using stratified sampling, we selected 1980 participants from visit 5 (2011-2013) for high-resolution 3T-magnetic resonance angiography. All images were analyzed in a centralized laboratory, and ICAS was graded as: no stenosis,

Prevalence of nonalcoholic fatty liver disease in the United States : The third national health and nutrition examination survey, 1988-1994

Lazo, M., Hernaez, R., Eberhardt, M. S., Bonekamp, S., Kamel, I., Guallar, E., Koteish, A., Brancati, F. L., & Clark, J. M. (n.d.).

Publication year

2013

Journal title

American Journal of Epidemiology

Volume

178

Issue

1

Page(s)

38-45

10.1093/aje/kws448

Abstract

Abstract

Previous estimates of the prevalence of nonalcoholic fatty liver disease (NAFLD) in the US population relied on measures of liver enzymes, potentially underestimating the burden of this disease. We used ultrasonography data from 12,454 adults who participated in the Third National Health and Nutrition Examination Survey, conducted in the United States from 1988 to 1994. We defined NAFLD as the presence of hepatic steatosis on ultrasonography in the absence of elevated alcohol consumption. In the US population, the rates of prevalence of hepatic steatosis and NAFLD were 21.4% and 19.0%, respectively, corresponding to estimates of 32.5 (95% confidence interval: 29.9, 35.0) million adults with hepatic steatosis and 28.8 (95% confidence interval: 26.6, 31.2) million adults with NAFLD nationwide. After adjustment for age, income, education, body mass index (weight (kg)/height (m)2), and diabetes status, NAFLD was more common in Mexican Americans (24.1%) compared with non-Hispanic whites (17.8%) and non-Hispanic blacks (13.5%) (P = 0.001) and in men (20.2%) compared with women (15.8%) (P < 0.001). Hepatic steatosis and NAFLD were also independently associated with diabetes, with insulin resistance among people without diabetes, with dyslipidemia, and with obesity. Our results extend previous national estimates of the prevalence of NAFLD in the US population and highlight the burden of this disease. Men, Mexican Americans, and people with diabetes and obesity are the most affected groups.

Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort the PESA (Progression of Early Subclinical Atherosclerosis) study

Fernández-Friera, L., Peñalvo, J. L., Fernández-Ortiz, A., Ibañez, B., López-Melgar, B., Laclaustra, M., Oliva, B., Mocoroa, A., Mendiguren, J., De Vega, V. M., García, L., Molina, J., Sánchez-González, J., Guzmán, G., Alonso-Farto, J. C., Guallar, E., Civeira, F., Sillesen, H., Pocock, S., … Fuster, V. (n.d.).

Publication year

2015

Journal title

Circulation

Volume

131

Issue

24

Page(s)

2104-2113

10.1161/CIRCULATIONAHA.114.014310

Abstract

Abstract

Background-Data are limited on the presence, distribution, and extent of subclinical atherosclerosis in middle-aged populations. Methods and Results-The PESA (Progression of Early Subclinical Atherosclerosis) study prospectively enrolled 4184 asymptomatic participants 40 to 54 years of age (mean age, 45.8 years; 63% male) to evaluate the systemic extent of atherosclerosis in the carotid, abdominal aortic, and iliofemoral territories by 2-/3-dimensional ultrasound and coronary artery calcification by computed tomography. The extent of subclinical atherosclerosis, defined as presence of plaque or coronary artery calcification ≥1, was classified as focal (1 site affected), intermediate (2-3 sites), or generalized (4-6 sites) after exploration of each vascular site (right/left carotids, aorta, right/left iliofemorals, and coronary arteries). Subclinical atherosclerosis was present in 63% of participants (71% of men, 48% of women). Intermediate and generalized atherosclerosis was identified in 41%. Plaques were most common in the iliofemorals (44%), followed by the carotids (31%) and aorta (25%), whereas coronary artery calcification was present in 18%. Among participants with low Framingham Heart Study (FHS) 10-year risk, subclinical disease was detected in 58%, with intermediate or generalized disease in 36%. When longer-term risk was assessed (30-year FHS), 83% of participants at high risk had atherosclerosis, with 66% classified as intermediate or generalized. Conclusions-Subclinical atherosclerosis was highly prevalent in this middle-aged cohort, with nearly half of the participants classified as having intermediate or generalized disease. Most participants at high FHS risk had subclinical disease; however, extensive atherosclerosis was also present in a substantial number of low-risk individuals, suggesting added value of imaging for diagnosis and prevention.

