Eliseo Guallar
Eliseo Guallar
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Chair and Professor of the Department of Epidemiology
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Professional overview
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Dr. Guallar is an epidemiologist whose research is focused on the study of cardiovascular disease epidemiology and prevention, with an emphasis on evaluating the role of environmental and nutritional exposures in the development of cardiovascular disease. This research has made critically important and novel contributions to our understanding of risk factors for chronic disease both in the US and globally. He has published seminal articles and is a leading figure in an emerging field highlighting the risks of exposure to levels of metals previously considered safe for cardiovascular health. In addition to his work in toxic metals, Dr. Guallar has made important contributions to understanding the effects of certain micronutrients and vitamin supplements on cardiovascular disease risk and outcomes. Publications in this area were influential in changing consumer habits and attitudes towards these products. Much of this research has been funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Heart Association, the CDC, and other funders.
Dr. Guallar was the founding director of the Center for Clinical Epidemiology at the Samsung Medical Center and a lead investigator of the Kangbuk Samsung Cohort Study at the Kangbuk Samsung Hospital since its inception in 2010. Dr. Guallar has published over 500 research papers in peer-reviewed journals. He is also a Deputy Editor for Methods at the Annals of Internal Medicine and a past member and Chair of the Cancer, Heart, and Sleep Study Section at the National Institutes of Health.
Prior to teaching at NYU, Dr. Guallar was a Professor of Epidemiology and Medicine at the Johns Hopkins University Bloomberg School of Public Health and a core faculty member of the Welch Center for Prevention, Epidemiology, and Clinical Research at Johns Hopkins. In the Department of Epidemiology, Dr. Guallar was the Director of the Environmental and Occupational Area of Concentration and the Co-Director of the PhD Program. Dr. Guallar was also an adjunct Professor at the Department of Clinical Research Design and Evaluation of the Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, in Seoul, Korea.
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Education
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Diploma of English, Spanish Official School of Languages at Zaragoza (Escuela Oficial de Idiomas de Zaragoza), Zaragoza, SpainMD, University of Zaragoza, Zaragoza, SpainMPH, University of Minnesota, Minneapolis, MNDrPH, Harvard University, Boston, MA
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Honors and awards
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Six Honor Calls in the MD Program, University of Zaragoza School of Medicine (1981)Fellow of Spain’s Program of Training of Graduate Research of the Ministry of Education and Science, University of Zaragoza (1988)Fulbright Scholar, sponsored by Spain’s Ministry of Health and Consumer Affairs (1989)Faculty Innovation Award, Johns Hopkins University Bloomberg School of Public Health (2001)Scientist Development Award, American Heart Association (2002)Fellow of the American Heart Association, Council on Epidemiology and Prevention (2013)Advising, Mentoring, and Teaching Recognition Award 2014 – 2015, Johns Hopkins University Bloomberg School of Public Health (2015)High Impact Research Icon, University of Malaya (2015)
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Publications
Publications
Seafood intake and urine concentrations of total arsenic, dimethylarsinate and arsenobetaine in the US population
AbstractNavas-Acien, A., Francesconi, K. A., Silbergeld, E. K., & Guallar, E. (n.d.).Publication year
2011Journal title
Environmental ResearchVolume
111Issue
1Page(s)
110-118AbstractBackground: Seafood is the main source of organic arsenic exposure (arsenobetaine, arsenosugars and arsenolipids) in the population. Arsenosugars and arsenolipids are metabolized to several species including dimethylarsinate (DMA). Objective: Evaluate the association of seafood intake with spot urine arsenic concentrations in the 2003-2006 National Health Nutrition and Examination Survey (NHANES). Methods: We studied 4276 participants ≥6 years. Total arsenic was measured using inductively coupled plasma dynamic reaction cell mass spectrometry (ICPMS). Urine DMA and arsenobetaine were measured by high-performance liquid chromatography coupled with ICPMS. Results: Participants reporting seafood in the past 24-h had higher urine concentrations of total arsenic (median 24.5 vs. 7.3 γg/L), DMA (6.0 vs. 3.5 γg/L), arsenobetaine (10.2 vs. 0.9 γg/L) and total arsenic minus arsenobetaine (11.0 vs. 5.5 γg/L). Participants reporting seafood ≥2/wk vs. never during the past year had 2.3 (95% confidence interval 1.9, 2.7), 1.4 (1.2, 1.6), 6.0 (4.6, 7.8) and 1.7 (1.4, 2.0) times higher (p-trend <0.001) concentrations of total arsenic, DMA, arsenobetaine and total arsenic minus arsenobetaine, respectively. In participants without detectable arsenobetaine and in analyses adjusted for arsenobetaine, seafood consumption in the past year was not associated with total arsenic or DMA concentrations in urine. Conclusion: Seafood intake was a major determinant of increased urine concentrations of total arsenic, DMA, arsenobetaine and total arsenic minus arsenobetaine in the US population. Epidemiologic studies that use total arsenic, DMA, the sum of inorganic arsenic, methylarsonate and DMA, and total arsenic minus arsenobetaine as markers of inorganic arsenic exposure and/or metabolism need to address seafood intake.Selenium status and blood lipids: The cardiovascular risk in young finns study
