Eliseo Guallar

Chair and Professor of the Department of Epidemiology

Professional overview

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

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

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

Education

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

MD, University of Zaragoza, Zaragoza, Spain

MPH, University of Minnesota, Minneapolis, MN

DrPH, Harvard University, Boston, MA

Honors and awards

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

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

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

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

Scientist Development Award, American Heart Association (2002)

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

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

High Impact Research Icon, University of Malaya (2015)

Publications

Publications

Shock Index as a Predictor of Myocardial Injury in ST-segment Elevation Myocardial Infarction

Hwang, J. K., Jang, W. J., Song, Y. B., Lima, J. A., Guallar, E., Choe, Y. H., Choi, S., Kim, E. K., Hahn, J. Y., Choi, S. H., Lee, S. C., & Gwon, H. C. (n.d.).

Publication year

2016

Journal title

American Journal of the Medical Sciences

Volume

352

Issue

6

Page(s)

574-581

10.1016/j.amjms.2016.09.003

Abstract

Abstract

Background: Little is known about the association between shock index and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: We analyzed cardiac magnetic resonance imaging from 306 consecutive patients treated with primary PCI for STEMI. The patients were divided into the following 2 groups: initial shock index >0.7 (n = 88) and ≤0.7 (n = 218). Shock index was calculated as the ratio of heart rate to systolic blood pressure based on the first recorded vital signs upon arrival. The primary end point was myocardial infarct size. Results: The shock index >0.7 group, exhibited a lower baseline left ventricular ejection fraction (P = 0.01), higher N-terminal prohormone of brain natriuretic peptide level (P = 0.01), higher Killip class (P < 0.01) and higher prevalence of diabetes (P = 0.02) than the shock index ≤0.7 group. There were no significant differences in the angiographic or procedural characteristics between the 2 groups. In cardiac magnetic resonance imaging analysis, the shock index >0.7 group had a larger infarct size than did the shock index ≤0.7 group (22.9 ± 11.2% versus 19.2 ± 11.5%, P < 0.01). According to multivariate analysis, shock index >0.7 was associated with large myocardial infarctions (odds ratio = 3.02; 95% CI: 1.62-5.65; P < 0.01). Conclusions: Initial shock index is a potentially reliable predictor of myocardial injury in patients with STEMI undergoing primary PCI.

Sleep duration and subclinical atherosclerosis : The Aragon Workers' Health Study

Blasco-Colmenares, E., Moreno-Franco, B., Latre, M. L., Mur-Vispe, E., Pocovi, M., Jarauta, E., Civeira, F., Laclaustra, M., Casasnovas, J. A., & Guallar, E. (n.d.).

Publication year

2018

Journal title

Atherosclerosis

Volume

274

Page(s)

35-40

10.1016/j.atherosclerosis.2018.05.003

Abstract

Abstract

Background and aims: Few studies have evaluated the association of sleep duration with subclinical atherosclerosis, and with heterogeneous findings. We evaluated the association of sleep duration with the presence of coronary, carotid, and femoral subclinical atherosclerosis in healthy middle-age men with low prevalence of clinical comorbidities. Methods: We performed a cross-sectional analysis of 1968 men, 40–60 years of age, participating in the Aragon Workers' Health Study (AWHS). Duration of sleep during a typical work week was assessed by questionnaire. Coronary artery calcium scores (CACS) was assessed by computed tomography and the presence of carotid plaque and femoral plaque by ultrasound. Results: In fully adjusted models, the odds ratios (95% CI) for CACS >0 comparing sleep durations of ≤5, 6, and ≥8 h with 7 h were 1.34 (0.98–1.85), 1.35 (1.08–1.69) and 1.21 (0.90–1.62), respectively (p = 0.04). A similar U-shaped association was observed for CACS ≥100 and for CACS. The corresponding odds ratios for the presence of at least one carotid plaque were ≤5, 6, and ≥8 h with 7 h were 1.23 (0.88–1.72), 1.09 (0.86–1.38), and 0.86 (0.63–1.17), respectively (p = 0.31), and for the presence of at least one femoral plaque were 1.25 (0.87–1.80), 1.19 (0.93–1.51) and 1.17 (0.86–1.61), respectively (p = 0.39). Conclusions: Middle-aged men reporting 7 h of sleep duration had the lowest prevalence of subclinical coronary atherosclerosis as assessed by CACs. Our results support that men with very short or very long sleep durations are at increased risk of atherosclerosis.

