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
Physical activity and white matter lesion progression: Assessment using MRI
AbstractPodewils, L. J., Guallar, E., Beauchamp, N., Lyketsos, C. G., Kuller, L. H., & Scheltens, P. (n.d.).Publication year
2007Journal title
NeurologyVolume
68Issue
15Page(s)
1223-1226AbstractWe evaluated the association between physical activity and changes in white matter lesions (WMLs) on MRI in a sample of 179 older adults comprising 59 incident cases of Alzheimer disease, 60 persons with mild cognitive impairment, and 60 persons who remained cognitively stable over a median 5-year follow-up. Physical activity was not significantly associated with a decreased rate of periventricular or deep WML progression.Rapid response systems: A systematic review
AbstractWinters, B. D., Pham, J. C., Hunt, E. A., Guallar, E., Berenholtz, S., & Pronovost, P. J. (n.d.).Publication year
2007Journal title
Critical care medicineVolume
35Issue
5Page(s)
1238-1243AbstractCONTEXT: Rapid response systems have been advocated as a potential model to identify and intervene in patients who are experiencing deterioration on general hospital wards. OBJECTIVE: To conduct a meta-analysis to evaluate the impact of rapid response systems on hospital mortality and cardiac arrest rates. DATA SOURCE: We searched MEDLINE, EMBASE, and the Cochrane Library from January 1, 1990, to June 30, 2005, for all studies relevant to rapid response systems. We restricted the search to the English language and by age category (all adults: ≥19 years). STUDY SELECTION: We selected observational and randomized trials of rapid response systems that provided empirical data on hospital mortality and cardiac arrest in control and intervention groups. We reviewed 10,228 abstracts and identified eight relevant studies meeting these criteria. DATA SYNTHESIS: Of the included studies, five used historical controls, one used concurrent controls, and two used a cluster-randomized design. The pooled relative risk for hospital mortality comparing rapid response teams to control was 0.76 (95% confidence interval, 0.39-1.48) between the two randomized studies and 0.87 (95% confidence interval, 0.73-1.04) among the five observational studies. The pooled relative risk for cardiac arrest comparing rapid response systems to control was 0.94 (95% confidence interval, 0.79-1.13) in the single randomized study and 0.70 (95% confidence interval, 0.56-0.92) in four observational studies. CONCLUSIONS: We found weak evidence that rapid response systems are associated with a reduction in hospital mortality and cardiac arrest rates, but limitations in the quality of the original studies, the wide confidence intervals, and the presence of heterogeneity limited our ability to conclude that rapid response systems are effective interventions. Large randomized controlled trials are needed to clarify the efficacy of rapid response systems before they should become standard of care.Reply to J Hathcock [3]
Bleys, J., Miller, E. R., Appel, L. J., & Guallar, E. (n.d.). In American Journal of Clinical Nutrition (1–).Publication year
2007Volume
85Issue
5Page(s)
1435-1436Risk factors, risk prediction, and the apolipoprotein B-apolipoprotein A-I ratio
Berkwits, M., & Guallar, E. (n.d.).Publication year
2007Journal title
Annals of internal medicineVolume
146Issue
9Page(s)
677-679Selenium and diabetes: More bad news for supplements
Bleys, J., Navas-Acien, A., & Guallar, E. (n.d.).Publication year
2007Journal title
Annals of internal medicineVolume
147Issue
4Page(s)
271-272Serum selenium and diabetes in U.S. adults
AbstractBleys, J., Navas-Acien, A., & Guallar, E. (n.d.).Publication year
2007Journal title
Diabetes CareVolume
30Issue
4Page(s)
829-834AbstractOBJECTIVE - The purpose of this study was to examine the relationship between serum selenium levels and the prevalence of diabetes among U.S. adults. RESEARCH DESIGN AND METHODS - We conducted a cross-sectional analysis of 8,876 adults ≥20 years of age who participated in the Third National Health and Nutrition Examination Survey. Diabetes was defined as the presence of a fasting plasma glucose ≥126 mg/dl, a self-report of a physician diagnosis of diabetes, or current use of insulin or oral hypoglycemic medication. Serum selenium was measured by atomic absorption spectrometry. RESULTS - Mean serum selenium levels in participants with and without diabetes were 126.5 and 125.7 ng/ml, respectively. Age-, sex-, race-, and BMI-adjusted mean selenium levels were 126.8 ng/ml in participants with diabetes and 124.7 ng/ml in participants without diabetes (adjusted difference 2.1 ng/ml [95% CI 0.4-3.8]; P = 