Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

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

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

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

Education

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

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

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

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

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

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

Scientist Development Award, American Heart Association (2002)

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

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

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

Arsenic species and selected metals in human urine: Validation of HPLC/ICPMS and ICPMS procedures for a long-term population-based epidemiological study

Scheer, J., Findenig, S., Goessler, W., Francesconi, K. A., Howard, B., Umans, J. G., Pollak, J., Tellez-Plaza, M., Silbergeld, E. K., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2012

Journal title

Analytical Methods

Volume

4

Issue

2

Page(s)

406-413

10.1039/c2ay05638k

Abstract

Abstract

Exposure to high inorganic arsenic concentrations in drinking water has been related to detrimental health effects, including cancers and possibly cardiovascular disease, in many epidemiological studies. Recent studies suggest that arsenic might elicit some of its toxic effects also at lower concentrations. The Strong Heart Study, a large epidemiological study of cardiovascular disease in American Indian communities, collected urine samples and performed medical examinations on 4549 participants over a 10 year period beginning in 1989. We used anion-exchange HPLC/ICPMS to determine concentrations of arsenic species (methylarsonate, dimethylarsinate and arsenate) in 5095 urine samples from the Strong Heart Study. We repeated the chromatography on a portion of the urine sample that had been oxidised, by addition of H 2O 2, to provide additional information on the presence of As(iii) species and thio-arsenicals, and by difference, of arsenobetaine and other non-retained cations. Total concentrations for As, Cd, Mo, Pb, Sb, Se, U, W, and Zn were also determined in the urine samples by ICPMS. The dataset will be used to evaluate the relationships between the concentrations of urinary arsenic species and selected metals with various cardiometabolic health endpoints. We present and discuss the analytical protocol put in place to produce this large and valuable dataset.

Cadmium exposure and all-cause and cardiovascular mortality in the U.S. general population

Tellez-Plaza, M., Navas-Acien, A., Menke, A., Crainiceanu, C. M., Pastor-Barriuso, R., & Guallar, E. (n.d.).

Publication year

2012

Journal title

Environmental health perspectives

Volume

120

Issue

7

Page(s)

1017-1022

10.1289/ehp.1104352

Abstract

Abstract

Background: Urine cadmium concentrations were associated with all-cause and cardiovascular mortality in men in the 1988-1994 U.S. National Health and Nutrition Examination Survey (NHANES) population. Since 1988, cadmium exposure has decreased substantially in the United States. The associations between blood and urine cadmium and cardiovascular disease (CVD) mortality at more recent levels of exposure are unknown. Objectives: We evaluated the prospective association of blood and urine cadmium concentrations with all-cause and CVD mortality in the 1999-2004 U.S. population. Methods: We followed 8,989 participants who were ≥ 20 years of age for an average of 4.8 years. Hazard ratios for mortality end points comparing the 80th to the 20th percentiles of cadmium distributions were estimated using Cox regression. Results: The multivariable adjusted hazard ratios [95% confidence intervals (CIs)] for blood and urine cadmium were 1.50 (95% CI: 1.07, 2.10) and 1.52 (95% CI: 1.00, 2.29), respectively, for all-cause mortality, 1.69 (95% CI: 1.03, 2.77) and 1.74 (95% CI: 1.07, 2.83) for CVD mortality, 1.98 (95% CI: 1.11, 3.54) and 2.53 (95% CI: 1.54, 4.16) for heart disease mortality, and 1.73 (95% CI: 0.88, 3.40) and 2.09 (95% CI: 1.06, 4.13) for coronary heart disease mortality. The population attributable risks associated with the 80th percentile of the blood (0.80 μg/L) and urine (0.57 μg/g) cadmium distributions were 7.0 and 8.8%, respectively, for all-cause mortality and 7.5 and 9.2%, respectively, for CVD mortality Conclusions: We found strongly suggestive evidence that cadmium, at substantially low levels of exposure, remains an important determinant of all-cause and CVD mortality in a representative sample of U.S. adults. Efforts to further reduce cadmium exposure in the population could contribute to a substantial decrease in CVD disease burden.

Cancer incidence in a sample of Maryland residents with serious mental illness

McGinty, E. E., Zhang, Y., Guallar, E., Ford, D. E., Steinwachs, D., Dixon, L. B., Keating, N. L., & Daumit, G. L. (n.d.).

Publication year

2012

Journal title

Psychiatric Services

Volume

63

Issue

7

Page(s)

714-717

10.1176/appi.ps.201100169

Abstract

Abstract

Objective: Persons with serious mental illness have an increased mortality rate and a higher burden of many medical conditions compared with persons without serious mental illness. Cancer risk in the population with serious mental illness is uncertain, and its incidence was examined by race, sex, and cancer site in a community-based cohort of adults with schizophrenia or bipolar disorder. Methods: The authors calculated standardized incidence ratios of total and site-specific cancers in a cohort of 3,317 Maryland Medicaid adult beneficiaries with schizophrenia or bipolar disorder followed from 1994 through 2004 for comparison with the U.S. population. Results: Total cancer incidence for adults with schizophrenia or bipolar disorder was 2.6 times higher in the cohort. Elevated risk was greatest for cancer of the lung. No differences in risk were found for African-American versus white Medicaid beneficiaries with serious mental illness. Conclusions: These findings suggest that there is a heightened risk of cancer among adults with schizophrenia or bipolar disorder. Clinicians should promote appropriate cancer screening and work to reduce modifiable risk factors, such as smoking, among persons with serious mental illness.

Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death

Wu, K. C., Gerstenblith, G., Guallar, E., Marine, J. E., Dalal, D., Cheng, A., Marbán, E., Lima, J. A., Tomaselli, G. F., & Weiss, R. G. (n.d.).

Publication year

2012

Journal title

Circulation: Cardiovascular Imaging

Volume

5

Issue

2

Page(s)

178-186

10.1161/CIRCIMAGING.111.968024

Abstract

Abstract

Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35% undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19%) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P<0.001). Patients in the lowest tertile for both GZ and hsCRP (n=42) were at particularly low risk (0.7% per year event rate), whereas those in the highest tertile for both GZ and hsCRP (n=32) had an event rate of 16.1% per year, P<0.001. Conclusions-In a cohort of primary prevention ICD candidates, combining a myocardial heterogeneity index with an inflammatory biomarker identified a subgroup with a very low risk for adverse cardiac events, including ventricular arrhythmias. This novel approach warrants further investigation to confirm its value as a clinical risk stratification tool. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00181233.

Correspondence

Wu, K. C., Gerstenblith, G., Marine, J. E., Dalal, D., Cheng, A., Lima, J. A., Tomaselli, G. F., Weiss, R. G., Guallar, E., & Marban, E. (n.d.). In Circulation: Cardiovascular Imaging (1–).

Publication year

2012

Volume

5

Issue

4

Page(s)

e53

10.1161/CIRCIMAGING.112.977215

Effects of vitamin c supplementation on blood pressure: A meta-analysis of randomized controlled trials

Juraschek, S. P., Guallar, E., Appel, L. J., & Miller, E. R. (n.d.).

Publication year

2012

Journal title

American Journal of Clinical Nutrition

Volume

95

Issue

5

Page(s)

1079-1088

10.3945/ajcn.111.027995

Abstract

Abstract

Background: In observational studies, increased vitamin C intake, vitamin C supplementation, and higher blood concentrations of vitamin C are associated with lower blood pressure (BP). However, evidence for blood pressure-lowering effects of vitamin C in clinical trials is inconsistent. Objective: The objective was to conduct a systematic review and meta-analysis of clinical trials that examined the effects of vitamin C supplementation on BP. Design: We searched Medline, EMBASE, and Central databases from 1966 to 2011. Prespecified inclusion criteria were as follows: 1) use of a randomized controlled trial design; 2) trial reported effects on systolic BP (SBP) or diastolic BP (DBP) or both; 3) trial used oral vitamin C and concurrent control groups; and 4) trial had a minimum duration of 2 wk. BP effects were pooled by random-effects models, with trials weighted by inverse variance. Results: Twenty-nine trials met eligibility criteria for the primary analysis. The median dose was 500 mg/d, the median duration was 8 wk, and trial sizes ranged from 10 to 120 participants. The pooled changes in SBP and DBP were -3.84 mm Hg (95% CI: -5.29, -2.38 mm Hg; P < 0.01) and -1.48 mm Hg (95% CI: -2.86, -0.10 mm Hg; P = 0.04), respectively. In trials in hypertensive participants, corresponding reductions in SBP and DBP were -4.85 mm Hg (P < 0.01) and -1.67 mm Hg (P = 0.17). After the inclusion of 9 trials with imputed BP effects, BP effects were attenuated but remained significant. Conclusions: In short-term trials, vitamin C supplementation reduced SBP and DBP. Long-term trials on the effects of vitamin C supplementation on BP and clinical events are needed.

Efficacy of an educational material on second primary cancer screening practice for cancer survivors: A randomized controlled trial

Shin, D. W., Cho, J., Kim, Y. W., Oh, J. H., Kim, S. W., Chung, K. W., Lee, W. Y., Lee, J. E., Guallar, E., & Lee, W. C. (n.d.).

Publication year

2012

Journal title

PloS one

Volume

7

Issue

3

10.1371/journal.pone.0033238

Abstract

Abstract

Background: Cancer surivors have limited knowledge about second primary cancer (SPC) screening and suboptimal rates of completion of screening practices for SPC. Our objective was to test the efficacy of an educational material on the knowledge, attitudes, and screening practices for SPC among cancer survivors. Methods: Randomized, controlled trial among 326 cancer survivors from 6 oncology care outpatient clinics in Korea. Patients were randomized to an intervention or an attention control group. The intervention was a photo-novel, culturally tailored to increase knowledge about SPC screening. Knowledge and attitudes regarding SPC screening were assessed two weeks after the intervention, and screening practices were assessed after one year. Results: At two weeks post-intervention, the average knowledge score was significantly higher in the intervention compared to the control group (0.81 vs. 0.75, P&0.01), with no significant difference in their attitude scores (2.64 vs. 2.57, P = 0.18). After 1 year of follow-up, the completion rate of all appropriate cancer screening was 47.2% in both intervention and control groups. Conclusion: While the educatinal material was effective for increasing knowledge of SPC screening, it did not promote cancer screening practice among cancer survivors. More effective interventions are needed to increase SPC screening rates in this population. Trial Registration: ClinicalTrial.gov NCT00948337.