Sleep duration, sleep quality, and markers of subclinical arterial disease in healthy men and women

Kim, C. W., Chang, Y., Zhao, D., Cainzos-Achirica, M., Ryu, S., Jung, H. S., Yun, K. E., Choi, Y., Ahn, J., Zhang, Y., Rampal, S., Baek, Y., Lima, J. A., Shin, H., Guallar, E., Cho, J., & Sung, E. (n.d.).

Publication year

2015

Journal title

Arteriosclerosis, Thrombosis, and Vascular Biology

Volume

35

Issue

10

Page(s)

2238-2245

10.1161/ATVBAHA.115.306110

Abstract

Abstract

Objective.Short and long sleep duration are associated with increased risk of clinical cardiovascular events, but the association between sleep duration and subclinical cardiovascular disease is not well established. We examined the association between sleep duration and sleep quality with coronary artery calcification (CAC) and with brachial.ankle pulse wave velocity (PWV) in a large sample of young and middle-aged asymptomatic adults. Approach and Results.We conducted a cross-sectional study of adult men and women who underwent a health checkup examination, including assessment of sleep duration and quality and coupled with either CAC (n=29 203) or brachial. ankle PWV (n=18 106). The multivariate-adjusted CAC score ratios (95% confidence interval) comparing sleep durations of ≥5, 6, 8, and ≤9 hours with 7 hours of sleep were 1.50 (1.17.1.93), 1.34 (1.10.1.63), 1.37 (0.99.1.89), and 1.72 (0.90. 3.28), respectively (P for quadratic trend=0.002). The corresponding average differences in brachial.ankle PWV were 6.7 (0.75.12.6), 2.9 (.1.7 to 7.4), 10.5 (4.5.16.5), and 9.6 (.0.7 to 19.8) cm/s, respectively (P for quadratic trend=0.019). Poor subjective sleep quality was associated with CAC in women but not in men, whereas the association between poor subjective sleep quality and brachial.ankle PWV was stronger in men than in women. Conclusions.In this large study of apparently healthy men and women, extreme sleep duration and poor subjective sleep quality were associated with increased prevalence of CAC and higher PWV. Our results underscore the importance of an adequate quantity and quality of sleep to maintain cardiovascular health.

Smoking habit change after cancer diagnosis : effect on cardiovascular risk

Lee, H. H., Lee, H., Bhatt, D. L., Lee, G. B., Han, J., Shin, D. W., Kang, D., Youn, J. C., Guallar, E., Cho, J., & Kim, H. C. (n.d.).

Publication year

2024

Journal title

European Heart Journal

Volume

45

Issue

2

Page(s)

132-135

10.1093/eurheartj/ehad199

Abstract

Abstract

~

Something fishy? News media presentation of complex health issues related to fish consumption guidelines

Greiner, A., Clegg Smith, K., & Guallar, E. (n.d.).

Publication year

2010

Journal title

Public Health Nutrition

Volume

13

Issue

11

Page(s)

1786-1794

10.1017/S1368980010000923

Abstract

Abstract

Objective 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.

Spatial clustering of toxic trace elements in adolescents aroun. The Torreón, Mexico lead-zinc smelter

Garcia-Vargas, G. G., Rothenberg, S. J., Silbergeld, E. K., Weaver, V., Zamoiski, R., Resnick, C., Rubio-Andrade, M., Parsons, P. J., Steuerwald, A. J., Navas-Acién, A., & Guallar, E. (n.d.).

Publication year

2014

Journal title

Journal of Exposure Science and Environmental Epidemiology

Volume

24

Issue

6

Page(s)