AbstractStranges, S., Tabák, A. G., Guallar, E., Rayman, M. P., Akbaraly, T. N., Laclaustra, M., Alfthan, G., Mussalo-Rauhamaa, H., Viikari, J. S., Raitakari, O. T., & Kivimäki, M. (n.d.).Publication year
2011Journal title
Journal of Internal MedicineVolume
270Issue
5Page(s)
469-477AbstractBackground. Concern has been recently raised about possible adverse cardio-metabolic effects of high selenium status, such as increased risks of diabetes and hyperlipidaemia. However, most of the evidence comes from selenium-replete populations such as that of the United States. Objectives. To examine cross-sectional and longitudinal associations of serum selenium with cardiovascular risk factors in Finland where selenium levels were amongst the lowest in the world until the early 1980s before the implementation of a nationwide selenium fertilization programme. Methods. Serum selenium was measured in 1235 young Finns aged 3-18years at baseline in 1980 (prefertilization) and in a subgroup (N=262) at the 6-year follow-up (1986, postfertilization). During the 27-year follow-up, serum lipids, blood pressure, body mass index and smoking were assessed five times (1980, 1983, 1986, 2001 and 2007). Results. Mean (±SD) serum selenium concentrations were 74.3±14.0ngmL -1 in 1980 and 106.6±12.5ngmL -1 in 1986 (average increase 32.3ngmL -1; 95% CI: 30.3 to 34.3, P<0.0001). In univariate and multivariable cross-sectional models in 1980 and 1986, increased serum selenium levels were consistently associated with increased total, HDL and Low-density lipoprotein (LDL) cholesterol. However, the average longitudinal changes in lipids were -0.20mmolL -1 (95% CI: -0.30 to -0.10, P<0.0001) for total cholesterol, 0.06mmolL -1 (95% CI: 0.03 to 0.10, P<0.0001) for HDL cholesterol, and -0.23mmolL -1 (95% CI: -0.31 to -0.14, P<0.0001) for LDL cholesterol. Selenium measured in 1986 was not associated with lipids assessed in 2001 and 2007. Conclusions. Cross-sectional findings from the Young Finns study corroborate positive associations of selenium status with serum lipids. However, longitudinal evidence does not support the causality of this link.Serum 25-hydroxyvitamin D, calcium, phosphorus, and electrocardiographic QT interval duration: Findings from NHANES III and ARIC
AbstractZhang, Y., Post, W. S., Dalal, D., Bansal, S., Blasco-Colmenares, E., Jan De Beur, S., Alonso, A., Soliman, E. Z., Whitsel, E. A., Brugada, R., Tomaselli, G. F., & Guallar, E. (n.d.).Publication year
2011Journal title
Journal of Clinical Endocrinology and MetabolismVolume
96Issue
6Page(s)
1873-1882AbstractContext: Disturbances in 25-hydroxyvitamin D, calcium, and phosphorus concentrations have been associated with increased risks of total and cardiovascular mortality. It is possible that changes in electrocardiographic QT interval duration may mediate these effects, but the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration has not been evaluated in general population samples. Objective: The objective of the study was to evaluate the association of 25-hydroxyvitamin D, phosphorus, and calcium concentrations with QT interval duration in two large samples of the U.S. general population. Design: This study included cross-sectional analyses the Third National Health and Nutrition Survey (NHANES III) and the Atherosclerosis Risk in Communities (ARIC) study. Setting: The study was conducted in the general community. Patients or Other Participants: Patients included 7,312 men and women from NHANES III and 14,825 men and women from the ARIC study. Interventions: Serum 25-hydroxyvitamin D, total and ionized calcium, and inorganic phosphorus were measured in NHANES III, and serum total calcium and inorganic phosphorus were measured in ARIC. Main Outcome Measure: QT interval duration was obtained from standard 12-lead electrocardiograms. Results: In NHANES III, the multivariate adjusted differences in average QT interval duration comparing the highest vs. the lowest quartiles of serum total calcium, ionized calcium, and phosphorus were -3.6 msec (-5.8 to -1.3; P for trend = 0.005), -5.4 msec (-7.4 to -3.5; P for trend < 0.001), and 3.9 msec (2.0-5.9; P for trend <0.001), respectively. The corresponding differences in ARIC were -3.1 msec (-4.3 to -2.0; P for trend <0.001), -2.9 msec (-3.8 to -1.9; P for trend <0.001), and 2.3 msec (1.3-3.3; P for trend <0.001). No association was found between 25-hydroxyvitamin D concentrations and QT interval duration. Conclusions: In two large samples of the general population, QT interval duration was inversely associated with the serum total and ionized calcium and positively associated with serum phosphorus.Serum uric acid levels predict incident nonalcoholic fatty liver disease in healthy Korean men
AbstractRyu, S., Chang, Y., Kim, S. G., Cho, J., & Guallar, E. (n.d.).Publication year
2011Journal title
Metabolism: Clinical and ExperimentalVolume
60Issue
6Page(s)