Ethnic Differences in the Prevalence of Metabolic Syndrome: Results from a Multi-Ethnic Population-Based Survey in Malaysia

Rampal, S., Mahadeva, S., Guallar, E., Bulgiba, A., Mohamed, R., Rahmat, R., Arif, M. T., & Rampal, L. (n.d.).

Publication year

2012

Journal title

PloS one

Volume

7

Issue

9

10.1371/journal.pone.0046365

Abstract

Abstract

Introduction: The prevalence of metabolic syndrome is increasing disproportionately among the different ethnicities in Asia compared to the rest of the world. This study aims to determine the differences in the prevalence of metabolic syndrome across ethnicities in Malaysia, a multi-ethnic country. Methods: In 2004, we conducted a national cross-sectional population-based study using a stratified two-stage cluster sampling design (N = 17,211). Metabolic syndrome was defined according to the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (IDF/NHLBI/AHA-2009) criteria. Multivariate models were used to study the independent association between ethnicity and the prevalence of the metabolic syndrome. Results: The overall mean age was 36.9 years, and 50.0% participants were female. The ethnic distribution was 57.0% Malay, 28.5% Chinese, 8.9% Indian and 5.0% Indigenous Sarawakians. The overall prevalence of the metabolic syndrome was 27.5%, with a prevalence of central obesity, raised triglycerides, low high density lipoprotein cholesterol, raised blood pressure and raised fasting glucose of 36.9%, 29.3%, 37.2%, 38.0% and 29.1%, respectively. Among those <40 years, the adjusted prevalence ratios for metabolic syndrome for ethnic Chinese, Indians, and Indigenous Sarawakians compared to ethnic Malay were 0.81 (95% CI 0.67 to 0.96), 1.42 (95% CI 1.19 to 1.69) and 1.37 (95% CI 1.08 to 1.73), respectively. Among those aged ≥40 years, the corresponding prevalence ratios were 0.86 (95% CI 0.79 to 0.92), 1.25 (95% CI 1.15 to 1.36), and 0.94 (95% CI 0.80, 1.11). The P-value for the interaction of ethnicity by age was 0.001. Conclusions: The overall prevalence of metabolic syndrome in Malaysia was high, with marked differences across ethnicities. Ethnic Chinese had the lowest prevalence of metabolic syndrome, while ethnic Indians had the highest. Indigenous Sarawakians showed a marked increase in metabolic syndrome at young ages.

Influence of serum selenium concentrations on hypertension: The Lipid Analytic Cologne cross-sectional study

Berthold, H. K., Michalke, B., Krone, W., Guallar, E., & Gouni-Berthold, I. (n.d.).

Publication year

2012

Journal title

Journal of Hypertension

Volume

30

Issue

7

Page(s)

1328-1335

10.1097/HJH.0b013e32835414df

Abstract

Abstract

Aims: Selenium is an antioxidant micronutrient with potential associations with hypertension. Few studies have investigated the association of serum selenium concentrations with blood pressure and hypertension in countries with low dietary selenium intake such as Germany, with inconsistent findings. Methods: We undertook a cross-sectional analysis of participants in the Lipid Analytic Cologne (LIANCO) cohort. To reduce potential confounding, we restricted the analysis to 792 participants who were never smokers, who did not use antihypertensive medications, and who did not have diabetes or known atherosclerotic disease. Hypertension was defined as blood pressure at least 140 and/or at least 90 mmHg. About half of the cohort was diagnosed as hypertensive. Selenium was measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry (ICP-DRC-MS). Results: Mean ± standard deviation (SD) serum selenium concentration was 68 ± 32 μg/l. The multivariable adjusted differences (95% confidence intervals) in blood pressure levels comparing the highest (>91.9 μg/l) to the lowest (≤42.8 μg/l) quartile of serum selenium were 5.2 (1.4 to 8.9), 2.8 (0.7 to 4.8), and 2.4 (-0.4 to 5.2) mmHg for systolic, diastolic, and pulse pressure, respectively (P for trend for all <0.003). The corresponding multivariable adjusted odds ratio for the presence of hypertension was 1.52 (0.98 to 2.36; P trend = 0.004). Conclusions: The data suggest that even in a population with very low serum selenium concentrations higher serum selenium concentrations are associated with higher blood pressure levels and a higher prevalence of hypertension. These findings call for careful evaluation of the effects of selenium on blood pressure endpoints in randomized clinical trials.