634-642

10.1038/jes.2014.11

Abstract

Abstract

High blood lead (BPb) levels in children and elevated soil and dust arsenic, cadmium, and lead were previously found in Torreón, northern Mexico, host t. The world's fourth largest lead-zinc metal smelter. The objectives of this study were to determine spatial distributions of adolescents with higher BPb and creatinine-corrected urine total arsenic, cadmium, molybdenum, thallium, and uranium aroun. The smelter. Cross-sectional study of 512 male and female subjects 12-15 years of age was conducted. We measured BPb by graphite furnace atomic absorption spectrometry and urine trace elements by inductively coupled plasma-mass spectrometry, with dynamic reaction cell mode for arsenic. We constructed multiple regression models including sociodemographic variables and adjusted for subject residence spatial correlation with spatial lag or error terms. We applied local indicators of spatial association statistics to model residuals to identify hot spots of significant spatial clusters of subjects with higher trace elements. We found spatial clusters of subjects with elevated BPb (range 3.6-14.7 μg/dl) and urine cadmium (0.18-1.14 μg/g creatinine) adjacent to and downwind o. The smelter and elevated urine thallium (0.28-0.93 μg/g creatinine) and uranium (0.07-0.13 μg/g creatinine) near ore transport routes, former waste, and industrial discharge sites. The conclusion derived from this study was that spatial clustering of adolescents with high BPb and urine cadmium adjacent to and downwind o. The smelter and residual waste pile, areas identified over a decade ago with high lead and cadmium in soil and dust, suggests that past and/or present plant operations continue to present health risks to children in those neighborhoods.

Stages of menopause and abnormal lung function : a cross-sectional study of middle-aged women

Hong, Y. S., Park, H. Y., Chang, Y., Jang, E. H., Zhao, D., Kim, S., Guallar, E., Kim, H., Cho, J., & Ryu, S. (n.d.).

Publication year

2021

Journal title

Menopause

Volume

28

Issue

7

Page(s)

811-818

10.1097/GME.0000000000001779

Abstract

Abstract

Objective:Whether hormonal changes during menopausal transition postmenopause stages influence pulmonary function is not clearly understood. We evaluated the association between each stage of menopause and the prevalence of abnormal lung function in healthy middle-aged women. We hypothesized that the prevalence of abnormal lung function would increase from the late menopausal transition stage during menopausal transition postmenopause stages.Methods:The study population included women 40 to 65 years of age who underwent comprehensive health screening examination at the Kangbuk Samsung Hospital Total Healthcare Centers from January 2015 to December 2017. Stages of menopause (premenopausal, early menopausal transition, late menopausal transition, and postmenopausal) were defined using the 2011 Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Abnormal lung function was defined based on spirometry as forced expiratory volume in 1 second/forced vital capacity less than70% or forced vital capacity less than 80% predicted. Prevalence ratios (PRs) for abnormal lung function by stages of menopause were estimated from logistic regression models adjusted for age, anthropometric measurements, lifestyle factors, medical history, lipid and inflammatory biomarkers, and reproductive factors.Results:Among 43,822 participants, there were 4,615 participants (10.5%) with restrictive ventilatory disorder and 653 participants (1.5%) with obstructive ventilatory disorder. The fully adjusted PRs (95% confidence interval) for abnormal ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stage to premenopausal stage were 1.01 (0.94-1.08), 1.13 (1.03-1.22), and 1.10 (0.98-1.22), respectively. The fully adjusted PRs for restrictive ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stages to premenopausal stage were 1.02 (0.94-1.11), 1.18 (1.06-1.30), and 1.15 (1.00-1.31), respectively. There was, however, no clear association between stages of menopause and obstructive ventilatory disorder.Conclusions:In this large study of middle-aged women, the fully adjusted prevalence of abnormal lung function, particularly that of restrictive ventilatory disorder, was higher in women in late menopausal transition and menopausal stages compared to women in premenopausal stage.

Standardization and Prediction to Control Confounding : Estimating Risk Differences and Ratios for Clinical Interpretations and Decision Making

Localio, A. R., Henegan, J. A., Chang, S., Meibohm, A. R., Ross, E. A., Goodman, S. N., Couper, D., Guallar, E., & Griswold, M. E. (n.d.).

Publication year

2025

Journal title

Annals of internal medicine

Volume

178

Issue

6

Page(s)

829-835

10.7326/ANNALS-25-00082

Abstract

Abstract

What is the added risk for death from smoking? Logistic regression has become the most common statistical method to answer such questions in the biomedical literature. However, the typical analyses estimate odds ratios, a metric too often misunderstood and misinterpreted. Although estimates of risks, and their differences and ratios, offer transparent clinical interpretations, commonly used statistical models have known methodological shortcomings. “Standardization” through modeling, weighting, or matching offers a solution. The goals of this article are to review classical concepts of standardization and to link them to regression modeling for causal inference. The authors also describe approaches based on weighting and matching compared with regression-based standardization. Using an example of smoking from the ARIC (Atherosclerosis Risk in Communities) study, they explain the value of standardization, long used in medicine and public health, to estimate risks and their differences and ratios for binary outcomes. The authors demonstrate how standard statistical software using models that best fit the data and respect underlying biological or clinical processes can reexpress results in clinically meaningful metrics. The Supplement offers examples with common software packages.