860-866AbstractThe objective of the study was to assess the prospective association between serum uric acid levels and incident nonalcoholic fatty liver disease in a cohort of healthy Korean men. A cohort study was performed on 5741 Korean men, 30 to 59 years of age, with no evidence of fatty liver disease on liver ultrasound and with no major risk factors for liver disease at baseline. Study participants were followed in annual or biennial health examinations between 2002 and 2008. The presence of fatty liver was determined at each examination by ultrasound. Cox proportional hazards models were used to evaluate the association of baseline and time-dependent levels of serum uric acid with incident fatty liver, adjusted for potential confounders. During 23 995 person-years of follow-up, 1717 participants developed fatty liver on ultrasound examination. After adjustment for age, body mass index, smoking, and alcohol intake, the hazard ratios (95% confidence intervals) for incident fatty liver comparing quartiles 2 to 4 of serum uric acid to quartile 1 were 1.17 (1.01-1.37), 1.28 (1.11-1.48), and 1.51 (1.31-1.73), respectively (P for trend = .001). The adjusted hazard ratio comparing participants with hyperuricemia (serum uric acid ≥7.0 mg/dL) to those with normouricemia (<7.0 mg/dL) was 1.29 (1.14-1.46). A graded and statistically significant association persisted after adjusting for other cardiometabolic factors and also in time-dependent models. Serum uric acid was an independent risk factor of incident fatty liver detected by ultrasonography. Additional research should clarify the mechanisms underlying this association and the role of hyperuricemia in the development of fatty liver.Sex-steroid hormones and electrocardiographic qt-interval duration: Findings from the third national health and nutrition examination survey and the multi-ethnic study of atherosclerosis
AbstractZhang, Y., Ouyang, P., Post, W. S., Dalal, D., Vaidya, D., Blasco-Colmenares, E., Soliman, E. Z., Tomaselli, G. F., & Guallar, E. (n.d.).Publication year
2011Journal title
American Journal of EpidemiologyVolume
174Issue
4Page(s)
403-411AbstractThe association between physiologic levels of sex hormones and QT-interval duration in humans was evaluated using data from 727 men enrolled in the Third National Health and Nutrition Examination Survey and 2,942 men and 1,885 postmenopausal women enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA). Testosterone, estradiol, and sex hormone-binding globulin levels were measured in serum and free testosterone was calculated from those values. QT interval was measured using a standard 12-lead electrocardiogram. In men from the Third National Health and Nutrition Survey, the multivariate adjusted differences in average QT-interval duration comparing the highest quartiles with the lowest quartiles of total testosterone and free testosterone were-8.5 ms (95% confidence interval (CI):-15.5,-1.4) and-8.0 ms (95% CI:-13.2,-2.8), respectively. The corresponding differences were-1.8 ms (95% CI:-3.8,-0.2), and-4.7 ms (95% CI:-6.7,-2.6), respectively, in men from MESA and-0.6 ms (95% CI:-3.0, 1.8) and 0.8 ms (95% CI:-1.6, 3.3), respectively, in postmenopausal women from MESA. Estradiol levels were not associated with QT-interval duration in men, but there was a marginally significant positive association in postmenopausal women. The findings suggest that testosterone levels may explain differences in QT-interval duration between men and women and could be a contributor to population variability in QT-interval duration among men.Structured management strategy versus usual care for gastroesophageal reflux disease: Rationale for pooled analysis of five European cluster-randomized trials
AbstractPonce, J., Garrigues, V., Tabaglio, E., Gschwantler, M., Güallar, E., Tafalla, M., Nuevo, J., & Hatlebakk, J. G. (n.d.).Publication year
2011Journal title
Therapeutic Advances in GastroenterologyVolume
4Issue
1Page(s)
11-26AbstractBackground: Gastroesophageal reflux disease (GERD) has a major impact at the primary care level and there is a need to evaluate whether the diagnosis and therapeutic management of GERD in Europe needs to be improved. Methods: This project was designed to test the hypothesis that a new primary care management strategy would improve outcomes for patients with GERD, compared with usual care, in Europe. The analysis pools five separate cluster-randomized studies conducted in Austria, Italy, Norway, Spain and Sweden. These studies used a strategy based on the self-administered GerdQ questionnaire to stratify adult patients with symptoms of heartburn or regurgitation according to the frequency and impact of symptoms. A score of ≥8 indicates a high probability of suffering GERD. Patients with a GerdQ impact score ≤2 were treated with generic proton-pump inhibitors according to local guidance, and patients with an impact score ≥3 were treated with esomeprazole 40 mg once daily. Results: In total, 2400 patients were enrolled across the five studies. The protocols were modified by individual countries according to their local guidelines/requirements. In Norway, the new management strategy was compared with traditional routine endoscopy and 24-hour pH-metry, and encompassed proton-pump inhibitor reimbursement restrictions. Outcome measures differed by country, but included control of GERD symptoms, self-rated health status and work productivity, treatment changes, specialist referrals and physician adherence. GERD-related use of healthcare resources was also evaluated. Conclusion: The pooled analysis will determine whether a locally adapted primary care management strategy for GERD, using GerdQ as a patient-tailored diagnostic and therapeutic evaluation tool, is beneficial compared with usual care across five countries with different standard approaches to GERD management and control.Urine arsenic and hypertension in US adults: The 2003-2008 national health and nutrition examination survey
AbstractJones, M. R., Tellez-Plaza, M., Sharrett, A. R., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2011Journal title
EpidemiologyVolume
22Issue
2Page(s)