Post-myocardial-infarction quality of care among disabled Medicaid beneficiaries with and without serious mental illness

McGinty, 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

2012

Journal title

General Hospital Psychiatry

Volume

34

Issue

5

Page(s)

493-499

10.1016/j.genhosppsych.2012.05.004

Abstract

Abstract

Objective: 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.

Reduction in cadmium exposure in the United States population, 1988-2008: The contribution of declining smoking rates

Tellez-Plaza, M., Navas-Acien, A., Caldwell, K. L., Menke, A., Muntner, P., & Guallar, E. (n.d.).

Publication year

2012

Journal title

Environmental health perspectives

Volume

120

Issue

2

Page(s)

204-209

10.1289/ehp.1104020

Abstract

Abstract

Background: Public health policies such as tobacco control, air pollution reduction, and hazardous waste remediation may have reduced cadmium exposure among U.S. adults. However, trends in urine cadmium, a marker of cumulative cadmium exposure, have not been evaluated. Objectives: We estimated the trends in urine cadmium concentrations in U.S. adults using data from the National Health and Nutrition Examination Surveys (NHANES) from 1988 to 2008. We also evaluated the impact of changes in the distribution of available cadmium determinants (age, sex, race, education, body mass index, smoking, and occupation) at the population level to explain cadmium trends. Methods: The study population included 19,759 adults ≥ 20 years of age with measures of urine cadmium and cadmium determinants. Results: Age-adjusted geometric means of urine cadmium concentrations were 0.36, 0.35, 0.27, 0.27, 0.28, 0.25, and 0.26 μg/g creatinine in 1988-1991, 1991-1994, 1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008, respectively. The age, sex, and race/ethnicity-adjusted percent reduction in urine cadmium geometric means comparing 1999-2002 and 2003-2008 with 1988-1994 were 27.8% (95% confidence interval: 22.3%, 32.9%) and 34.3% (29.9%, 38.4%), respectively (p-trend < 0.001), with reductions in all participant subgroups investigated. In never smokers, reductions in serum cotinine accounted for 15.6% of the observed reduction. In ever smokers, changes in smoking cessation, and cumulative and recent dose accounted for 17.1% of the observed reduction. Conclusions: Urine cadmium concentrations decreased markedly between 1988 and 2008. Declining smoking rates and changes in exposure to tobacco smoke may have played an important role in the decline of urine cadmium concentrations, benefiting both smokers and nonsmokers. Cadmium has been associated to several health outcomes in NHANES 1999-2008. Consequently, despite the observed decline, further reduction in cadmium exposure is needed.

Serum sex steroid hormones and frailty in older American men of the Third National Health and Nutrition Examination Survey (NHANES III)

Eichholzer, M., Barbir, A., Basaria, S., Dobs, A. S., Feinleib, M., Guallar, E., Menke, A., Nelson, W. G., Rifai, N., Platz, E. A., & Rohrmann, S. (n.d.).

Publication year

2012

Journal title

Aging Male

Volume

15

Issue

4

Page(s)

208-215

10.3109/13685538.2012.705366

Abstract

Abstract

Objective: To determine whether frailty is associated with circulating total and free testosterone, total and free estradiol, and sex hormone-binding globulin (SHBG) in older men. Methods: With NHANES III data of 461 men aged 60 years and older, we used logistic regression to analyze the associations between serum concentrations of sex steroid hormones, SHBG and frailty. Participants meeting any three or more of the five frailty criteria were classified as "frail", all others were considered as non-frail. Results: 2.5% of men were frail. Men with SHBG ≥66 nmol/L had three times the odds of frailty (OR = 2.97; 95% CI 1.28-6.86) compared to men with SHBG <66 nmol/L. Men with free testosterone levels below 243 pmol/L had an increased odds of frailty (OR = 3.92; 95% CI 1.29-11.89). None of these associations was statistically significant after additionally adjusting for body mass index, smoking and history of cardiovascular diseases (CVD). Total testosterone, and total and free estradiol serum levels were not statistically significantly associated with frailty. Conclusions: In this US nationally representative study of older men, low free testosterone and high SHBG serum levels were associated with a significantly increased odds of frailty after adjustment for age and race/ethnicity. These associations may, however, be explained by confounding due to obesity, smoking, and the higher prevalence of CVD in frail men or by low hormones or high SHBG mediating the association between obesity, smoking, CVD and frailty.

Structured management strategy based on the Gastro-oesophageal Reflux Disease (GERD) Questionnaire (GerdQ) vs. usual primary care for GERD: Pooled analysis of five cluster-randomised European studies

Ponce, J., Garrigues, V., Agréus, L., Tabaglio, E., Gschwantler, M., Guallar, E., Tafalla, M., Nuevo, J., & Hatlebakk, J. (n.d.).