Statins and cancer : A case of meta-uncertainty

Guallar, E., & Goodman, S. N. (n.d.).

Publication year

2001

Journal title

American Journal of Medicine

Volume

110

Issue

9

Page(s)

738-740

10.1016/S0002-9343(01)00758-6

Abstract

Abstract

~

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

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

Publication year

2012

Journal title

International Journal of Clinical Practice

Volume

66

Issue

9

Page(s)

897-905

10.1111/j.1742-1241.2012.02992.x

Abstract

Abstract

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

Structured management strategy versus usual care for gastroesophageal reflux disease : Rationale for pooled analysis of five European cluster-randomized trials

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

Publication year

2011

Journal title

Therapeutic Advances in Gastroenterology

Volume

4

Issue

1

Page(s)

11-26

10.1177/1756283X10387060

Abstract

Abstract

Background: 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.

Studies using randomized trial data to compare nonrandomized exposures

Stack, C. B., Meibohm, A. R., Liao, J. M., & Guallar, E. (n.d.).

Publication year

2020

Journal title

Annals of internal medicine

Volume

172

Issue

7

Page(s)

492-494

10.7326/M20-0071

Abstract

Abstract

~

Subclinical Hypothyroidism and Incident Depression in Young and Middle-Age Adults

Kim, J. S., Zhang, Y., Chang, Y., Ryu, S., Guallar, E., Shin, Y. C., Shin, H., Lim, S. W., & Cho, J. (n.d.).

Publication year

2018

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

103

Issue

5

Page(s)

1827-1833

10.1210/jc.2017-01247

Abstract

Abstract

Background: The role of subclinical hypothyroidism in the development of depression remains controversial. We examined the prospective association between subclinical hypothyroidism and incident depressive symptoms. Methods: We conducted a prospective cohort study of 220,545 middle-age adults without depression who had undergone at least two comprehensive health examinations between 1 January 2011 and 31 December 2014. Thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured using an electrochemiluminescent immunoassay. The study outcome was incident depressive symptoms, defined as a Center for Epidemiologic Studies- Depression score .16. Results: During a median follow-up period of 2 years, incident depressive symptoms occurred in 7323 participants. The multivariable-adjusted hazard ratio for incident depressive symptoms comparing subclinical hypothyroid and euthyroid participants was 0.97 (95% confidence interval, 0.87 to 1.09). Similarly, among euthyroid participants (n = 87,822), no apparent association was found between thyroid hormone levels and an increased risk of incident depressive symptoms. Conclusions: No apparent association was found between subclinical hypothyroidism and incident depressive symptoms in a large prospective cohort of middle-age men and women.

Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women

Chun, S., Choi, Y., Chang, Y., Cho, J., Zhang, Y., Rampal, S., Zhao, D., Ahn, J., Suh, B. S., Pastor-Barriuso, R., Lima, J. A., Chung, E. C., Shin, H., Guallar, E., & Ryu, S. (n.d.).

Publication year

2016

Journal title

American Heart Journal

Volume

177

Page(s)

17-24

10.1016/j.ahj.2016.03.018

Abstract

Abstract

Background Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease, but its association with subclinical coronary heart disease remains unclear. We investigated the relationship between sugar-sweetened carbonated beverage consumption and coronary artery calcium (CAC) in a large study of asymptomatic men and women. Methods This was a cross-sectional study of 22,210 adult men and women who underwent a comprehensive health screening examination between 2011 and 2013 (median age 40 years). Sugar-sweetened carbonated beverage consumption was assessed using a validated food frequency questionnaire, and CAC was measured by cardiac computed tomography. Multivariable-adjusted CAC score ratios and 95% CIs were estimated from robust Tobit regression models for the natural logarithm (CAC score +1). Results The prevalence of detectable CAC (CAC score >0) was 11.7% (n = 2,604). After adjustment for age; sex; center; year of screening examination; education level; physical activity; smoking; alcohol intake; family history of cardiovascular disease; history of hypertension; history of hypercholesterolemia; and intake of total energy, fruits, vegetables, and red and processed meats, only the highest category of sugar-sweetened carbonated beverage consumption was associated with an increased CAC score compared with the lowest consumption category. The multivariable-adjusted CAC ratio comparing participants who consumed ≥5 sugar-sweetened carbonated beverages per week with nondrinkers was 1.70 (95% CI, 1.03-2.81). This association did not differ by clinical subgroup, including participants at low cardiovascular risk. Conclusion Our findings suggest that high levels of sugar-sweetened carbonated beverage consumption are associated with a higher prevalence and degree of CAC in asymptomatic adults without a history of cardiovascular disease, cancer, or diabetes.