153-161AbstractBackground: High chronic exposure to inorganic arsenic may contribute to the development of hypertension. Limited information is available, however, on the association of low to moderate exposure to inorganic arsenic with blood pressure levels and hypertension. We investigated the association of exposure to inorganic arsenic (as measured in urine) with systolic and diastolic blood pressure levels and the prevalence of hypertension in US adults. Methods: We studied 4167 adults 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 through 2008 and for whom total arsenic, dimethylarsinate (DMA), and arsenobetaine had been assessed in urine. Results: The median (interquartile range) urine concentrations were 8.3 μg/L (4.2-17.1) for total arsenic, 3.6 μg/L (2.0-6.0) for DMA, and 1.4 μg/L (0.3-6.3) for arsenobetaine. The weighted prevalence of hypertension in the study population was 36%. After multivariable adjustment, a 2-fold increase in total arsenic was associated with a hypertension odds ratio of 0.98 (95% confidence interval = 0.86-1.11). A doubling of total arsenic minus arsenobetaine was associated with a hypertension OR of 1.03 (0.94-1.14) and a doubling of DMA concentrations was associated with a hypertension OR of 1.11 (0.99-1.24). Total arsenic, total arsenic minus arsenobetaine, or DMA levels were not associated with systolic or diastolic blood pressure. Conclusions: At the low to moderate levels, typical of the US population, total arsenic, total arsenic minus arsenobetaine, and DMA concentrations in urine were not associated with the prevalence of hypertension or with systolic or diastolic blood pressure levels. A weak association of DMA with hypertension could not be ruled out.A comparison of cancer screening practices in cancer survivors and in the general population: The Korean national health and nutrition examination survey (KNHANES) 2001-2007
AbstractCho, J., Guallar, E., Hsu, Y. J., Shin, D. W., & Lee, W. C. (n.d.).Publication year
2010Journal title
Cancer Causes and ControlVolume
21Issue
12Page(s)
2203-2212AbstractObjective: This study aimed to describe cancer screening rates for second primary cancer among cancer survivors in Korea, and to compare these rates with those of two control groups: individuals without a history of cancer but with other chronic diseases, and individuals without a history of cancer and without other chronic diseases. Methods: The study is a cross-sectional analysis of 15,556 adults ≥30 years old who participated in the 2001, 2005, and 2007 Korean National Health and Nutrition Examination Surveys (KNHANES). The prevalence of breast, cervical, gastric, and colorectal cancer screening examinations according to national guidelines was assessed and compared to two control groups. Results: Screening rates among cancer survivors were 48.5, 54.7, 34.7, and 28.6% for breast, cervical, gastric, and colorectal cancer screening, respectively. Cancer survivors showed higher screening rates for all four cancer sites compared with both control groups, but breast cancer screening was only statistically significant after adjusting gender, age, marital status, education, income, working status, health insurance, smoking and drinking status, and self-reported health status. Conclusions: Cancer survivors were more likely than individuals without a cancer history to obtain screening examinations according to recommended guidelines. Still, screening rates even among survivors were suboptimal, emphasizing the need for a more systematic approach to second primary cancer screening and prevention.A prospective study of dietary selenium intake and risk of type 2 diabetes
AbstractStranges, S., Sieri, S., Vinceti, M., Grioni, S., Guallar, E., Laclaustra, M., Muti, P., Berrino, F., & Krogh, V. (n.d.).Publication year
2010Journal title
BMC public healthVolume
10AbstractBackground: Growing evidence raises concern about possible associations of high selenium exposure with diabetes in selenium-replete populations such as the US. In countries with lower selenium status, such as Italy, there is little epidemiological evidence on the association between selenium and diabetes. This study examined the prospective association between dietary selenium intake and risk of type 2 diabetes. Methods: The ORDET cohort study comprised a large sample of women from Northern Italy (n = 7,182). Incident type 2 diabetes was defined as a self-report of a physician diagnosis, use of antidiabetic medication, or a hospitalization discharge. Dietary selenium intake was measured by a semi-quantitative food-frequency questionnaire at the baseline examination (1987-1992). Participants were divided in quintiles based on their baseline dietary selenium intake. Results: Average selenium intake at baseline was 55.7 μg/day. After a median follow-up of 16 years, 253 women developed diabetes. In multivariate logistic regression analyses, the odds ratio for diabetes comparing the highest to the lowest quintile of selenium intake was 2.39, (95% CI: 1.32, 4.32; P for linear trend = 0.005). The odds ratio for diabetes associated with a 10 μg/d increase in selenium intake was 1.29 (95% CI: 1.10, 1.52). Conclusions: In this population, increased dietary selenium intake was associated with an increased risk of type 2 diabetes. These findings raise additional concerns about the association of selenium intake above the Recommended Dietary Allowance (55 μg/day) with diabetes risk.Blood lead level and kidney function in US adolescents: The third national health and nutrition examination survey
AbstractFadrowski, J. J., Navas-Acien, A., Tellez-Plaza, M., Guallar, E., Weaver, V. M., & Furth, S. L. (n.d.).Publication year
2010Journal title