Publication year

2012

Journal title

International Journal of Clinical Practice

Volume

66

Issue

9

Page(s)

897-905

10.1111/j.1742-1241.2012.02992.x

Abstract

Abstract

Background: Response to treatment among primary care patients with gastro-oesophageal disease (GERD) is variable. Aim: The GERD Management Project (GMP) evaluated the effectiveness of a structured management approach to GERD vs. standard treatment (usual care). Methods: Data from five cluster-randomised clinical trials in adult primary care patients with symptoms of GERD were pooled. The structured pathway was based on the self-administered GERD Questionnaire (GerdQ) and was compared with standard treatment. Results: 1734 patients were enrolled (structured treatment, n = 834; standard treatment, n = 900). The difference in the mean GerdQ score change from baseline favoured the structured pathway (-0.61; 95% CI: -0.88, -0.34; p < 0.001). The odds ratio for an indication for treatment revision at the end of follow-up (structured vs. standard treatment) was 0.39 (95% CI: 0.29, 0.52; p = 0.001). Conclusions: Management of primary care patients with GERD can be improved by systematic stratification of patients using a patient management tool such as the GerdQ.

Survey of physicians' practices in the control of cardiovascular risk factors: The EURIKA study

Dallongeville, J., Banegas, J. R., Tubach, F., Guallar, E., Borghi, C., Backer, G. D., Halcox, J. P., Massó-González, E. L., Perk, J., Sazova, O., Steg, P. G., & Artalejo, F. R. (n.d.).

Publication year

2012

Journal title

European Journal of Preventive Cardiology

Volume

19

Issue

3

Page(s)

541-550

10.1177/1741826711407705

Abstract

Abstract

Objectives: To assess the practices of physicians in 12 European countries in the primary prevention of cardiovascular disease (CVD).Methods: In 2009, 806 physicians from 12 European countries answered a questionnaire, delivered electronically or by post, regarding their assessment of patients with cardiovascular risk factors, and their use of risk calculation tools and clinical practice guidelines (ClinicalTrials.gov number: NCT00882336). Approximately 60 physicians per country were selected (participation rate varied between 3.1% in Sweden and 22.8% in Turkey).Results: Among participating physicians, 85.2% reported using at least one clinical guideline for CVD prevention. The most popular were the ESC guidelines (55.1%). Reasons for not using guidelines included: the wide choice available (47.1%), time constraints (33.3%), lack of awareness of guidelines (27.5%), and perception that guidelines are unrealistic (23.5%). Among all physicians, 68.5% reported using global risk calculation tools. Written charts were the preferred method (69.4%) and the most commonly used was the SCORE equation (35.4%). Reasons for not using equations included time constraints (59.8%), not being convinced of their usefulness (21.7%) and lack of awareness (19.7%). Most physicians (70.8%) believed that global risk-equations have limitations; 89.8% that equations overlook important risk factors, and 66.5% that they could not be used in elderly patients. Only 46.4% of physicians stated that their local healthcare framework was sufficient for primary prevention of CVD, while 67.2% stated that it was sufficient for secondary prevention of CVD.Conclusions: A high proportion of physicians reported using clinical guidelines for primary CVD prevention. However, time constraints, lack of perceived usefulness and inadequate knowledge were common reasons for not using CVD prevention guidelines or global CVD risk assessment tools.

The association of biomarkers of iron status with mortality in US adults

Menke, A., Muntner, P., Fernández-Real, J. M., & Guallar, E. (n.d.).

Publication year

2012

Journal title

Nutrition, Metabolism and Cardiovascular Diseases

Volume

22

Issue

9

Page(s)

734-740

10.1016/j.numecd.2010.11.011

Abstract

Abstract

Background and Aims: Elevated iron biomarkers are associated with diabetes and other cardiometabolic abnormalities in the general population. It is unclear whether they are associated with an increased risk of all-cause or cause-specific mortality. The purpose of the current analysis was to evaluate the association of ferritin and transferrin saturation levels with all-cause, cardiovascular, and cancer mortality in the general US adult population. Methods and Results: A prospective cohort study was conducted with 12,258 adults participating in the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of the US population. Study participants were recruited in 1988-1994 and followed through December 31, 2006 for all-cause, cardiovascular disease, and cancer mortality. The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause mortality comparing the fourth versus the second quartiles of ferritin and transferrin saturation were 1.09 (0.82-1.44; p-trend across quartiles = 0.92) and 1.08 (0.82-1.43; p-trend across quartiles = 0.62), respectively, for men, 1.43 (0.63-3.23; p-trend across quartiles = 0.31) and 1.48 (0.70-3.11; p-trend across quartiles = 0.60), respectively, for premenopausal women, and 1.03 (0.79-1.34; p-trend across quartiles = 0.95) and 1.17 (0.92-1.49; p-trend across quartiles = 0.63), respectively, for postmenopausal women. Quartile of ferritin and transferrin saturation also showed no association between biomarkers of iron status and mortality. Conclusions: In a large nationally representative sample of US adults, within the spectrum of normal iron metabolism, ferritin and transferrin saturation were not associated with risk of mortality among people who were not taking iron supplements and did not have a baseline history of cardiovascular disease or cancer.

Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: The EURIKA study

Banegas, J. R., López-García, E., Dallongeville, J., Guallar, E., Halcox, J. P., Borghi, C., Massó-González, E. L., Jiménez, F. J., Perk, J., Steg, P. G., De Backer, G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2011

Journal title

European Heart Journal

Volume

32

Issue

17

Page(s)

2143-2152

10.1093/eurheartj/ehr080

Abstract

Abstract

Aims Most studies on the primary prevention of cardiovascular disease (CVD) have been limited to patients at high CVD risk. We assessed the achievement of treatment goals for CVD risk factors among patients with a substantial variation in CVD risk. Methods and resultsThis study was conducted with 7641 outpatients aged <50 years, free of clinical CVD and with at least one major CVD risk factor, selected from 12 European countries in 2009. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Cholesterol fractions and glycated haemoglobin (HbA1c) were measured in a central laboratory. Cardiovascular disease risk was estimated with the SCORE equation. Patients mean age was 63 years (48 men), and 40.1 had a high CVD risk. Among treated hypertensives (94.2), only 38.8 achieved the blood pressure target of <140/90 mmHg [between-country range (BCR): 32.147.5]. Among treated dyslipidaemic patients (74.4), 41.2 attained both the total-and LDL-cholesterol target of <5 and <3 mmol/L, respectively (BCR: 24.368.4). Among treated type 2 diabetic patients (87.2), 36.7 achieved the <6.5 HbA1c target (BCR: 23.448.4). Among obese patients on non-pharmacological treatment (92.2), 24.7 reached the body mass index target of <30 kg/m 2 (BCR: 12.737.1). About one-third of controlled patients on treatment were still at high remaining CVD risk. Although most patients were advised to reduce excess weight and to follow a low-calorie diet, less than half received written recommendations. Conclusion sIn Europe, a large proportion of patients in primary prevention have CVD risk factors that remain uncontrolled, and lifestyle counselling is not well implemented; moreover, there is substantial between-country variation, which indicates additional room for improvement. Raised residual CVD risk is relatively frequent among patients despite control of their primary risk factors and should be addressed.

Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations

Spector, J. T., Navas-Acien, A., Fadrowski, J., Guallar, E., Jaar, B., & Weaver, V. M. (n.d.).

Publication year

2011

Journal title

Nephrology Dialysis Transplantation

Volume

26

Issue

9

Page(s)

2786-2792

10.1093/ndt/gfq773

Abstract

Abstract

Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (<60 mL/min/1.73 m 2) were increased for all estimates of GFR.Conclusions. These results support the inclusion of cystatin C-based eGFR in future lead research and provide additional evidence for environmental lead exposure as a CKD risk factor.

Blood cadmium and estimated glomerular filtration rate in Korean adults

Hwangbo, Y., Weaver, V. M., Tellez-Plaza, M., Guallar, E., Lee, B. K., & Navas-Acien, A. (n.d.).

Publication year

2011

Journal title

Environmental health perspectives

Volume

119

Issue

12

Page(s)

1800-1805

10.1289/ehp.1003054

Abstract

Abstract

Background: Cadmium is a nephrotoxicant at high exposure levels. Few studies have evaluated the role of cadmium in kidney function at low-exposure levels. Objective: We evaluated the association of blood cadmium with estimated glomerular filtration rate (eGFR) in the Korean adult population. Methods: We evaluated 1,909 adults ≥ 20 years of age who participated in the 2005 Korean National Health and Nutrition Examination Survey and had blood cadmium determinations. eGFR was calculated using the Modification of Diet in Renal Disease equation. Results: Blood cadmium geometric means were 1.57 μg/L for men and 1.49 μg/L for women. The difference in eGFR levels that compared participants in the highest versus lowest cadmium tertiles, after multivariable adjustment, was -1.85 [95% confidence interval (CI): -3.55, -0.16] mL/min per 1.73 m2 in women and 0.67 (-1.16, 2.50) mL/min per 1.73 m2 in men. Among men, the association between blood cadmium and eGFR was modified by blood lead levels (p-value for interaction = 0.048). The fully adjusted differences in eGFR levels for a 2-fold increase in blood cadmium levels were -1.14 (-3.35, 1.07) and 1.84 (0.54, 3.14) mL/min per 1.73 m2 in men with blood lead levels below and above the median (2.75 μg/dL), respectively. Conclusion: Elevated blood cadmium levels were associated with lower eGFR in women, which supports the role of cadmium as a risk factor for chronic kidney disease. In men, there was no overall association, although elevated blood cadmium levels were associated with higher eGFR levels in men with high blood lead levels and nonstatistically associated with lower eGFR levels in men with low blood lead levels.

Body fatness and sex steroid hormone concentrations in US men: Results from NHANES III

Rohrmann, S., Shiels, M. S., Lopez, D. S., Rifai, N., Nelson, W. G., Kanarek, N., Guallar, E., Menke, A., Joshu, C. E., Feinleib, M., Sutcliffe, S., & Platz, E. A. (n.d.).