Previous disability as a predictor of outcome in a geriatric rehabilitation unit

Valderrama-Gama, E., Damián, J., Guallar, E., & Rodríguez-Mañas, L. (n.d.).

Publication year

1998

Journal title

Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Volume

53

Issue

5

Page(s)

M405-M409

10.1093/gerona/53A.5.M405

Abstract

Abstract

Background. Functional status at admission has been shown consistently to predict rehabilitation results, but the impact of previous disability has been seldom considered. Methods. A prospective follow-up study of elderly patients admitted to a geriatric rehabilitation unit in Madrid Spain, was carried out. The study population comprised 135 subjects aged 65 years or older, who were consecutively admitted during a 7-month period. Outcome variables included the Barthel Index (BI) at discharge, the improvement in BI from admission to discharge, the achieved percentage of potential gain, and the efficiency of gains. Previous BI, admission BI, diagnosis, source (hospital/others), mental status, age, and gender were examined as explanatory variables. Results. In multiple regression analysis, previous BI was the only significant independent predictor for all the outcome variables. For each 5-point increase in previous BI, the increase in BI at discharge was 1.7 (p = .007). Corresponding values for the achieved percentage of potential gain and for the efficiency of galas were 0105 (p = .01) and 0.05 (p = .04), respectively. Except for the achieved percentage of potential gain, admission BI and source of referral were also independent significant predictors of outcome. Conclusions. Previous functional situation of elderly people is important to predict rehabilitation outcome, even after taking into account information on disability at admission. As a consequence, a measure of the achieved percentage of potential gain corrected by the preadmission functional status is proposed, especially in the case of elderly patients.

Prior antiviral treatment and mortality among patients with hepatitis C virus-related hepatocellular carcinoma : A national cohort study

Sinn, D. H., Kang, D., Hong, Y. S., Koh, K. C., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

8 August

10.1371/journal.pone.0255624

Abstract

Abstract

Background The current antiviral treatments available for hepatitis C virus (HCV) infection decrease the risk of hepatocellular carcinoma (HCC). Hence, patients with HCV infection who have not received antiviral treatment and have developed HCC may be those who missed timely antiviral treatment for HCV. However, the proportion of patients who missed timely antiviral treatment and its implications are largely unexplored. Methods A nationwide retrospective cohort of 4,592 newly diagnosed HCV-related HCC patients (2013-2017) was identified from the Korean National Health Insurance Service database. Prior antiviral treatment for HCV was defined as a history of at least one HCV-specific antiviral treatment before HCC diagnosis. The outcome was all-cause mortality. Results Prior antiviral treatment for HCV was identified in 802 (17.4%) patients, and 16%, 16%, 17%, 19%, and 19% of patients received antiviral treatment in the years 2013, 2014, 2015, 2016, and 2017, respectively (P = 0.21). During 8,085 person-years of follow-up (median, 1.4; maximum, 5.3 years of follow-up), 1,970 patients died. Mortality rates were lower in patients with prior antiviral treatment (15 deaths/100 person-years) than in those without prior antiviral treatment (27 deaths/100 person-years). The adjusted hazard ratio (95% confidence interval) for all-cause mortality on comparing patients who did and did not receive prior antiviral treatment was 0.68 (0.59, 0.79). Conclusion Timely antiviral treatment for HCV was suboptimal at the population level. Prior antiviral treatment for HCV reduced mortality rate in HCV-related HCC patients.

Prognostic factors of renal outcomes after heart transplantation : A nationwide retrospective study

Jeon, J., Park, H., Kim, Y., Kang, D., Lee, J. E., Huh, W., Guallar, E., Cho, J., & Jang, H. R. (n.d.).