Archives of Internal MedicineVolume
170Issue
1Page(s)
75-82AbstractBackground: Chronic, high-level lead exposure is a known risk factor for kidney disease. The effect of current low-level environmental lead exposure is less well known, particularly among children, a population generally free from kidney disease risk factors such as hypertension and diabetes mellitus. Therefore, in this study, we investigated the association between lead exposure and kidney function in a representative sample of US adolescents. Methods: Participants included 769 adolescents aged 12 to 20 years for whom whole blood lead and serum cystatin C were measured in the Third National Health and Nutrition Examination Survey, conducted from 1988-1994. The association between blood lead level and level of kidney function (glomerular filtration rate [GFR]), determined by cystatin C-based and creatinine-based estimating equations, was examined. Results: Median whole blood lead level was 1.5 μg/dL (to convert to micromoles per liter, multiply by 0.0483), and median cystatin C-estimated GFR was 112.9 mL/min/ 1.73 m2. Participants with lead levels in the highest quartile (≥3.0 μg/dL) had 6.6 mL/min/1.73 m2-lower estimated GFR (95% confidence interval, -0.7 to -12.6 mL/min/1.73m2) compared with those in the first quartile (<1 μg/dL). A doubling of blood lead level was associated with a 2.9 mL/min/1.73 m2-lower estimated GFR (95% confidence interval, -0.7 to -5.0 mL/min/1.73 m2). Lead levels were also associated with lower creatinine-based estimated GFR levels, but the association was weaker than with cystatin C-based GFR and not statistically significant. Conclusions: Higher blood lead levels in a range below the current Centers for Disease Control and Prevention-designated level of concern (10 μg/dL) were associated with lower estimated GFRs in a representative sample of US adolescents. This finding contributes to the increasing epidemiologic evidence indicating an adverse effect of low-level environmental lead exposure.Cadmium and peripheral arterial disease: Gender differences in the 1999-2004 US national health and nutrition examination survey
AbstractTellez-Plaza, M., Navas-Acien, A., Crainiceanu, C. M., Sharrett, A. R., & Guallar, E. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
172Issue
6Page(s)
671-681AbstractGender differences in the association of blood and urine cadmium concentrations with peripheral arterial disease (PAD) were evaluated by using data from 6,456 US adults aged ≥40 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. PAD was defined as an ankle-brachial blood pressure index of <0.9 in at least one leg. For men, the adjusted odds ratios for PAD comparing the highest with the lowest quintiles of blood and urine cadmium concentrations were 1.82 (95% confidence interval (CI): 0.82, 4.05) and 4.90 (95% CI: 1.55, 15.54), respectively, with a progressive dose-response relation and no difference by smoking status. For women, the corresponding odds ratios were 1.19 (95% CI: 0.66, 2.16) and 0.56 (95% CI: 0.18, 1.71), but there was evidence of effect modification by smoking: among women ever smokers, there was a positive, progressive dose-response relation; among women never smokers, there was a U-shaped dose-response relation. Higher blood and urine cadmium levels were associated with increased prevalence of PAD, but women never smokers showed a U-shaped relation with increased prevalence of PAD at very low cadmium levels. These findings add to the concern of increased cadmium exposure as a cardiovascular risk factor in the general population.Higher selenium status is associated with adverse blood lipid profile in British adults
AbstractStranges, S., Laclaustra, M., Ji, C., Cappuccio, F. P., Navas-Acien, A., Ordovas, J. M., Rayman, M., & Guallar, E. (n.d.).Publication year
2010Journal title
Journal of NutritionVolume
140Issue
1Page(s)
81-87AbstractRecent findings have raised concern about possible associations of high selenium exposure with diabetes and hyperlipidemia in the US, a population with high selenium status. In the UK, a population with lower selenium status, there is little data on the association of selenium status with cardio-metabolic risk factors in the general population. Weexamined the association of plasma selenium concentration with blood lipids in a nationally representative sample of British adults. A cross-sectional study was conducted among 1042 white participants (aged 19-64 y) in the 2000-2001 UK National Diet and Nutrition Survey. Plasma selenium was measured by inductively coupled-plasma mass spectrometry. Total and HDL cholesterol were measured in nonfasting plasma samples. Mean plasma selenium concentration was 1.10 ± 0.19 μmol/L. The multivariate adjusted differences between the highest (≥1.20 μmol/L) and lowest (<0.98 μmol/L) quartiles of plasma selenium were 0.39 (95% CI 0.18, 0.60) mmol/L for total cholesterol, 0.38 (0.17, 0.59) for non-HDL cholesterol, and 0.01 (-0.05, 0.07) for HDL cholesterol. Higher plasma selenium (i.e., ≥1.20 μmol/L) was associated with increased total and non-HDL cholesterol levels but not with HDL in the UK adult population. These findings raise additional concern about potential adverse cardio-metabolic effects of high selenium status. Randomized and mechanistic evidence is necessary to assess causality and to evaluate the impact of this association on cardiovascular risk.In response
Guallar, E., Miller, E. R., Ordovas, J. M., & Stranges, S. (n.d.). In Annals of internal medicine (1–).Publication year
2010Volume
153Issue
3Page(s)
209-210Is there an association between low-to-moderate alcohol consumption and risk of cognitive decline?