Publication year

2011

Journal title

Cancer Causes and Control

Volume

22

Issue

8

Page(s)

1141-1151

10.1007/s10552-011-9790-z

Abstract

Abstract

Objective: Obesity is associated with a variety of chronic diseases, including cancer, which may partly be explained by its influence on sex steroid hormone concentrations. Whether different measures of obesity, i.e., body mass index (BMI), waist circumference, and percent body fat were differentially associated with circulating levels of sex steroid hormones was examined in 1,265 men, aged 20-90+ years old, attending the morning examination session of the Third National Health and Nutrition Examination Survey (NHANES III). Materials and methods: Serum hormones were measured by immunoassay. Weight, height, and waist circumference were measured by trained staff. Percent body fat was estimated from bioelectrical impedance. Multivariate linear regression was used to estimate associations between body fatness measures and hormone levels. Results: Total and free testosterone and sex hormone binding globulin concentrations decreased, whereas total and free estradiol increased with increasing BMI, waist circumference, and percent body fat (all p trend\0.05). The magnitude of change in these hormones was similar for a one-quartile increase in each body fatness measure. Conclusion: Measured BMI, waist circumference, and percent body fat led to similar inferences about their association with hormone levels in men.

Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)

Mata, N., Alonso, R., Badimán, L., Padrá, T., Fuentes, F., Mũiz, O., Perez-Jiménez, F., Lápez-Miranda, J., Díaz, J. L., Vidal, J. I., Barba, A., Piedecausa, M., Sanchez, J. F., Irigoyen, L., Guallar, E., Ordovas, J. M., & Mata, P. (n.d.).

Publication year

2011

Journal title

Lipids in Health and Disease

Volume

10

10.1186/1476-511X-10-94

Abstract

Abstract

Abstract. Aim. Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART. Methods and Results. A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe. Conclusion: Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.

Coffee, alcohol, smoking, physical activity and QT interval duration: 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

PloS one

Volume

6

Issue

2

10.1371/journal.pone.0017584

Abstract

Abstract

Background: Abnormalities in the electrocardiographic QT interval duration have been associated with an increased risk of ventricular arrhythmias and sudden cardiac death. However, there is substantial uncertainty about the effect of modifiable factors such as coffee intake, cigarette smoking, alcohol consumption, and physical activity on QT interval duration. Methods: We studied 7795 men and women from the Third National Health and Nutrition Survey (NHANES III, 1988-1994). Baseline QT interval was measured from the standard 12-lead electrocardiogram. Coffee and tea intake, alcohol consumption, leisure-time physical activities over the past month, and lifetime smoking habits were determined using validated questionnaires during the home interview. Results: In the fully adjusted model, the average differences in QT interval comparing participants drinking ≥6 cups/day to those who did not drink any were -1.2 ms (95% CI -4.4 to 2.0) for coffee, and -2.0 ms (-11.2 to 7.3) for tea, respectively. The average differences in QT interval duration comparing current to never smokers was 1.2 ms (-0.6 to 2.9) while the average difference in QT interval duration comparing participants drinking ≥7 drinks/week to non-drinkers was 1.8 ms (-0.5 to 4.0). The age, race/ethnicity, and RR-interval adjusted differences in average QT interval duration comparing men with binge drinking episodes to non-drinkers or drinkers without binge drinking were 2.8 ms (0.4 to 5.3) and 4.0 ms (1.6 to 6.4), respectively. The corresponding differences in women were 1.1 (-2.9 to 5.2) and 1.7 ms (-2.3 to 5.7). Finally, the average differences in QT interval comparing the highest vs. the lowest categories of total physical activity was -0.8 ms (-3.0 to 1.4). Conclusion: Binge drinking was associated with longer QT interval in men but not in women. QT interval duration was not associated with other modifiable factors including coffee and tea intake, smoking, and physical activity.

Comentarios a las guías de práctica clínica sobre manejo de las dislipemias de la Sociedad Europea de Cardiología y la Sociedad Europea de Aterosclerosis 2011. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

Anguita, M., Alegría, E., Barrios, V., Escobar, C., León, M., Luengo, E., Comín, J., Fernández-Ortiz, A., Heras, M., Pan, M., Worner, F., Barón, G., Bernal, E., Borrás, X., Civeira, F., Cordero, A., Guallar, E., Ib́ñez B., De Pablo, C., … Laclaustra, M. (n.d.).

Publication year

2011

Journal title

Revista Espanola de Cardiologia

Volume

64

Issue

12

Page(s)

1090-1095

10.1016/j.recesp.2011.10.004

Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis

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

Publication year

2011

Journal title

Hepatology

Volume

54

Issue

3

Page(s)

1082-1090

10.1002/hep.24452

Abstract

Abstract

Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultrasonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Conclusion: Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings.

Discordance in perceived needs between patients and physicians in oncology practice: A nationwide survey in Korea

Shin, D. W., Kim, S. Y., Cho, J., Sanson-Fisher, R. W., Guallar, E., Chai, G. Y., Kim, H. S., Park, B. R., Park, E. C., & Park, J. H. (n.d.).