Publication year

2021

Journal title

Journal of Clinical Medicine

Volume

10

Issue

21

10.3390/jcm10215110

Abstract

Abstract

Renal dysfunction after heart transplantation (HT) is associated with poor survival. We investigated the predictive factors of renal outcomes after HT using nationwide cohort data. In this retrospective cohort study using the Health Insurance Review and Assessment database of Korea, 654 patients who received HT between 2008 and 2016 and survived until discharge after HT were analyzed. The median (interquartile range) age was 52 (40–60) years, and 68.1% were male. Perioperative renal replacement therapy (RRT) was performed in 27.8% of patients. During 2.8 years of median followup, end-stage kidney disease (ESKD) developed in 12 patients (1.8%). In a fully adjusted model, RRT >3 weeks, the use of inotropes/vasopressors and non-use of ACEi/ARB were associated with ESKD. Preexisting renal disease tended to be associated with ESKD. Among the 561 patients without preexisting CKD, 104 (18.5 %) developed chronic kidney disease (CKD). Age, extracorporeal membrane oxygenation, and RRT were associated with the development of CKD after HT. Our nationwide cohort study demonstrated that perioperative RRT was a predictor of poor renal outcomes after HT. These results suggest that an active renoprotective strategy is required during the perioperative period.

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

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

Publication year

2018

Journal title

Journal of Critical Care

Volume

48

Page(s)

26-31

10.1016/j.jcrc.2018.08.009

Abstract

Abstract

Purpose: Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known. Methods: We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). Results: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was −58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 – 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. Conclusion: Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.

Prospective observational study of implantable cardioverter-defibrillators in primary prevention of sudden cardiac death : study design and cohort description.

Cheng, A., Dalal, D., Butcher, B., Norgard, S., Zhang, Y., Dickfeld, T., Eldadah, Z. A., Ellenbogen, K. A., Guallar, E., & Tomaselli, G. F. (n.d.).

Publication year

2013

Journal title

Unknown Journal

Volume

2

Issue

1

Page(s)

e000083

10.1161/JAHA.112.000083

Abstract

Abstract

Primary-prevention implantable cardioverter-defibrillators (ICDs) reduce total mortality in patients with severe left ventricular systolic function. However, only a minority of patients benefit from these devices. We designed the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD) to identify risk factors and enhance our understanding of the biological mechanisms that predispose to arrhythmic death in patients undergoing ICD implantation for primary prevention of sudden death. This is a multicenter prospective cohort study with a target enrollment of 1200 patients. The primary end point is ICD shocks for adjudicated ventricular tachyarrhythmias. The secondary end point is total mortality. All patients undergo a comprehensive evaluation including history and physical examination, signal-averaged electrocardiograms, and blood sampling for genomic, proteomic, and metabolomic analyses. Patients are evaluated every 6 months and after every known ICD shock for additional electrocardiographic and blood sampling. As of December 2011, a total of 1177 patients have been enrolled with more nonwhite and female patients compared to previous randomized trials. A total of 143 patients have reached the primary end point, whereas a total of 260 patients died over an average follow-up of 59 months. The PROSE-ICD study represents a real-world cohort of individuals with systolic heart failure receiving primary-prevention ICDs. Extensive electrophysiological and structural phenotyping as well as the availability of serial DNA and serum samples will be important resources for evaluating novel metrics for risk stratification and identifying patients at risk for arrhythmic sudden death. URL: http://clinicaltrials.gov/ Unique Identifier: NCT00733590.

Prospective study of serum adiponectin and incident metabolic syndrome : The ARIRANG study

Kim, J. Y., Ahn, S. V., Yoon, J. H., Koh, S. B., Yoon, J., Yoo, B. S., Lee, S. H., Park, J. K., Choe, K. H., & Guallar, E. (n.d.).

Publication year

2013

Journal title

Diabetes Care

Volume

36

Issue

6

Page(s)

1547-1553

10.2337/dc12-0223

Abstract

Abstract

OBJECTIVE - Increased adiponectin levels may play a protective role in the development of metabolic abnormalities, but prospective studies of the predictive value of serum adiponectin to identify individuals at high risk of new-onset metabolic syndrome are lacking. We investigated whether serum adiponectin predicts incident cases of the metabolic syndrome in a populationbased longitudinal study. RESEARCH DESIGN ANDMETHODS - A prospective cohort study was conducted of 2,044 adults (831 men and 1,213 women) aged 40-70 years without metabolic syndrome examined in 2005-2008 (baseline) and 2008 - 2011 (follow-up). Baseline serum adiponectin concentrations were measured by radioimmunoassay. RESULTS - During an average of 2.6 years of follow-up, 153 men (18.4%) and 199 women (16.4%) developed metabolic syndrome. In multivariable-adjusted models, the odds ratio for incident metabolic syndrome comparing the highest with the lowest quartiles of adiponectin levels was 0.25 (95% CI 0.14-0.47) in men and 0.45 (0.28-0.74) in women. While serum adiponectin did not improve the area under the ROC curve for predicting new-onset metabolic syndrome based on information from metabolic syndrome components, the net reclassification improvement and the integrated discrimination improvement of prediction models including adiponectin were significantly higher compared with those of models not including adiponectin among men, with a signi ficant difference between men and women (P = 0.001). CONCLUSIONS - Increased adiponectin is an independent protective factor for incident metabolic syndrome in men and women, and it may have a clinical role in predicting new-onset metabolic syndrome among men.