AbstractLobo, E., Dufouil, C., Marcos, G., Quetglas, B., Saz, P., Guallar, E., & Lobo, A. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
172Issue
6Page(s)
708-716AbstractThe authors evaluated the association of low-to-moderate alcohol consumption with risk of cognitive decline in a census-based cohort study of men and women aged ≥55 years conducted in Zaragoza, Spain (1994-1999). Participants free of dementia at baseline (N = 3,888) were examined after 2.5 and 4.5 years of follow-up. Information on alcohol intake was collected with the EURODEM Risk Factors Questionnaire and the History and Aetiology Schedule. The study endpoint was severe cognitive decline, defined as loss of ≥1 point/year on the Mini-Mental State Examination or a diagnosis of incident dementia (Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, Text Revision criteria). Compared with those for abstainers, the multivariate-adjusted odds ratios for severe cognitive decline for male drinkers of <12 g alcohol/day, drinkers of 12-24 g alcohol/day, and former drinkers were 0.61 (95% confidence interval (CI): 0.31, 1.20), 1.19 (95% CI: 0.61, 2.32), and 1.03 (95% CI: 0.59, 1.82), respectively. The corresponding odds ratios for women were 0.88 (95% CI: 0.45, 1.72), 2.38 (95% CI: 0.98, 5.77), and 1.03 (95% CI: 0.48, 2.23). This study did not support the hypothesis that low-to-moderate alcohol consumption prevents cognitive decline. The inverse association between low-to-moderate alcohol intake and cognitive decline observed in other studies may have been due to inclusion of former drinkers in the abstainers reference category.Meta-analysis of folic acid supplementation trials on risk of cardiovascular disease and risk interaction with baseline homocysteine levels
AbstractMiller, E. R., Juraschek, S., Pastor-Barriuso, R., Bazzano, L. A., Appel, L. J., & Guallar, E. (n.d.).Publication year
2010Journal title
American Journal of CardiologyVolume
106Issue
4Page(s)
517-527AbstractExperimental models and observational studies suggest that homocysteine-lowering therapy with folic acid (FA) may prevent cardiovascular disease (CVD). However, FA also stimulates cell proliferation and might promote progression of atherosclerosis. Our objectives were to perform a meta-analysis of FA supplementation trials on CVD events and to explore a potential interaction between FA supplementation and baseline homocysteine levels on CVD events. We searched MEDLINE for randomized controlled trials of FA supplementation to prevent CVD events (January 1966 to July 2009) and performed meta-analyses using random effects models. For trials that reported responses to FA supplementation stratified by baseline levels of homocysteine, we pooled within-trial estimates of differences in log-relative risks by baseline homocysteine levels using a random effects model. Overall, FA supplementation did not affect primary cardiovascular clinical end points (relative risk 1.02, 95% confidence interval [CI] 0.93 to 1.13, p = 0.66) or stroke (relative risk 0.95, 95% CI 0.84 to 1.08, p = 0.43). However, in trials that reported analyses stratified by baseline homocysteine, effect of FA supplementation differed by strata of baseline homocysteine (p for interaction = 0.030). Specifically, risks of primary clinical CVD events comparing FA supplementation to control were 1.06 (95% CI 1.00 to 1.13) in strata with mean baseline homocysteine levels >12 μmol/L and 0.94 (95% CI 0.86 to 1.03) in strata with baseline homocysteine levels <12 μmol/L. In conclusion, FA had no effect on CVD or stroke. However, analysis of within-trial results stratified by baseline homocysteine suggests potential harm in those with high homocysteine at baseline. This interaction may have important implications for recommendations of FA supplement use. In the meantime, FA supplementation should not be recommended as a means to prevent or treat CVD or stroke.Quality of care for heart failure among disabled Medicaid recipients with and without severe mental illness
AbstractBlecker, S., Zhang, Y., Ford, D. E., Guallar, E., DosReis, S., Steinwachs, D. M., Dixon, L. B., & Daumit, G. L. (n.d.).Publication year
2010Journal title
General Hospital PsychiatryVolume
32Issue
3Page(s)
255-261AbstractObjective: 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.Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: The ACHIEVE trial
AbstractCasagrande, S. S., Jerome, G. J., Dalcin, A. T., Dickerson, F. B., Anderson, C. A., Appel, L. J., Charleston, J., Crum, R. M., Young, D. R., Guallar, E., Frick, K. D., Goldberg, R. W., Oefinger, M., Finkelstein, J., Gennusa, J. V., Fred-Omojole, O., Campbell, L. M., Wang, N. Y., & Daumit, G. L. (n.d.).Publication year
2010Journal title
BMC psychiatryVolume
10AbstractBackground: Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group.Methods/Design: A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months.Discussion: Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.Rationale and methods of the european study on cardiovascular risk prevention and management in daily practice (EURIKA)
AbstractRodríguez-Artalejo, F., Guallar, E., Borghi, C., Dallongeville, J., De Backer, G., Halcox, J. P., Hernndez-Vecino, R., Jiménez, F. J., Massá-Gonzlez, E. L., Perk, J., Steg, P. G., & Banegas, J. R. (n.d.).Publication year
2010Journal title
BMC public healthVolume