0.02). The multivariable adjusted odds ratio for diabetes comparing the highest to the lowest quintile of serum selenium was 1.57 [1.16-2.13]. However, the association between high serum selenium and the prevalence of diabetes was nonlinear, with no clear trend in quintiles 2-4. CONCLUSIONS - In a probability sample of the U.S. population, high serum selenium levels were positively associated with the prevalence of diabetes. Until findings from prospective studies and randomized controlled trials are available, selenium intake, including selenium supplementation, should not be recommended for primary or secondary diabetes prevention in populations with adequate selenium status such as the U.S. population.A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization
AbstractSymons, J. M., Wang, L., Guallar, E., Howell, E., Dominici, F., Schwab, M., Ange, B. A., Samet, J., Ondov, J., Harrison, D., & Geyh, A. (n.d.).Publication year
2006Journal title
American Journal of EpidemiologyVolume
164Issue
5Page(s)
421-433AbstractPersons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of <2.5 μm (PM2.5) and onset of symptom exacerbation leading to hospital admission in Baltimore, Maryland. They used a case-crossover design for 135 case events occurring among 125 persons with prevalent congestive heart failure who were admitted to a single hospital through the emergency department during 2002. The case period was assigned using three index times: 8-hour and 24-hour periods of symptom onset and date of hospital admission. Controlling for weather, the authors detected a modest relative increase in risk for cases defined by 8-hour symptom onset for an interquartile-range increase in PM2.5 at a 2-day lag (odds ratio = 1.09, 95% confidence interval: 0.91, 1.30). A corresponding increase in risk was not observed when admission date was used to define the case period. A series of simulations based on study data indicated that the study had adequate statistical power to detect odds ratios of 1.2 or higher. Although overall findings were not statistically significant, the identification of case events defined by an 8-hour onset period may be more relevant than either a 24-hour onset period or the admission date for estimating harmful effects of air pollutant exposure on cardiovascular health.Adulthood consumption of preserved and nonpreserved vegetables and the risk of nasopharyngeal carcinoma: A systematic review
AbstractGallicchio, L., Matanoski, G., Tao, X., Chen, L., Lam, T. K., Boyd, K., Robinson, K. A., Balick, L., Mickelson, S., Caulfield, L. E., Herman, J. G., Guallar, E., & Alberg, A. J. (n.d.).Publication year
2006Journal title
International Journal of CancerVolume
119Issue
5Page(s)
1125-1135AbstractThe incidence rates of nasopharyngeal carcinoma (NPC) are dramatically higher in certain regions of Asia compared to the rest of the world. Few risk factors for NPC are known; however, in contrast to the hypothesized health benefits of nonpreserved vegetables, it is thought that preserved vegetable intake may play a role in contributing to the higher incidence of NPC in high-risk regions. Therefore, the purpose of this study was to systematically review the epidemiologic evidence on the associations between adulthood intake of preserved and nonpreserved vegetables and NPC risk. A search of the epidemiological literature from 1966 to 2004 was performed using several bibliographic databases, including PubMed and the Chinese Biomedical Literature Database System. There were no language restrictions. Meta-analysis was conducted to obtain pooled odds ratios (ORs) for the highest-versus-lowest categories of preserved and nonpreserved vegetable intake. A total of 16 case-control studies were identified in the search. Results showed that highest-versus-lowest preserved vegetable intake was associated with a 2-fold increase in the risk of NPC (Random Effects Odds Ratio (RE OR) 2.04; 95% Confidence Limits (CL) 1.43, 2.92). Conversely, high nonpreserved vegetable intake was associated with 36% decrease in the risk of NPC (RE OR 0.64; 95% CL 0.48, 0.85). Findings for both preserved and nonpreserved vegetables were consistent across vegetable type and by country of study. Further research in high-risk areas to gain insight into the risk associated with preserved vegetables and protection associated with nonpreserved vegetables may advance understanding of NPC and yield clues for prevention.Adverse events during medical and surgical hospitalizations for persons with schizophrenia
AbstractDaumit, G. L., Pronovost, P. J., Anthony, C. B., Guallar, E., Steinwachs, D. M., & Ford, D. E. (n.d.).Publication year