Publication year

2011

Journal title

Journal of Clinical Oncology

Volume

29

Issue

33

Page(s)

4424-4429

10.1200/JCO.2011.35.9281

Abstract

Abstract

Purpose: Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient-physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient-physician concordance. Patients and Methods: A national, multicenter, cross-sectional survey of patient-physician dyads was performed, and 97 oncologists (participation rate, 86.5%) and 495 patients (participation rate, 87.4%) were included. A short form of the Comprehensive Needs Assessment Tool for Cancer Patients was independently administered to patients and their oncologists. Concordance and agreement rates between physicians and patients were calculated. Mixed logistic regression was used to identify predictors of concordance and to explore the association of concordance with patient satisfaction and trust in physicians. Results: Physicians systematically underestimated patient needs and patient-physician concordance was generally poor, with weighted κ statistics ranging from 0.04 to 0.15 for individual items and Spearman's ρ coefficients ranging from 0.11 to 0.21 for questionnaire domains. Length of experience as oncologist was the only significant predictor of concordance (adjusted odds ratio for overall concordance [aOR] = 2.09; 95% CI, 1.02 to 4.31). Concordance was not significantly associated with overall patient satisfaction (aOR = 1.24; 95% CI, 0.74 to 2.07) or trust in physician (aOR = 1.17; 95% CI, 0.76 to 1.81). Conclusion: Our findings revealed significant underestimation of patient needs and poor concordance between patients and physicians in assessing perceived needs of supportive care. The clinical implications of this discordance warrant further investigation.

Effect of supplementation with high-selenium yeast on plasma lipids: A randomized trial

Rayman, M. P., Stranges, S., Griffin, B. A., Pastor-Barriuso, R., & Guallar, E. (n.d.).

Publication year

2011

Journal title

Annals of internal medicine

Volume

154

Issue

10

Page(s)

656-665

10.7326/0003-4819-154-10-201105170-00005

Abstract

Abstract

Background: High selenium status has been linked to elevated blood cholesterol levels in cross-sectional studies. Objective: To investigate the effect of selenium supplementation on plasma lipids. Design: Randomized, placebo-controlled, parallel-group study stratified by age and sex. Participants, research nurses, and persons assessing outcomes were blinded to treatment assignment. (International Standard Randomised Controlled Trial Number Register registration number: ISRCTN25193534) Setting: 4 general practices in the United Kingdom. Participants: 501 volunteers aged 60 to 74 years. Intervention: Participants received selenium, 100 mcg/d (n =127), 200 mcg/d (n = 127), or 300 mcg/d (n =126), as high-selenium yeast or a yeast-based placebo (n = 121) for 6 months. Measurements: Total and high-density lipoprotein (HDL) cholesterol concentrations were measured in nonfasting plasma samples stored from participants in the UK PRECISE (United Kingdom PREvention of Cancer by Intervention with SElenium) Pilot Study at baseline (n =454) and at 6 months (n = 394). Non-HDL cholesterol levels were calculated. Results: Mean plasma selenium concentration was 88.8 ng/g (SD, 19.2) at baseline and increased statistically significantly in the treatment groups. The adjusted difference in change in total cholesterol levels for selenium compared with placebo was -0.22 mmol/L (-8.5 mg/dL) (95% CI, -0.42 to -0.03 mmol/L [-16.2 to -1.2 mg/dL]; P = 0.02) for 100 mcg of selenium per day, -0.25 mmol/L (-9.7 mg/dL) (CI, -0.44 to -0.07 mmol/L [-17.0 to-2.7 mg/dL]; P = 0.008) for 200 mcg of selenium per day, and -0.07 mmol/L (-2.7 mg/dL) (CI, -0.26 to 0.12 mmol/L [-10.1 to 4.6 mg/dL]; P =0.46) for 300 mcg of selenium per day. Similar reductions were observed for non-HDL cholesterol levels. There was no apparent difference in change in HDL cholesterol levels with 100 and 200 mcg of selenium per day, but the difference was an adjusted 0.06 mmol/L (2.3 mg/dL) (CI, 0.00 to 0.11 mmol/L [0.0 to 4.3 mg/dL]; P = 0.045) with 300 mcg of selenium per day. The total-HDL cholesterol ratio decreased progressively with increasing selenium dose (overall P = 0.01). Limitation: The duration of supplementation was limited, as was the age range of the participants. Conclusion: Selenium supplementation seemed to have modestly beneficial effects on plasma lipid levels in this sample of persons with relatively low selenium status. The clinical significance of the findings is unclear and should not be used to justify the use of selenium supplementation as additional or alternative therapy for dyslipidemia. This is particularly true for persons with higher selenium status, given the limitations of the trial and the potential additional risk in other metabolic dimensions. Primary Funding Source: The Cancer Research Campaign (now Cancer Research UK) and the University of Surrey.