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

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

Publication year

2012

Journal title

European Journal of Preventive Cardiology

Volume

19

Issue

3

Page(s)

541-550

10.1177/1741826711407705

Abstract

Abstract

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

Survival in untreated hepatocellular carcinoma : A national cohort study

Kim, Y. A., Kang, D., Moon, H., Sinn, D., Kang, M., Woo, S. M., Chang, Y. J., Park, B., Kong, S. Y., Guallar, E., Shin, S. Y., Gwak, G., Back, J. H., Lee, E. S., & Cho, J. (n.d.).

Publication year

2021

Journal title

PloS one

Volume

16

Issue

2 February

10.1371/journal.pone.0246143

Abstract

Abstract

This study aimed to analyze the proportion, characteristics and prognosis of untreated hepatocellular carcinoma (HCC) patients in a large representative nationwide study. A cohort study was conducted using the National Health Insurance Service (NHIS) database in Korea. A total of 63,668 newly-diagnosed HCC patients between January 2008 and December 2013 were analyzed. Patients were categorized into treatment group and no treatment group using claim codes after HCC diagnosis. The proportion of untreated HCC patients was 27.6%, decreasing from 33.4% in 2008 to 24.8% in 2013. Compared to treated patients, untreated patients were more likely to be older (P< 0.001), female (P< 0.01), to have a distant SEER stage (P< 0.001), severe liver disease (P< 0.001), and lower income (P< 0.001). The fully-Adjusted hazard ratio for all-cause mortality comparing untreated to treated patients was 3.11 (95% CI, 3.04 3.18). The risk of mortality was higher for untreated patients in all pre-defined subgroups, including those with distant SEER stage and those with severe liver disease. About one fourth of newly diagnosed HCC patients did not receive any HCC-specific treatment. Untreated patients showed higher risk of mortality compared to treated patients in all subgroups. Further studies are needed to identify obstacles for HCC treatment and to improve treatment rates.

Synergistic opportunities in the interplay between cancer screening and cardiovascular disease risk assessment : Together we are stronger

Handy, C. E., Quispe, R., Pinto, X., Blaha, M. J., Blumenthal, R. S., Michos, E. D., Lima, J. A., Guallar, E., Ryu, S., Cho, J., Kaye, J. A., Comin-Colet, J., Corbella, X., & Cainzos-Achirica, M. (n.d.).

Publication year

2018

Journal title

Circulation

Volume

138

Issue

7

Page(s)

727-734

10.1161/CIRCULATIONAHA.118.035516

Abstract

Abstract

Cardiovascular disease (CVD) and cancer continue to be the 2 leading causes of death in developed countries despite significant improvements in the prevention, screening, and treatment of both diseases. They remain significant public health problems, growing in importance globally. Despite this threat, the fields of cardiology and oncology have been relatively disconnected. With many shared modifiable risk factors, cancer and CVD often coexist in the same individuals; those diagnosed with lung cancer, breast cancer, and colon cancer are at higher risk of CVD, and those with CVD are at higher risk of developing many types of common cancers. Screening paradigms have been established in parallel, but there are opportunities for combined risk assessments for cancer and CVD risk. Joining forces for combined cardiovascular and hemato-oncological preventive and research efforts will likely have synergistic, worldwide public health benefits.

Systematic review for the 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines

American College of Cardiology, A., American College of Cardiology/American Heart Association, A., Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. R., Polonsky, T., Thompson-Paul, A. M., Vupputuri, S., Levine, G. N., O'Gara, P. T., Halperin, J. L., Past, I., Al-Khatib, S. M., Beckman, J. A., Birtcher, K. K., … Hundley, J. (n.d.).