2006Journal title
Archives of General PsychiatryVolume
63Issue
3Page(s)
265-272AbstractContext: Persons with schizophrenia have a high risk of premature mortality. It is not clear if greater risk for adverse events during hospitalization is a contributing factor. Objectives: To estimate the prevalence of adverse events in medical and surgical hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and to examine the relation between adverse events and intensive care unit admission, in-hospital death, length of stay, and total charges for hospitalizations for persons with schizophrenia. Design: Cross-sectional study. Setting: We studied discharges from all Maryland acute care hospitals' medical and surgical services in 2001 and 2002. Patients: There were 1746 medical and surgical hospitalizations for adults with a secondary diagnosis of schizophrenia and 732 158 for adults without schizophrenia. Main Outcome Measures: For primary outcomes, we applied the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs), which were developed to detect adverse events in administrative data. We compared PSIs for hospitalizations for patients with a secondary diagnosis of schizophrenia with those for patients without and determined the association between schizophrenia and each PSI adjusting for patient and hospital characteristics. For hospitalizations for patients with schizophrenia, for secondary outcomes we examined the association between each PSI and intensive care unit admission, in-hospital death, length of stay, and total charges. Results: Hospitalizations for patients with schizophrenia had the following higher adjusted relative odds of having PSIs compared with those for patients without schizophrenia: infections due to medical care (odds ratio [OR], 2.49 [95% confidence interval (CI), 1.28 to 4.88]); postoperative respiratory failure (OR, 2.08 [95% CI, 1.41 to 3.06]); postoperative deep venous thrombosis (OR, 1.96 [95% CI, 1.18 to 3.26]); and postoperative sepsis (OR, 2.29 [95% CI, 1.49 to 3.51]). For hospitalizations for patients with schizophrenia, having respiratory failure or sepsis resulted in at least twice the adjusted odds for intensive care unit admission and death. The median adjusted increase in length of stay was at least 10 days, and median hospital charges were elevated by at least $20 000 for infections due to medical care, respiratory failure, deep venous thrombosis, and sepsis. Conclusions: Medical and surgical hospitalizations for persons with schizophrenia had at least twice the odds of several types of adverse events than those for persons without schizophrenia. These adverse events were associated with poor clinical and economic outcomes during the hospital admission. Efforts to reduce these adverse events should become a research priority.Arsenic exposure and type 2 diabetes: A systematic review of the experimental and epidemiologic evidence
AbstractNavas-Acien, A., Silbergeld, E. K., Streeter, R. A., Clark, J. M., Burke, T. A., & Guallar, E. (n.d.).Publication year
2006Journal title
Environmental health perspectivesVolume
114Issue
5Page(s)
641-648AbstractChronic arsenic exposure has been suggested to contribute to diabetes development. We performed a systematic review of the experimental and epidemiologic evidence on the association of arsenic and type 2 diabetes. We identified 19 in vitro studies of arsenic and glucose metabolism. Five studies reported that arsenic interfered with transcription factors involved in insulin-related gene expression: upstream factor 1 in pancreatic β-cells and peroxisome proliferative-activated receptor γ in preadipocytes. Other in vitro studies assessed the effect of arsenic on glucose uptake, typically using very high concentrations of arsenite or arsenate. These studies provide limited insight on potential mechanisms. We identified 10 in vivo studies in animals. These studies showed inconsistent effects of arsenic on glucose metabolism. Finally, we identified 19 epidemiologic studies (6 in high-arsenic areas in Taiwan and Bangladesh, 9 in occupational populations, and 4 in other populations). In studies from Taiwan and Bangladesh, the pooled relative risk estimate for diabetes comparing extreme arsenic exposure categories was 2.52 (95% confidence interval, 1.69-3.75), although methodologic problems limit the interpretation of the association. The evidence from occupational studies and from general populations other than Taiwan or Bangladesh was inconsistent. In summary, the current available evidence is inadequate to establish a causal role of arsenic in diabetes. Because arsenic exposure is widespread and diabetes prevalence is reaching epidemic proportions, experimental studies using arsenic concentrations relevant to human exposure and prospective epidemiologic studies measuring arsenic biomarkers and appropriately assessing diabetes should be a research priority.Blood lead below 0.48 μmol/L (10 μg/dL) and mortality among US adults