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)

Cheng, 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

2014

Journal title

Circulation: Arrhythmia and Electrophysiology

Volume

7

Issue

6

Page(s)

1084-1091

10.1161/CIRCEP.113.001705

Abstract

Abstract

Background: 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.

Proton pump inhibitor use increases pyogenic liver abscess risk : A Nationwide Cohort study

Oh, J. H., Kang, D., Kang, W., Guallar, E., Cho, J., & Min, Y. W. (n.d.).

Publication year

2021

Journal title

Journal of Neurogastroenterology and Motility

Volume

27

Issue

4

Page(s)

555-564

10.5056/jnm20221

Abstract

Abstract

Background/Aims Proton pump inhibitors (PPIs) increase gastric pH and alter the gut microbiome. An increased risk for infectious diseases has been reported in PPI users. However, little is known about the association of PPI use with pyogenic liver abscess (PLA) incidence risk. Methods We conducted a population-based cohort study using data from a nationwide representative sample of the Korean general population followed up for 10 years (January 1, 2003 to December 31, 2013). We identified PPI prescriptions and considered PPI as a timevarying variable. Proportional hazards regression model was used for incident PLA comparing PPI use versus non-use. Propensity score matching was also conducted. Results During the 4 209 229 person-years of follow-up, 58 595 participants had at least 1 PPI prescription and 541 patients developed liver abscess. The age-, sex-, residential area-, and income-adjusted hazard ratio for PLA incidence with PPI use was 4.19 (95% CI, 2.54- 6.92). The association was observed in fully adjusted models (hazard ratio 3.88; 95% CI, 2.33-6.44). The positive association between PPI use and PLA was consistent in all subgroups analyzed and in propensity score matching group. Conclusion The present data indicate that PPI use is associated with an increased PLA risk. Therefore, it is necessary to prescribe PPIs with clear indication and to avoid improper use of PPIs.

Public attitudes toward cancer and cancer patients : A national survey in Korea

Cho, J., Smith, K., Choi, E. K., Kim, I. R., Chang, Y. J., Park, H. Y., Guallar, E., & Shim, Y. M. (n.d.).

Publication year

2013

Journal title

Psycho-Oncology

Volume

22

Issue

3

Page(s)

605-613

10.1002/pon.3041

Abstract

Abstract

Background Regardless of improved survival rate, negative images and myths about cancer still abound. Cancer stigma may reduce patients' life opportunities resulting in social isolation, decreased level of emotional well-being, and poor health outcomes. This study was aimed to evaluate public attitudes toward cancer and cancer patients and people's willingness to disclose cancer diagnosis in South Korea. Methods A cross-sectional survey was conducted in August and September 2009. A nationally representative sample of 1011 men and women with no history of cancer was recruited. A set of 12 questions grouped into three domains (impossibility of recovery, cancer stereotypes, and discrimination) was used to assess public attitudes toward cancer. Results It was found 58.5% of study participants agreed that it is impossible to treat cancer regardless of highly developed medical science, 71.8% agreed that cancer patients would not be able to make contributions to society, and 23.5% agreed that they would avoid working with persons who have cancer. The proportions of people who said that that they would not disclose a cancer diagnosis to family, friends or neighbors, or coworkers were 30.2%, 47.0%, and 50.7%, respectively. Negative attitudes toward cancer were strongly associated with lower willingness to disclose a cancer diagnosis. Conclusions Negative attitudes, stereotypes, and discriminating attitudes toward cancer and people affected by the disease were very common in spite of clinical progress and improved survivorship. Impact Our findings emphasize the need for health policy and social changes to provide a more supportive environment for cancer survivors.