Publication year

2018

Journal title

Hypertension

Volume

71

Issue

6

Page(s)

E116-E135

10.1161/HYP.0000000000000067

Abstract

Abstract

Objective-To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods-Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results-Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. (., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (n.d.).

Publication year

2018

Journal title

Journal of the American College of Cardiology

Volume

71

Issue

19

Page(s)

2176-2198

10.1016/j.jacc.2017.11.004

Abstract

Abstract

Objective: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. P., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (n.d.).

Publication year

2018

Journal title

Circulation

Volume

138

Issue

17

Page(s)

e595-e616

10.1161/CIR.0000000000000601

Abstract

Abstract

Objective To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Systematic review of three decades of Spanish cardiovascular epidemiology : Improving translation for a future of prevention

Franco, M., Bilal, U., Guallar, E., Sanz, G., Gómez, A. F., Fuster, V., & Cooper, R. (n.d.).

Publication year

2013

Journal title

European Journal of Preventive Cardiology

Volume

20

Issue

4

Page(s)

565-576

10.1177/2047487312455314

Abstract

Abstract

Background: In order to improve national cardiovascular disease (CVD) epidemiology and prevention, we systematically reviewed and analyzed the relevant literature produced in the last three decades for Spain. Design: Systematic Review. Methods: We searched for all the articles aiming to monitor CVD clinical endpoints and risk factors in the Spanish general population that were indexed in MEDLINE and EMBASE. Based on international recommendations, we analyzed each article with a three-level scoring system (low to high) for the following criteria: data quality, representativeness and translation of results into preventive interventions. Results: We reviewed 2565 articles, selecting 314 for in-depth analysis. Articles about diet, blood pressure, obesity and smoking represented 53% of all published CVD studies, whereas those about physical activity or psychosocial factors represented only 5%. Low data quality was found in 67% and 60% of the articles about physical activity and smoking, respectively. High data quality was found in 77% and 61% of the articles dedicated to diet and blood pressure, respectively. Representativeness was low for 41%, 31% and 25% of the studies focusing on diet, smoking and diabetes, respectively. Translation of research results into prevention scored lowest of all three criteria, as 41% of all 314 articles scored low. None of the articles on obesity, diabetes, lipids, physical activity or psychosocial factors identified any specific preventive intervention. Conclusion: Future Spanish CVD epidemiology research will benefit from improving not just the quality and representativeness of the data measured, but drastically improving the translation of research results into future preventive interventions. The lack of a translational focus remains the fundamental gap in CVD research.

Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure : An Evaluation of Their Joint Effect on Mortality

Pastor-Barriuso, R., Banegas, J. R., Damián, J., Appel, L. J., & Guallar, E. (n.d.).

Publication year

2003

Journal title

Annals of internal medicine

Volume

139

Issue

9

Page(s)

731-739+I46

10.7326/0003-4819-139-9-200311040-00007

Abstract

Abstract

Background: The relative importance of blood pressure components (systolic blood pressure, diastolic blood pressure, and pulse pressure) on cardiovascular risk is currently being debated. Many studies, however, are limited by inadequate statistical methods to separate these effects. Objective: To evaluate the joint effect of blood pressure components on all-cause and cardiovascular mortality by using non-parametric and change point models. Design: Prospective cohort study. Setting: 15-year mortality follow-up of participants in the Second National Health and Nutrition Examination Survey. Participants: 7830 white and African-American men and women 30 to 74 years of age, apparently free of cardiovascular disease at baseline. Measurements: Baseline blood pressure, corrected for measurement error. Results: Of the 1588 patients who died, 582 died of cardiovascular disease. Systolic blood pressure was linearly related to all-cause and cardiovascular mortality in younger and elderly participants. The association of diastolic blood pressure with all-cause and cardiovascular mortality was hockey stick-shaped (flat then increasing) in younger participants and J-shaped in elderly participants. Increased pulse pressure was associated with increased risk, decreased risk, or no change in risk depending on age and systolic and diastolic blood pressure. Conclusions: On the basis of these and previous data, the evidence for a monotonic association of systolic blood pressure with all-cause and cardiovascular mortality is compelling, but a J-shaped association for diastolic blood pressure may develop at older age. The complexity of the association of pulse pressure with mortality discourages its use for prognostic or therapeutic decisions.

Temporal patterns of chronic disease incidence after breast cancer : a nationwide population-based cohort study

Kang, D., Kang, M., Hong, Y. S., Park, J., Lee, J., Seo, H. J., Kim, D. W., Ahn, J. S., Park, Y. H., Lee, S. K., Shin, D. W., Guallar, E., & Cho, J. (n.d.).

Publication year

2022

Journal title

Scientific reports

Volume

12

Issue

1

10.1038/s41598-022-09542-w

Abstract

Abstract

We conducted a retrospective cohort study to evaluate the temporal pattern of incidence of chronic conditions after developing breast cancer using a population-based national registry. We selected 84,969 women with newly diagnosed breast cancer between 2002 and 2016 and a 1:10 sample of age-matched non-breast cancer controls (N = 1,057,674). The main study exposure was incident breast cancer, considered as a time-varying exposure. The outcomes were incident cases of leukemia, endometrial cancer, myeloma, cardiomyopathy, osteoporosis, end stage renal disease (ESRD), pulmonary fibrosis, hypothyroidism, type 2 diabetes, hypertension and hyperlipidemia. The development of breast cancer was associated with a significantly increased risk of all outcomes analyzed except for ESRD and hypertension. The fully-adjusted risks of leukemia (HR 3.09; 95% CI 2.11–4.51), cardiomyopathy (HR 2.65; 95% CI 1.90–3.68), endometrial cancer (HR 3.53; 95% CI 2.76–4.53), hypothyroidism (HR 1.29; 95% CI 1.19–1.40), pulmonary fibrosis (HR 1.84; 95% CI 1.12–3.02), and hyperlipidemia (HR 1.24; 95% CI 1.20–1.28) remained significantly elevated after more than 5 years since diagnosis. Optimal care for breast cancer survivors requires close collaboration between oncologists and allied health care professionals to identify and manage the long-term morbidity and mortality associated with these chronic conditions.

Testosterone and Cardiovascular Disease in Men

Zhao, D., & Guallar, E. (n.d.).

Publication year

2022

Journal title

Annals of internal medicine

Volume

175

Issue

2

Page(s)

287-288

10.7326/M21-4777

Abstract

Abstract

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The association between blood pressure and lipid levels in Europe : European study on cardiovascular risk prevention and management in usual daily practice

Borghi, C., Rodriguez-Artalejo, F., De Backer, G., Dallongeville, J., Medina, J., Guallar, E., Perk, J., Banegas, J. R., Tubach, F., Roy, C., & Halcox, J. P. (n.d.).

Publication year

2016

Journal title

Journal of Hypertension

Volume

34

Issue

11

Page(s)

2155-2163

10.1097/HJH.0000000000001078

Abstract

Abstract

Objectives: Several studies have suggested a positive association between serum lipid levels and blood pressure (BP). This study investigated this association in a large population from 12 European countries. Methods: Data were taken from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (ClinicalTrials.gov identifier: NCT00882336). Associations between BP and lipid levels in patients free from cardiovascular disease and with at least one major cardiovascular disease risk factor (N=7641) were assessed using linear regression analyses. Results: Overall, 72.8 and 64.8% of patients had hypertension and dyslipidaemia, respectively; 47.0% had both conditions. Regression coefficients (95% confidence interval) for the associations of LDL cholesterol, non-HDL cholesterol, total cholesterol and apolipoprotein B levels with SBP, adjusted for age, sex and BMI, were 0.93 mmHg/mmol per l (0.54-1.31), 1.07 mmHg/mmol per l (0.73-1.40), 1.02 mmHg/mmol per l (0.69-1.35) and 4.94 mmHg/g per l (3.43-6.46), respectively. The corresponding values (95% confidence interval) for the associations with DBP were 0.96 mmHg/mmol per l (0.73-1.19), 0.95 mmHg/mmol per l (0.75-1.15), 0.87 mmHg/mmol per l (0.67-1.07) and 4.33 mmHg/g per l (3.42-5.23), respectively. Most of these associations remained significant whether patients were treated with statins or not. Conclusion: Small but statistically significant associations between lipid levels and BP were observed in a large, multinational European population. Further research is warranted to assess the causality of this association and its implications on the management of patients with both hypertension and dyslipidaemia.