AbstractMenke, A., Muntner, P., Batuman, V., Silbergeld, E. K., & Guallar, E. (n.d.).Publication year
2006Journal title
CirculationVolume
114Issue
13Page(s)
1388-1394AbstractBACKGROUND - Blood lead levels above 0.48 μmol/L (10 μg/dL) in adults have been associated with increased risk of cardiovascular, cancer, and all-cause mortality. The objective of the present study was to determine the association between blood lead levels below 0.48 μmol/L and mortality in the general US population. METHODS AND RESULTS - Blood lead levels were measured in a nationally representative sample of 13 946 adult participants of the Third National Health and Nutrition Examination Survey recruited in 1988 to 1994 and followed up for up to 12 years for all-cause and cause-specific mortality. The geometric mean blood lead level in study participants was 0.12 μmol/L (2.58 μg/dL). After multivariate adjustment, the hazard ratios (95% CI) for comparisons of participants in the highest tertile of blood lead (≥0.17 μmol/L [≥3.62 μg/dL]) with those in the lowest tertile (<0.09 μmol/L [<1.94 μg/dL]) were 1.25 (1.04 to 1.51; Ptrend across tertiles=0.002) for all-cause mortality and 1.55 (1.08 to 2.24; Ptrend across tertiles=0.003) for cardiovascular mortality. Blood lead level was significantly associated with both myocardial infarction and stroke mortality, and the association was evident at levels >0.10 μmol/L (≥2 μg/dL). There was no association between blood lead and cancer mortality in this range of exposure. CONCLUSIONS - The association between blood lead levels and increased all-cause and cardiovascular mortality was observed at substantially lower blood lead levels than previously reported. Despite the marked decrease in blood lead levels over the past 3 decades, environmental lead exposures remain a significant determinant of cardiovascular mortality in the general population, constituting a major public health problem.Body-mass index and mortality in Korean men and women
AbstractSun, H. J., Jae, W. S., Park, J., Lee, S. Y., Ohrr, H., Guallar, E., & Samet, J. M. (n.d.).Publication year
2006Journal title
New England Journal of MedicineVolume
355Issue
8Page(s)
779-787AbstractBACKGROUND: Obesity is associated with diverse health risks, but the role of body weight as a risk factor for death remains controversial. METHODS: We examined the association between body weight and the risk of death in a 12-year prospective cohort study of 1,213,829 Koreans between the ages of 30 and 95 years. We examined 82,372 deaths from any cause and 48,731 deaths from specific diseases (including 29,123 from cancer, 16,426 from atherosclerotic cardiovascular disease, and 3362 from respiratory disease) in relation to the body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters). RESULTS: In both sexes, the average baseline BMI was 23.2, and the rate of death from any cause had a J-shaped association with the BMI, regardless of cigarette-smoking history. The risk of death from any cause was lowest among patients with a BMI of 23.0 to 24.9. In all groups, the risk of death from respiratory causes was higher among subjects with a lower BMI, and the risk of death from atherosclerotic cardiovascular disease or cancer was higher among subjects with a higher BMI. The relative risk of death associated with BMI declined with increasing age. CONCLUSIONS: Underweight, overweight, and obese men and women had higher rates of death than men and women of normal weight. The association of BMI with death varied according to the cause of death and was modified by age, sex, and smoking history.Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function
AbstractGuallar, E., Silbergeld, E. K., Navas-Acien, A., Malhotra, S., Astor, B. C., Sharrett, A. R., & Schwartz, B. S. (n.d.).Publication year
2006Journal title
American Journal of EpidemiologyVolume
163Issue
8Page(s)