10AbstractBackground. The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) across Europe. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice. Methods/Design. Cross-sectional study conducted simultaneously in 12 countries across Europe. The study has two components: firstly at the physician level, assessing eight hundred and nine primary care and specialist physicians with a daily practice in CVD prevention. A physician specific questionnaire captures information regarding physician demographics, practice settings, cardiovascular prevention beliefs and management. Secondly at the patient level, including 7641 patients aged 50 years or older, free of clinical CVD and with at least one classical risk factor, enrolled by the participating physicians. A patient-specific questionnaire captures information from clinical records and patient interview regarding sociodemographic data, CVD risk factors, and current medications. Finally, each patient provides a fasting blood sample, which is sent to a central laboratory for measuring serum lipids, apolipoproteins, hemoglobin-A1c, and inflammatory biomarkers. Discussion. Primary prevention of CVD is an extremely important clinical issue, with preventable circulatory diseases remaining the leading cause of major disease burden. The EURIKA study will provide key information to assess effectiveness of and attitudes toward primary prevention of CVD in Europe. A transnational study creates opportunities for benchmarking good clinical practice across countries and improving outcomes.Selenium status and cardiometabolic health: State of the evidence
AbstractStranges, S., Navas-Acien, A., Rayman, M. P., & Guallar, E. (n.d.).Publication year
2010Journal title
Nutrition, Metabolism and Cardiovascular DiseasesVolume
20Issue
10Page(s)
754-760AbstractUse of selenium enriched foods, supplements and fertilizers has increased markedly in recent years in the US and other Western countries because of the perception that the anti-oxidant properties of selenium could potentially reduce the risk of cancer and other chronic diseases. However, concern has been raised recently about possible adverse cardiometabolic effects of high selenium exposure, including an increased risk of diabetes and hyperlipidemia with high selenium intake. Hence, from a public health perspective, the relationship between selenium status and cardiometabolic health should be clarified in order to help guide consumers in their choices of nutritional supplements and enriched food products. Additional experimental evidence is needed to provide new insights into the role of selenium and of specific selenoproteins in human biology, especially to clarify the underlying mechanisms linking selenium to chronic disease endpoints. Further epidemiological studies and randomized clinical trials across populations with different selenium status should be conducted to determine the causal effect of selenium on cardiovascular disease and risk factors. Nevertheless, at the present time the widespread use of selenium supplements or other strategies that artificially increase selenium status above the level required for optimal selenoprotein activity is not justified and should not be encouraged.Serum selenium and serum lipids in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2004
AbstractLaclaustra, M., Stranges, S., Navas-Acien, A., Ordovas, J. M., & Guallar, E. (n.d.).Publication year
2010Journal title
AtherosclerosisVolume
210Issue
2Page(s)
643-648AbstractObjective: High selenium has been recently associated with several cardiovascular and metabolic risk factors including diabetes, blood pressure and lipid levels. We evaluated the association of serum selenium with fasting serum lipid levels in the National Health and Nutrition Examination Survey (NHANES) 2003-2004, the most recently available representative sample of the US population that measured selenium levels. Methods: Cross-sectional analysis of 1159 adults ≥40 years old from NHANES 2003-2004. Serum selenium was measured by inductively coupled plasma-dynamic reaction cell-mass spectrometry. Fasting serum total cholesterol, triglycerides, and HDL cholesterol were measured enzymatically and LDL cholesterol was calculated. Results: Mean serum selenium was 136.7 μg/L. The multivariable adjusted average differences (95% confidence interval) comparing the highest (≥147 μg/L) to the lowest (<124 μg/L) selenium quartiles were 18.9 (9.9, 28.0). mg/dL for total cholesterol, 12.7 (3.3, 22.2). mg/dL for LDL cholesterol, 3.9 (0.4, 7.5). mg/dL for HDL cholesterol, and 11.5 (-7.6, 30.7). mg/dL for triglycerides. In spline regression models, total and LDL cholesterol levels increased progressively with increasing selenium concentrations. HDL cholesterol increased with selenium but reached a plateau above 120 μg/L of serum selenium (20th percentile). The triglyceride-selenium relationship was U-shaped. Conclusion: In US adults, high serum selenium concentrations were associated with increased serum concentrations of total and LDL cholesterol. Selenium was associated with increasing HDL cholesterol only at low selenium levels. Given increasing trends in dietary selenium intake and supplementation, the causal mechanisms underlying these associations need to be fully characterized.Sex steroid hormone concentrations and risk of death in US men
AbstractMenke, A., Guallar, E., Rohrmann, S., Nelson, W. G., Rifai, N., Kanarek, N., Feinleib, M., Michos, E. D., Dobs, A., & Platz, E. A. (n.d.).Publication year
2010Journal title
American Journal of EpidemiologyVolume
171Issue
5Page(s)
583-592AbstractThe association of sex hormone levels with mortality over a median of 16 years of follow-up was evaluated in a prospective cohort study. The study included 1,114 US men who participated in phase 1 (1988-1991) of the Third National Health and Nutrition Examination Survey Mortality Study and had no history of cardiovascular disease or cancer at baseline. Multivariable adjusted hazard ratios for all-cause mortality associated with a decrease in hormone concentration equal to the difference between the 90th and 10th percentiles of the sex hormone distributions were estimated by using proportional hazards regression. The hazard ratios associated with low free testosterone and low bioavailable testosterone levels were 1.43 (95% confidence interval (CI): 1.09, 1.87) and 1.52 (95% CI: 1.15, 2.02), respectively, for follow-up between baseline and year 9; they were 0.94 (95% CI: 0.51, 1.72) and 0.98 (95% CI: 0.56, 1.72), respectively, for follow-up between year 9 and year 18. Men with low free and bioavailable testosterone levels may have a higher risk of mortality within 9 years of hormone measurement. Future studies should be conducted to fully characterize the association of low free and bioavailable testosterone concentrations and mortality in men and to describe the mechanism underlying the association.Something fishy? News media presentation of complex health issues related to fish consumption guidelines
AbstractGreiner, A., Clegg Smith, K., & Guallar, E. (n.d.).Publication year
2010Journal title
Public Health NutritionVolume
13Issue
11Page(s)
1786-1794AbstractObjective The news media are an important source of dietary information. Understanding news content, particularly the portrayal of risks and benefits of certain foods, is relevant for effective public health communication. Fish consumption may reduce risk for CVD and aid neonatal development, but recent work shows public confusion about the benefits of fish, challenged by the evidence of mercury and other contaminants in fish. We present an analysis of the messages about fish in US news media over 15 years, identifying trends in coverage and highlighting implications of current messaging.Design We conducted a descriptive text analysis and coded for manifest content: locality of focus, story frame, reference to studies, inclusion of government guidelines and portrayal of uncertainty. We identified chronological patterns and analysed the data for statistically significant relationships between media source and content.Setting News stories were selected from five daily newspapers and five television networks (1993-2007).Subjects We analysed 310 health-related news stories on fish.Results Risk messages outweighed benefit messages four to one, and health benefits only became prominent after 2002. No difference existed in coverage topic by news source. Fish consumption has increasingly become a national issue.Conclusions With the bulk of messages about fish consumption focused on risk, the benefits may be lost to consumers. This gap creates a need for public health to work with news media to more effectively communicate benefits and risks around fish consumption and health and to consider options for communicating tailored information where it can be more readily utilised.Vitamin D supplementation in the age of lost innocence
Guallar, E., Miller, E. R., Ordovas, J. M., & Stranges, S. (n.d.).Publication year
2010Journal title
Annals of internal medicineVolume
152Issue
5Page(s)
327-329Alcohol consumption and the risk of nasopharyngeal carcinoma: A systematic review
AbstractChen, L., Gallicchio, L., Boyd-Lindsley, K., Tao, X., Robinson, K. A., Lam, T. K., Herman, J. G., Caulfield, L. E., Guallar, E., & Alberg, A. J. (n.d.).Publication year
2009Journal title
Nutrition and CancerVolume
61Issue
1Page(s)
1-15AbstractThe evidence concerning the influence of alcohol drinking on the risk of nasopharyngeal carcinoma (NPC) has yielded intriguing findings but has lacked a clear-cut interpretation due to inconsistencies. To unify this body of evidence, we performed a systematic review. With funding and using a protocol developed by the World Cancer Research Fund (WCRF), 15 bibliographic databases were searched for epidemiological studies that reported a measure of association between alcoholic beverage consumption and NPC. Pooled odds ratios (ORs) for highest-vs.-lowest categories of total alcohol intake was obtained by using an inverse-variance weighted random-effects model. A dose-response trend was examined in models using generalized least square estimation. The search identified 14 case-control studies from 5 countries. For total alcohol intake, the pooled ORs in a comparison of the highest to the lowest category was 1.33 (95% CI: = 1.09-1.62) in 11 studies. Data from 6 studies indicated a J-shape dose-response trend, with NPC risk decreasing with up to 15 drinks/wk and increasing with higher intake. Fewer data were available to assess the associations between NPC and intake of beer, wine, and spirits. The potential J-shaped dose-response trend suggests a reduced risk of NPC related to the light alcohol drinking, an observation that warrants further study. Considered in total, the quantitative summaries of the case-control evidence suggest that heavy alcohol consumption is associated with an increased risk of NPC.Antioxidant enzyme activity and coronary heart disease: Meta-analyses of observational studies
AbstractCovas, M. I., Flores-Mateo, G., Carrillo-Santisteve, P., Elosua, R., Guallar, E., Marrugat, J., & Bleys, J. (n.d.).Publication year
2009Journal title
American Journal of EpidemiologyVolume
170Issue
2Page(s)
135-147AbstractControversial data exist concerning the relation between the activities of scavenger antioxidant enzymes and coronary heart disease (CHD) risk. The authors report updated meta-analyses of studies assessing the activities of 3 antioxidant enzymes - glutathione peroxidase, superoxide dismutase, and catalase - and CHD risk. Computer-based and manual searches of the relevant literature from January 1966 to January 2008 were performed. Studies assessing glutathione peroxidase, superoxide dismutase, and catalase activities in cells or biologic fluids and clinical CHD outcomes were selected. Pooled odds ratios for CHD were calculated by using an inverse-variance-weighted random-effects model. Forty-two case-control studies and 3 prospective studies were included. The pooled odds ratios for CHD associated with a 1-standard-deviation increase in glutathione peroxidase, superoxide dismutase, and catalase activity levels were 0.51 (95% confidence interval: 0.35, 0.75), 0.48 (95% confidence interval: 0.32, 0.72), and 0.32 (95% confidence interval: 0.16, 0.61), respectively, with substantial between-study heterogeneity (I 2>90% for the 3 enzymes). These findings were remarkably robust in the sensitivity analysis. The authors' meta-analyses support an inverse association between circulating levels of superoxide dismutase, glutathione peroxidase, and catalase activities with CHD and emphasize the need for additional high-quality prospective studies.