QT-interval duration and mortality rate results from the third national health and nutrition examination survey

Zhang, Y., Post, W. S., Dalal, D., Blasco-Colmenares, E., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Archives of Internal Medicine

Volume

171

Issue

19

Page(s)

1727-1733

10.1001/archinternmed.2011.433

Abstract

Abstract

Background: Extreme prolongation or reduction of the QT interval predisposes patients to malignant ventricular arrhythmias and sudden cardiac death, but the association of variations in the QT interval within a reference range with mortality end points in the general population is unclear. Methods: We included 7828 men and women from the Third National Health and Nutrition Examination Survey. Baseline QT interval was measured via standard 12-lead electrocardiographic readings. Mortality end points were assessed through December 31, 2006 (2291 deaths). Results: After an average follow-up of 13.7 years, the association between QT interval and mortality end points was U-shaped. The multivariate-adjusted hazard ratios comparing participants at or above the 95th percentile of age-, sex-, race-, and R-R interval-corrected QT interval (≥439 milliseconds) with participants in the middle quintile (401 to

Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness

Blecker, S., Zhang, Y., Ford, D. E., Guallar, E., dosReis, S., Steinwachs, D. M., Dixon, L. B., & Daumit, G. L. (n.d.).

Publication year

2010

Journal title

General Hospital Psychiatry

Volume

32

Issue

3

Page(s)

255-261

10.1016/j.genhosppsych.2010.02.002

Abstract

Abstract

Objective: To examine the association between severe mental illness (SMI) and quality of care in heart failure. Methods: We conducted a cohort study between 2001 and 2004 of disabled Maryland Medicaid participants with heart failure. Quality measures and clinical outcomes were compared for individuals with and without SMI. Results: Of 1801 individuals identified with heart failure, 341 had comorbid SMI. SMI was not associated with differences in quality measures, including left ventricular assessment [adjusted relative risk (aRR) 0.99; 95% CI 0.91-1.07], utilization of angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) (aRR 1.04; 95% CI 0.92-1.17), or beta-blocker use (aRR 1.13; 95% CI 0.99-1.29). During the study period, 52.2% of individuals in the cohort filled a prescription for an ACE inhibitor or ARB and 45.5% filled a beta-blocker prescription. Individuals with and without SMI had similar rates of clinical outcomes, including hospitalizations, readmissions, and mortality. Both medication interventions were associated with improved mortality. Conclusions: In this sample of disabled Medicaid recipients with heart failure, persons with SMI received similar quality of care as those without SMI. Both groups had low rates of beneficial medical treatments. Quality improvement programs should consider how best to target these vulnerable populations.

Quality of life after acute respiratory distress syndrome : A meta-analysis

Dowdy, D. W., Eid, M. P., Dennison, C. R., Mendez-Tellez, P. A., Herridge, M. S., Guallar, E., Pronovost, P. J., & Needham, D. M. (n.d.).

Publication year

2006

Journal title

Intensive Care Medicine

Volume

32

Issue

8

Page(s)

1115-1124

10.1007/s00134-006-0217-3

Abstract

Abstract

Objective: To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors. Design: A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results. Measurements and results: Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15-26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge. Conclusions: ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.

Quantifying Individual-Level Inaccuracy in Glomerular Filtration Rate Estimation A Cross-Sectional Study

Shafi, T., Zhu, X., Lirette, S. T., Rule, A. D., Mosley, T., Butler, K. R., Hall, M. E., Vaitla, P., Wynn, J. J., Tio, M. C., Dossabhoy, N. R., Guallar, E., & Butler, J. (n.d.).

Publication year

2022

Journal title

Annals of internal medicine

Volume

175

Issue

8

Page(s)