700-708AbstractHomocysteine levels are associated with peripheral arterial disease (PAD) in observational studies. Lead and cadmium are risk factors for PAD that affect thiol metabolism, and they may partly explain the association of homocysteine with PAD. To evaluate the roles of lead and cadmium exposure in confounding the association between homocysteine and PAD, the authors performed a cross-sectional study among 4,447 persons aged ≥40 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ankle-brachial blood pressure index less than 0.90 in at least one leg. After adjustment for sociodemographic variables, the odds ratio for PAD in the highest quintile of homocysteine compared with the lowest was 1.92 (ptrend = 0.004). Adjusting for blood lead and cadmium levels reduced this odds ratio to 1.37 (ptrend = 0.13), and further adjusting for estimated glomerular filtration rate and smoking reduced it to 0.89 (p trend = 0.87). Adjustment for other risk factors did not affect this association. In the general population, the association of homocysteine level with PAD can be completely explained by confounding due to smoking, increased blood lead and cadmium levels, and impaired renal function. The association of lead and cadmium with PAD risk deserves further investigation.Mens sana in corpore sano
Podewils, L. J., & Guallar, E. (n.d.).Publication year
2006Journal title
Annals of internal medicineVolume
144Issue
2Page(s)
135-136Quality of life after acute respiratory distress syndrome: A meta-analysis
AbstractDowdy, D. W., Eid, M. P., Dennison, C. R., Mendez-Tellez, P. A., Herridge, M. S., Guallar, E., Pronovost, P. J., & Needham, D. M. (n.d.).Publication year
2006Journal title
Intensive Care MedicineVolume
32Issue
8Page(s)
1115-1124AbstractObjective: To summarize long-term quality of life (QOL) and the degree of variation in QOL estimates across studies of acute respiratory distress (ARDS) survivors. Design: A systematic review of studies evaluating QOL in ARDS survivors was conducted. Medline, EMBASE, CINAHL, pre-CINAHL, and the Cochrane Library were searched, and reference lists from relevant articles were evaluated. Two authors independently selected studies reporting QOL in adult survivors of ARDS or acute lung injury at least 30 days after intensive care unit discharge and extracted data on study design, patient characteristics, methods, and results. Measurements and results: Thirteen independent observational studies (557 patients) met inclusion criteria. Eight of these studies used eight different QOL instruments, allowing only qualitative synthesis of results. The five remaining studies (330 patients) measured QOL using the Medical Outcomes Study 36-Item Short Form survey (SF-36). Mean QOL scores were similar across these studies, falling within a range of 20 points for all domains. Pooled domain-specific QOL scores in ARDS survivors 6 months or later after discharge ranged from 45 (role physical) to 66 (social functioning), or 15-26 points lower than population norms, in all domains except mental health (11 points) and role physical (39 points). Corresponding confidence intervals were no wider than ± 9 points. Six studies all found stable or improved QOL over time, but only one found significant improvement beyond 6 months after discharge. Conclusions: ARDS survivors in different clinical settings experience similar decrements in QOL. The precise magnitude of these decrements helps clarify the long-term prognosis for ARDS survivors.Selenium and coronary heart disease: A meta-analysis
AbstractFlores-Mateo, G., Navas-Acien, A., Pastor-Barriuso, R., & Guallar, E. (n.d.).Publication year
2006Journal title
American Journal of Clinical NutritionVolume
84Issue
4Page(s)
762-773AbstractBackground: It is hypothesized that low selenium concentrations are associated with an increased risk of cardiovascular disease and that selenium supplements prevent coronary heart disease. Objective: The objective was to perform a meta-analysis on the association of selenium biomarkers with coronary heart disease endpoints in observational studies and on the efficacy of selenium supplements in preventing coronary heart disease endpoints in randomized trials. Design: The MEDLINE and the Cochrane Library databases were searched for studies conducted from 1966 through 2005. Relative risks were pooled by using an inverse-variance weighted random-effects model. Results: Twenty-five observational studies (14 cohort and 11 case-control studies) that measured blood or toenail selenium concentrations and 6 randomized trials that evaluated supplements containing selenium met our inclusion criteria. The pooled relative risk in a comparison of the highest with the lowest selenium concentration categories was 0.85 (95% CI: 0.74, 0.99) in cohort studies and 0.43 (0.29, 0.66) in case-control studies. In observational studies, a 50% increase in selenium concentrations was associated with a 24% (7%, 38%) reduction in coronary heart disease risk. In randomized trials, the pooled relative risk in a comparison of supplements containing selenium with placebo was 0.89 (0.68, 1.17). Conclusions: Selenium concentrations were inversely associated with coronary heart disease risk in observational studies. Because observational studies have provided misleading evidence for other antioxidants, the validity of this association is uncertain. Few randomized trials have addressed the cardiovascular efficacy of selenium supplementation, and their findings are still inconclusive. Evidence from large ongoing trials is needed to establish low selenium concentrations as a cardiovascular disease risk factor. Currently, selenium supplements should not be recommended for cardiovascular disease prevention.Three authors reply [2]
Navas-Acien, A., Sharrett, A. R., & Guallar, E. (n.d.). In American Journal of Epidemiology (1–).Publication year
2006Volume
164Issue
2Page(s)
195-196Vitamin-mineral supplementation and the progression of atherosclerosis: A meta-analysis of randomized controlled trials
AbstractBleys, J., Miller, E. R., Pastor-Barriuso, R., Appel, L. J., & Guallar, E. (n.d.).Publication year
2006Journal title
American Journal of Clinical NutritionVolume
84Issue
4Page(s)
880-887AbstractBackground: Laboratory and observational studies suggest that antioxidant and B vitamin supplementation may prevent atherosclerosis. Although trials have not shown a benefit of these supplements on clinical cardiovascular events, it is unknown whether they affect the progression of atherosclerosis as measured by imaging techniques. Objective: The objective was to perform a meta-analysis of randomized controlled trials of the effect of vitamin-mineral supplementation on atherosclerosis progression. Design: We searched the MEDLINE, EMBASE, and CENTRAL databases for relevant studies. No language restrictions were applied. We separately analyzed trials using antioxidants (vitamins E and C, β-carotene, or selenium) and trials using B vitamins (folate, vitamin B-6, or vitamin B-12). The progression of atherosclerosis was evaluated by B-mode ultrasound, intravascular ultrasound, or angiography. Effect sizes were calculated for the difference in slope of atherosclerosis progression between participants assigned to supplements and those assigned to the control group. Results: In trials not involving percutaneous transluminal coronary angioplasty, the pooled effect size was -0.06 (95% CI: -0.20, 0.09; 7 trials) for antioxidants and -0.93 (95% CI: -2.11, 0.26; 4 trials) for B vitamins. In trials involving percutaneous transluminal coronary angioplasty, the pooled relative risk of restenosis was 0.82 (95% CI: 0.54, 1.26; 3 trials) for antioxidants and 0.84 (95% CI: 0.34, 2.07; 2 trials) for B vitamins. Conclusion: Our meta-analysis showed no evidence of a protective effect of antioxidant or B vitamin supplements on the progression of atherosclerosis, thus providing a mechanistic explanation for their lack of effect on clinical cardiovascular events.An editorial update: Annus horribilis for vitamin E
AbstractGuallar, E., Hanley, D. F., & Miller, E. R. (n.d.).Publication year
2005Journal title
Annals of internal medicineVolume
143Issue
2Page(s)
143-145AbstractIn-January 2005, we published a dose-response meta-analysis showing that high-dosage (≥400 IU/d) vitamin E supplementation was associated with a small but statistically significant increased risk for death. These findings were highly controversial: This issue of Annals includes 11 of more than 40 electronic rapid-response letters about our article. Rather than summarizing this exchange of views, however, this editorial reports further developments in the vitamin E story.Arsenic exposure and cardiovascular disease: A systematic review of the epidemiologic evidence
AbstractNavas-Acien, A., Sharrett, A. R., Silbergeld, E. K., Schwartz, B. S., Nachman, K. E., Burke, T. A., & Guallar, E. (n.d.).Publication year
2005Journal title
American Journal of EpidemiologyVolume
162Issue
11Page(s)
1037-1049AbstractArsenic exposure is a likely cause of blackfoot disease and a potential risk factor for atherosclerosis. The authors performed a systematic review of the epidemiologic evidence on the association between arsenic and cardiovascular outcomes. The search period was January 1966 through April 2005. Thirteen studies conducted in general populations (eight in high-arsenic areas in Taiwan, five in other countries) and 16 studies conducted in occupational populations were identified. Exposure was assessed ecologically in most studies. In Taiwan, relative risks comparing the highest arsenic exposure category with the lowest ranged from 1.59 to 4.90 for coronary disease, from 1.19 to 2.69 for stroke, and from 1.66 to 4.28 for peripheral arterial disease. In other general populations, relative