1073-1082

10.7326/M22-0610

Abstract

Abstract

Background: Although the population-level differences between estimated glomerular filtration rate (eGFR) and measured glomerular filtration rate (mGFR) are well recognized, the magnitude and potential clinical implications of individual-level differences are unknown. Objective: To quantify the magnitude and consequences of the individual-level differences between mGFRs and eGFRs. Design: Cross-sectional study. Setting: Four U.S. community-based epidemiologic cohort studies with mGFR. Patients: 3223 participants in 4 studies. Measurements: The GFRs were measured using urinary iothalamate and plasma iohexol clearance; the eGFR was calculated from serum creatinine concentration alone (eGFRCR) and with cystatin C. All GFR results are presented as mL/min/1.73 m2. Results: The participants' mean age was 59 years; 32% were Black, 55% were women, and the mean mGFR was 68. The population-level differences between mGFR and eGFRCR were small; the median difference (mGFR_eGFR) was -0.6 (95% CI, -1.2 to -0.2); however, the individual-level differences were large. At an eGFRCR of 60, 50% of mGFRs ranged from 52 to 67, 80% from 45 to 76, and 95% from 36 to 87. At an eGFRCR of 30, 50% of mGFRs ranged from 27 to 38, 80% from 23 to 44, and 95% from 17 to 54. Substantial disagreement in chronic kidney disease staging by mGFR and eGFRCR was present. Among those with eGFRCR of 45 to 59, 36% had mGFR greater than 60 whereas 20% had mGFR less than 45; among those with eGFRCR of 15 to 29, 30% had mGFR greater than 30 and 5% had mGFR less than 15. The eGFR based on cystatin C did not provide substantial improvement. Limitation: Single measurement of mGFR and serum markers without short-term replicates Conclusion: A substantial individual-level discrepancy exists between the mGFR and the eGFR. Laboratories reporting eGFR should consider including the extent of this uncertainty to avoid misinterpretation of eGFR as an mGFR replacement.

Race/ethnicity, residential segregation, and exposure to ambient air pollution : The Multi-Ethnic Study of Atherosclerosis (MESA)

Jones, 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

2014

Journal title

American journal of public health

Volume

104

Issue

11

Page(s)

2130-2137

10.2105/AJPH.2014.302135

Abstract

Abstract

Objectives. 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.

Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease

Lee, H., Shin, S. H., Gu, S., Zhao, D., Kang, D., Joi, Y. R., Suh, G. Y., Pastor-Barriuso, R., Guallar, E., Cho, J., & Park, H. Y. (n.d.).

Publication year

2018

Journal title

BMC Medicine

Volume

16

Issue

1

10.1186/s12916-018-1159-7

Abstract

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by multiple comorbidities, which are associated with an increased risk of exacerbation, a poor health-related quality of life, and high mortality. However, differences in comorbidity profile by race and ethnicity in COPD patients have not been fully elucidated. Methods: Participants aged 40 to 79 years with spirometry-defined COPD from the U.S. National Health and Nutrition Examination Survey (NHANES) (2007-2012) and from the Korea NHANES (2007-2015) were analyzed to compare the prevalence of comorbidities by race and ethnicity group. Comorbidities were defined using questionnaire data, physical exams, and laboratory tests. Results: Non-Hispanic Whites had the highest prevalence of dyslipidemia (65.5%), myocardial infarction (6.2%), osteoarthritis (40.1%), and osteoporosis (13.6%), while non-Hispanic Blacks had the highest prevalence of asthma (24.0%), hypertension (70.2%), stroke (7.3%), diabetes mellitus (DM) (23.3%), anemia (16.4%), and rheumatoid arthritis (11.9%). Compared to non-Hispanic Whites, non-Hispanic Blacks had a significantly higher prevalence of hypertension, stroke, DM, anemia, and rheumatoid arthritis after adjusting for age, sex, body mass index, and smoking status, while Hispanics had a significantly higher prevalence of DM and anemia, and Koreans had significantly lower prevalences of all comorbidities except stroke, DM, and anemia. Conclusions: COPD-related comorbidities varied significantly by race and ethnicity, and different strategies may be required for the optimal management of COPD and its comorbidities in different race and ethnicity groups.

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

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

Publication year

2017

Journal title

JAMA Cardiology

Volume

2

Issue

12

Page(s)

1341-1348

10.1001/jamacardio.2017.4041

Abstract

Abstract

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

Racial Differences in Sudden Cardiac Death : Atherosclerosis Risk in Communities Study (ARIC)

Zhao, D., Post, W. S., Blasco-Colmenares, E., Cheng, A., Zhang, Y., Deo, R., Pastor-Barriuso, R., Michos, E. D., Sotoodehnia, N., & Guallar, E. (n.d.).

Publication year

2019

Journal title

Circulation

Volume

139

Issue

14

Page(s)

1688-1697

10.1161/CIRCULATIONAHA.118.036553

Abstract

Abstract

Background: Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. Methods: This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors. Results: The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men. Conclusions: Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.

Racial patterns of cardiovascular disease risk factors in serious mental illness and the overall U.S. population

Keenan, T. E., Yu, A., Cooper, L. A., Appel, L. J., Guallar, E., Gennusa, J. V., Dickerson, F. B., Crum, R. M., Anderson, C. A., Campbell, L. M., Young, D. R., & Daumit, G. L. (n.d.).

Publication year

2013

Journal title

Schizophrenia Research

Volume

150

Issue

1

Page(s)

211-216

10.1016/j.schres.2013.07.022

Abstract

Abstract

Background: Serious mental illness (SMI) and minority race are each associated with elevated cardiovascular disease (CVD) mortality. However, little is known about racial variation in CVD risk factors in individuals with SMI. This study aimed to determine racial patterns of CVD risk factors in individuals with SMI and to compare these patterns to those of the general population. Methods: Overweight/obese adults with SMI (163 whites; 111 African Americans) examined from 2008 to 2011 during a weight loss trial were compared at study baseline to overweight/obese adults (1103 whites; 550 African Americans) of similar age, sex, and race in the 2007 to 2010 National Health and Nutrition Examination Survey. Results: All CVD risk factors except cholesterol were higher in SMI than the overall U.S. population. After adjusting for age and sex, both racial groups with SMI had similarly high risks of smoking, obesity, diabetes, and hypertension, while African Americans with SMI had lower risks of high cholesterol (RR 0.73; 95% CI 0.57-0.94) and metabolic syndrome (RR 0.75; 95% CI 0.63-0.91) than whites with SMI. In the U.S. population sample, African Americans compared to whites had higher risks of obesity (RR 1.23; 95% CI 1.14-1.34), diabetes (RR 1.68; 95% CI 1.21-2.34), and hypertension (RR 1.44; 95% CI 1.31-1.60) but no significant difference in smoking, high cholesterol, and metabolic syndrome. Conclusions: Compared to the general population, the greater burden and dissimilar racial pattern of CVD risk factors in SMI underscore the need for CVD prevention programs targeting the SMI population.

Random-effects meta-analysis of inconsistent effects : A time for change

Cornell, J. E., Mulrow, C. D., Localio, R., Stack, C. B., Meibohm, A. R., Guallar, E., & Goodman, S. N. (n.d.).

Publication year

2014

Journal title

Annals of internal medicine

Volume

160

Issue

4

Page(s)

267-270

10.7326/m13-2886

Abstract

Abstract

A 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.

Randomised controlled trial of the effect of long-term selenium supplementation on plasma cholesterol in an elderly Danish population

Cold, F., Winther, K. H., Pastor-Barriuso, R., Rayman, M. P., Guallar, E., Nybo, M., Griffin, B. A., Stranges, S., & Cold, S. (n.d.).

Publication year

2015

Journal title

British Journal of Nutrition

Volume

114

Issue

11

Page(s)

1807-1818

10.1017/S0007114515003499

Abstract

Abstract

Although cross-sectional studies have shown a positive association between Se and cholesterol concentrations, a recent randomised controlled trial in 501 elderly UK individuals of relatively low-Se status found that Se supplementation for 6 months lowered total plasma cholesterol. The Danish PRECISE (PREvention of Cancer by Intervention with Selenium) pilot study (ClinicalTrials.gov ID: NCT01819649) was a 5-year randomised, double-blinded, placebo-controlled trial with four groups (allocation ratio 1:1:1:1). Men and women aged 60-74 years (n 491) were randomised to 100 (n 124), 200 (n 122) or 300 (n 119) μg Se-enriched yeast or matching placebo-yeast tablets (n 126) daily for 5 years. A total of 468 participants continued the study for 6 months and 361 participants, equally distributed across treatment groups, continued for 5 years. Plasma samples were analysed for total and HDL-cholesterol and for total Se concentrations at baseline, 6 months and 5 years. The effect of different doses of Se supplementation on plasma lipid and Se concentrations was estimated by using linear mixed models. Plasma Se concentration increased significantly and dose-dependently in the intervention groups after 6 months and 5 years. Total cholesterol decreased significantly both in the intervention groups and in the placebo group after 6 months and 5 years, with small and nonsignificant differences in changes in plasma concentration of total cholesterol, HDL-cholesterol, non-HDL-cholesterol and total:HDL-cholesterol ratio between intervention and placebo groups. The effect of long-term supplementation with Se on plasma cholesterol concentrations or its sub-fractions did not differ significantly from placebo in this elderly population.