risks ranged from 0.84 to 1.54 for coronary disease, from 0.69 to 1.53 for stroke, and from 0.61 to 1.58 for peripheral arterial disease. In occupational populations, relative risks ranged from 0.40 to 2.14 for coronary disease mortality and from 0.30 to 1.33 for stroke mortality. Methodologic limitations, however, limited interpretation of the moderate-to-strong associations between high arsenic exposure and cardiovascular outcomes in Taiwan. In other populations or in occupational settings, the evidence was inconclusive. Because of the high prevalence of arsenic exposure, carefully performed studies of arsenic and cardiovascular outcomes should be a research priority.Body mass index and incident ischemic heart disease in South Korean men and women
AbstractJee, S. H., Pastor-Barriuso, R., Appel, L. J., Sun, I., Miller, E. R., & Guallar, E. (n.d.).Publication year
2005Journal title
American Journal of EpidemiologyVolume
162Issue
1Page(s)
42-48AbstractAsian populations have a higher body fat percentage for a given body mass index (BMI) than Caucasians. However, little information is available on the association of BMI with ischemic heart disease (IHD) incidence in Asians at low BMI levels. The authors prospectively evaluated the association of BMI (weight (kg)/height (m)2) with IHD incidence over 9 years of follow-up (1993-2001) among 133,740 South Korean adults (89,050 men, 44,690 women) who participated in the 1990 and 1992 examinations of the Korea Medical Insurance Corporation Study. Average BMI at baseline was 23.4 (standard deviation, 2.3) in men and 22.3 (standard deviation, 2.3) in women. After multivariate adjustment, there was a 14% (95% confidence interval: 12,16) increased risk of incident IHD per unit of increase in BMI. This trend was also observed within the range considered normal by Western standards, and a BMI of 24-<25 was associated with an IHD hazard ratio of 2.01 (95% confidence interval: 1.32, 3.05) in comparison with a BMI of 18-<19. The association of BMI with IHD in this cohort of relatively young South Korean men and women was progressive over the range of BMI values, with no threshold of change in risk and no indication of a U-shaped relation at low BMI levels.Direct, progressive association of cardiovascular risk factors with incident proteinuria: Results from the Korea Medical Insurance Corporation (KMIC) study
AbstractJee, S. H., Boulware, L. E., Guallar, E., Suh, I., Appel, L. J., & Miller, E. R. (n.d.).Publication year
2005Journal title
Archives of Internal MedicineVolume
165Issue
19Page(s)
2299-2304AbstractBackground: Proteinuria is a major risk factor for the progression of kidney disease and the development of cardiovascular disease. Little is known, however, about risk factors for incident proteinuria. Methods: We conducted a 10-year prospective cohort study of 104 523 Korean men and 52 854 women, aged 35 to 59 years, who attended Korea Medical Insurance Corporation health examinations and who did not have proteinuria at baseline. Incident proteinuria was assessed at biennial examinations during the next 10 years. We performed Cox proportional hazards analyses. Results: During 10 years of follow-up, proteinuria developed in 3951 men (3.8%) and 1527 women (2.9%). The adjusted relative risk (RR) of proteinuria associated with diabetes was 3.27 (95% confidence interval [CI], 2.98-3.58) in men and 2.60 (95% CI, 1.98-3.43) in women; with body mass index (calculated as weight in kilograms divided by the square of height in meters), it was 1.43 (95% CI, 1.35-1.50) in men and 1.45 (95% CI, 1.35-1.55) in women per 5-U increment. Compared with subjects with serum cholesterol levels of less than 200 mg/dL (<5.18 mmol/L), the adjusted RRs associated with serum cholesterol levels of 200 to 239 mg/dL (5.18-6.19 mmol/L) and 240 mg/dL or more (≥6.22 mmol/L) were 1.13 (95% CI, 1.05-1.21) and 1.40 (95% CI, 1.27-1.54), respectively, in men and 1.14 (95% CI, 1.01-1.28) and 1.22 (95% CI, 1.00-1.37), respectively, in women. Persons with stages 1 and 2 hypertension had a greater adjusted RR of incident proteinuria compared with those with normal blood pressure (1.62 [95% CI, 1.47-1.79] and 2.06 [95% CI, 1.81-2.34], respectively, in men and 1.37 [95% CI, 1.14-1.65] and 2.10 [95% CI, 1.59-2.76], respectively, in women). Conclusions: Fasting glucose and cholesterol levels, body mass index, and blood pressure were direct and independent predictors of incident proteinuria in Korean adults. These associations were present even at low levels of exposure, emphasizing the importance of early detection and management of these modifiable risk factors.High-dosage vitamin E supplementation and all-cause mortality [1] (multiple letters)
Blatt, D. H., Pryor, W. A., Krishnan, K., Campbell, S., Stone, W. L., Hemilä, H., Lim, W. S., Liscic, R. M., Xiong, C., Morris, J. C., Marras, C., Lang, A. E., Oakes, D., McDermott, M. P., Kieburtz, K., Shoulson, I., Tanner, C. M., Fahn, S., Meydani, S. N., … Pastor-Barriuso, R. (n.d.). In Annals of internal medicine (1–).Publication year
2005Volume
143Issue
2Page(s)
150-158Low toenail chromium concentration and increased risk of nonfatal myocardial infarction
AbstractGuallar, E., Jiménez, F. J., Van ’t Veer, P., Bode, P., Riemersma, R. A., Gómez-Aracena, J., Kark, J. D., Arab, L., Kok, F. J., & Martín-Moreno, J. M. (n.d.).Publication year
2005Journal title
American Journal of EpidemiologyVolume
162Issue
2Page(s)
157-164AbstractChromium intake may increase insulin sensitivity, glucose tolerance, and the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol. However, the epidemiologic evidence on the association between chromium and cardiovascular disease is very limited. To determine whether low toenail chromium concentrations were associated with risk of nonfatal myocardial infarction, the authors conducted an incident, population-based, case-control study in eight European countries and Israel in 1991-1992. Cases (n = 684) were men with a first diagnosis of myocardial infarction recruited from the coronary units of participating hospitals. Controls (n = 724) were men selected randomly from population registers (five study centers) or through other sources, such as hospitalized patients (three centers), general practitioners' practices (one center), or relatives or friends of cases (one center). Toenail chromium concentration was assessed by neutron activation analysis. Average toenail chromium concentrations were 1.10 μg/g in cases (95% confidence interval: 1.01, 1.18) and 1.30 μg/g in controls (95% CI: 1.21, 1.40). Multivariate odds ratios for quintiles 2-5 were 0.82 (95% CI: 0.52, 1.31), 0.68 (95% CI: 0.43, 1.08), 0.60 (95% CI: 0.37, 0.97), and 0.59 (95% CI: 0.37, 0.95). Toenail chromium concentration was inversely associated with the risk of a first myocardial infarction in men. These results add to an increasing body of evidence that points to the importance of chromium for cardiovascular health.Meta-analysis: High-dosage vitamin E supplementation may increase all-cause mortality
AbstractMiller, E. R., Pastor-Barriuso, R., Dalal, D., Riemersma, R. A., Appel, L. J., & Guallar, E. (n.d.).Publication year
2005Journal title
Annals of internal medicineVolume
142Issue
1Page(s)
37-46+I-40AbstractBackground: Experimental models and observational studies suggest that vitamin E supplementation may prevent cardiovascular disease and cancer. However, several trials of high-dosage vitamin E supplementation showed non-statistically significant increases in total mortality. Purpose: To perform a meta-analysis of the dose-response relationship between vitamin E supplementation and total mortality by using data from randomized, controlled trials. Patients: 135 967 participants in 19 clinical trials. Of these trials, 9 tested vitamin E alone and 10 tested vitamin E combined with other vitamins or minerals. The dosages of vitamin E ranged from 16.5 to 2000 IU/d (median, 400 IU/d). Data Sources: PubMed search from 1966 through August 2004, complemented by a search of the Cochrane Clinical Trials Data-base and review of citations of published reviews and meta-analyses. No language restrictions were applied. Data Extraction: 3 investigators independently abstracted study reports. The investigators of the original publications were contacted if required information was not available. Data Synthesis: 9 of 11 trials testing high-dosage vitamin E (≥400 IU/d) showed increased risk (risk difference > 0) for all-cause mortality in comparisons of vitamin E versus control. The pooled all-cause mortality risk difference in high-dosage vitamin E trials was 39 per 10 000 persons (95% CI, 3 to 74 per 10 000 persons; P = 0.035). For low-dosage vitamin E trials, the risk difference was -16 per 10 000 persons (CI, -41 to 10 per 10 000 persons; P > 0.2). A dose-response analysis showed a statistically significant relationship between vitamin E dosage and all-cause mortality, with increased risk of dosages greater than 150 IU/d. Limitations: High-dosage (≥ 400 IU/d) trials were often small and were performed in patients with chronic diseases. The generalizability of the findings to healthy adults is uncertain. Precise estimation of the threshold at which risk increases is difficult. Conclusion: High-dosage (≥400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided.