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
Vitamin-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.A guide to this supplement
AbstractHelfand, M., Morton, S., Guallar, E., & Mulrow, C. (n.d.).Publication year
2005Journal title
Annals of internal medicineVolume
142Issue
12 IIPage(s)
1033-1034Abstract~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-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 (High-dosage vitamin E supplementation and all-cause mortality [1] (multiple letters)
AbstractBlatt, 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.).Publication year
2005Journal title
Annals of internal medicineVolume
143Issue
2Page(s)
150-158Abstract~Low 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.Metals in urine and peripheral arterial disease
AbstractNavas-Acien, A., Silbergeld, E. K., Sharrett, A. R., Calderon-Aranda, E., Selvin, E., & Guallar, E. (n.d.).Publication year
2005Journal title
Environmental health perspectivesVolume
113Issue
2Page(s)
164-169AbstractExposure to metals may promote atherosclerosis. Blood cadmium and lead were associated with peripheral arterial disease (PAD) in the 1999-2000 National Health and Nutrition Examination Survey (NHANES). In the present study we evaluated the association between uninary levels of cadmium, lead, barium, cobalt, cesium, molybdenum, antimony, thallium, and tungsten with PAD in a cross-sectional analysis of 790 participants ≥ 40 years of age in NHANES 1999-2000. PAD was defined as a blood pressure ankle brachial index < 0.9 in at least one leg. Metals were measured in casual (spot) urine specimens by inductively coupled plasma-mass spectrometry. After multi-variable adjustment, subjects with PAD had 36% higher levels of cadmium in urine and 49% higher levels of tungsten compared with noncases. The adjusted odds ratio for PAD comparing the 75th to the 25th percentile of the cadmium distribution was 3.05 [95% confidence interval (CI), 0.97 to 9.58]; that for tungsten was 2.25 (95% CI, 0.97 to 5.24). PAD risk increased sharply at low levels of antimony and remained elevated beyond 0.1 μg/L. PAD was not associated with other metals. In conclusion, urinary cadmium, tungsten, and possibly antimony were associated with PAD in a representative ample of the U.S. poupulation. For cadmium, these results strengthen previous findings using blood cadmium as a biomarker, and they support its role in atherosclerosis. For tungsten and antimony, these results need to be interpreted cautiously in the context of an exploratory analysis but deserve further study. Other metals in urine were not associated with PAD at the levels found in the general population.Peripheral arterial disease and metals in urine and blood (multiple letters) [3]
AbstractPlusquin, M., Nawrot, T. S., Staessen, J. A., Navas-Acien, A., Silbergeld, E. K., & Guallar, E. (n.d.).Publication year
2005Journal title
Environmental health perspectivesVolume
113Issue
8Page(s)
A510-A511Abstract~Physical activity, APOE genotype, and dementia risk : Findings from the Cardiovascular Health Cognition Study
AbstractPodewils, L. J., Guallar, E., Kuller, L. H., Fried, L. P., Lopez, O. L., Carlson, M., & Lyketsos, C. G. (n.d.).Publication year
2005Journal title
American Journal of EpidemiologyVolume
161Issue
7Page(s)
639-651AbstractPhysical activity may help preserve cognitive function and decrease dementia risk, but epidemiologic findings are inconsistent. The authors conducted a prospective study to determine the association between physical activity and risk of dementia, Alzheimer's disease, and vascular dementia. The US study population comprised 3,375 men and women aged 65 years or older, free of dementia at baseline, who participated in the Cardiovascular Health Cognition Study in 1992-2000. Leisure-time energy expenditure and an activity index reflecting number of different physical activities were calculated. Analyses were based on Cox proportional hazards models. There were 480 incident cases of dementia over an average of 5.4 years of follow-up. After multivariate adjustment, participants in the highest quartile of physical energy expenditure had a relative risk of dementia of 0.85 (95% confidence interval: 0.61, 1.19) compared with those in the lowest quartile, and participants engaging in ≥4 activities had a relative risk of dementia of 0.51 (95% confidence interval: 0.33, 0.79) compared with those engaging in 0-1 activity. These associations were more marked in apolipoprotein E genotype (APOE) ε4 allele noncarriers but were absent in carriers. A similar pattern was observed for Alzheimer's disease and vascular dementia. Mechanisms to explain the observed relations deserve further study.Relationship of monocyte count and peripheral arterial disease : Results from the National Health and Nutrition Examination Survey 1999-2002
AbstractNasir, K., Guallar, E., Navas-Acien, A., Criqui, M. H., & Lima, J. A. (n.d.).Publication year
2005Journal title
Arteriosclerosis, Thrombosis, and Vascular BiologyVolume
25Issue
9Page(s)
1966-1971AbstractBackground - Although white blood cell (WBC) count has been consistently associated with cardiovascular end points, little information is available on the independent contribution of specific white blood cell types. The objective of this study is to assess the independent association of WBC types and other inflammatory markers with the presence of reduced ankle-brachial blood pressure index (ABI), a marker of subclinical peripheral arterial disease (PAD). Methods & Results - Cross-sectional study in 3949 individuals ≥40 years of age without known cardiovascular disease who participated in the 1999 to 2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ABIThe efficacy of sirolimus- and paclitaxel-eluting stents : A meta-analysis of randomized controlled trials
AbstractKittleson, M. M., Needham, D. M., Kim, S. J., Ravindran, B. K., Solomon, S. S., & Guallar, E. (n.d.).Publication year
2005Journal title
Canadian Journal of CardiologyVolume
21Issue
7Page(s)
581-587AbstractBackground: Drug-eluting stents prevent in-stent restenosis after percutaneous coronary intervention, and differences between sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) may exist in the rates of target lesion revascutarization, death, myocardial infarction and stent thrombosis. Objective: To compare the efficacy of SES and PES with the efficacy of bare-metal stents for de novo coronary lesions in patients with stable or unstable angina. Methods: A meta-analysis of randomized trials from MEDLINE, EMBASE and other electronic databases and conference proceedings was conducted. The efficacy of SES, PES with a polymer carrier (PPOL) and PES without a polymer carrier (PNPOL) was compared using random-effects models. Results: Ten trials comprising 5041 patients were included in the meta-analysis. There was an absolute decrease in target lesion revascularization of 17% (95% CI 14% to 20%), 9% (95% CI 6% to 11%) and 3% (95% CI 0% to 6%) with SES, PPOL and PNPOI, respectively, with significant difterences between SES and PPOL and between PPOL and PNPOL (PLead, cadmium, smoking, and increased risk of peripheral arterial disease.
AbstractNavas-Acien, A., Selvin, E., Sharrett, A. R., Calderon-Aranda, E., Silbergeld, E., & Guallar, E. (n.d.).Publication year
2004Journal title
CirculationVolume
109Issue
25Page(s)
3196-3201AbstractBACKGROUND: Lead and cadmium exposure may promote atherosclerosis, although the cardiovascular effects of chronic low-dose exposure are largely unknown. The objective of the present study was to evaluate the association between blood levels of lead and cadmium and peripheral arterial disease. METHODS AND RESULTS: We analyzed data from 2125 participants who were > or =40 years of age in the 1999 to 2000 National Health and Nutrition Examination Survey (NHANES). Peripheral arterial disease was defined as an ankle brachial indexPreoperative acute normovolemic hemodilution : A meta-analysis
AbstractSegal, J. B., Blasco-Colmenares, E., Norris, E. J., & Guallar, E. (n.d.).Publication year
2004Journal title
TransfusionVolume
44Issue
5Page(s)
632-644AbstractBACKGROUND: Acute normovolemic hemodilution (ANH) involves withdrawal of whole blood with concurrent infusion of fluids to maintain normovolemia. The aim of this study was to quantify the efficacy and safety of preoperative ANH with a systematic review and meta-analysis. STUDY DESIGN AND METHODS: Randomized controlled trials were identified through MEDLINE (1966-2002) and the Cochrane Controlled Trials Database and with hand searching of journals. All trials of preoperative ANH reporting on allogeneic transfusion, bleeding, or adverse outcomes were included. Paired reviewers independently abstracted data. Outcomes were pooled using random-effects models. RESULTS: A total of 42 trials compared hemodilution to usual care or to another blood conservation method. The risk of allogeneic transfusion was similar among patients receiving ANH and those receiving usual care (relative risk [RR], 0.96; 95% Cl, 0.90-1.01), or another blood conservation method (RR, 1.11; 95% Cl, 0.96-1.28). Hemodiluted patients, however, were transfused from 1 to 2 fewer units of allogeneic blood. They had less total bleeding than patients receiving usual care (91 mL; 95% Cl, 25-158 mL), although more intraoperative bleeding. Only one-third of studies reported on adverse events. CONCLUSIONS: The literature supports only modest benefits from preoperative ANH. The safety of the procedure is unproven. Widespread adoption of ANH cannot be encouraged.Serum ferritin and risk of the metabolic syndrome in U.S. adults
AbstractJehn, M., Clark, J. M., & Guallar, E. (n.d.).Publication year
2004Journal title
Diabetes CareVolume
27Issue
10Page(s)
2422-2428AbstractOBJECTIVE - We examined the relationship among iron stores, the metabolic syndrome, and insulin resistance. RESEARCH DESIGN AND METHODS - We conducted a cross-sectional study of 6,044 adults >20 years of age who participated in the Third National Health and Nutrition Examination Survey. Metabolic syndrome was defined as the presence of at least three of the following: elevated blood pressure, low HDL cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Insulin resistance was estimated using homeostasis model assessment (for insulin resistance), fasting insulin, and triglyceride-to-HDL cholesterol ratio. RESULTS - After excluding individuals with likely hemochromatosis, mean serum ferritin values in premenopausal women, postmenopausal women, and men were 33.6, 93.4, and 139.9 μg/l, respectively. Metabolic syndrome was more common in those with the highest compared with the lowest levels of serum ferritin in premenopausal women (14.9 vs. 6.4%, P = 0.002), postmenopausal women (47.5 vs. 28.2%, P < 0.001), and men (27.3 vs. 13.8%, P < 0.001). Insulin resistance also increased across quartiles of serum ferritin for men and postmenopausal women and persisted after adjustment for age, race/ethnicity, C-reactive protein, smoking, alcohol intake, and BMI. CONCLUSIONS - Elevated iron stores were positively associated with the prevalence of the metabolic syndrome and with insulin resistance.Mercury and the risk of myocardial infarction [3] (multiple letters)
AbstractPlante, M., Babo, S., Mutter, J., Naumann, J., Buettner, C., Guallar, E., Riemersma, R. A., Kok, F. J., Yoshizawa, K., Rimm, E. B., Willett, W. C., Bolger, P. M., & Schwetz, B. (n.d.).Publication year
2003Journal title
New England Journal of MedicineVolume
348Issue
21Page(s)
2151-2154Abstract~Meta-Analysis of Randomized Educational and Behavioral Interventions in Type 2 Diabetes
AbstractGary, T. L., Genkinger, J. M., Guallar, E., Peyrot, M., & Brancati, F. L. (n.d.).Publication year
2003Journal title
The Diabetes EducatorVolume
29Issue
3Page(s)
488-501AbstractPURPOSE this meta-analysis was conducted to assess the effect of educational and behavioral interventions on body weight and glycemic control in type 2 diabetes. MEHODS Studies selected for analysis were published randomized controlled trials that evaluated educational and behavioral interventions (no drug interventions) in type 2 diabetes (sample size 210). These criteria were applied to searches of electronic databases and relevant bibliographies. Data were independently abstracted by 2 reviewers and adjudicated by consensus. RESULTS Of the 63 articles that met the inclusion criteria, 18 provided enough information for pooled estimates of glycohemoglobin (total Ghb, HbA1, or HbA1 C). These 18 studies yielded 2720 participants (sample sizes of 18 to 749). Interventions ranged from 1 to 19 months; follow-up ranged from 1 to 26 months. Glycohemoglobin was reduced by a mean of 0.43%. When results were stratified by quality score, glycohemoglobin was -0.50% and -0.38% for studies with high and low quality scores, respectively. When weighting studies by sample size, fasting blood glucose was reduced by 24 mg/dL and weight by 3 lbs. CONCLUSIONS Previous educational and behavioral interventions in type 2 diabetes have produced modest improvements in glycemic control. Future research should refine such interventions and improve methodology.Outpatient prescriptions for atypical antipsychotics for African Americans, Hispanics, and whites in the United States
AbstractDaumit, G. L., Crum, R. M., Guallar, E., Powe, N. R., Primm, A. B., Steinwachs, D. M., & Ford, D. E. (n.d.).Publication year
2003Journal title
Archives of General PsychiatryVolume
60Issue
2Page(s)
121-128AbstractBackground: New antipsychotic medications introduced during the past decade - clozapine (1990), risperidone (1994), olanzapine (1996), and quetiapine fumarate (1997) - offer a decrease in serious adverse effects compared with traditional antipsychotic medications, but at up to 10 times the cost. We examined whether ethnic minorities achieve access to these new advanced treatments. Methods: Using national data on physician office and hospital outpatient department visits from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 1992 through 2000, we selected all patient visits at which an antipsychotic medication (atypical or traditional) was prescribed or continued and the patient was aged between 18 and 69 years. We performed a series of cross-sectional logistic regression analyses to determine the association of ethnic group and receipt of an atypical antipsychotic prescription over time, adjusted for potential confounders such as age, diagnosis, and health insurance type. Results: Antipsychotic medication was prescribed or continued in 5032 visits; 33% of overall visits involved an atypical antipsychotic prescription. During 1992 to 1994, the adjusted relative odds of receipt of an atypical antipsychotic prescription for African Americans was 0.50 (95% confidence interval [CI], 0.26-0.96) and for Hispanics was 0.43 (95% CI, 0.16-1.18) compared with whites. During 1995 to 1997, the odds of receipt of a prescription for atypical antipsychotics increased for African Americans (odds ratio [OR], 0.69; 95% CI, 0.54-0.85) and for Hispanics (OR, 0.84; 95% CI, 0.65-1.07) compared with whites; and during 1998 to 2000, the relative odds continued to increase for African Americans (OR, 0.88; 95% CI, 0.78-0.97) and for Hispanics (OR, 1.05; 95% CI, 0.92-1.16) compared with whites. For visits specified for psychotic disorders, receipt of atypical antipsychotics was still lower for African Americans by 1998 to 2000 (adjusted OR, 0.74; 95% CI, 0.61-0.89) compared with whites, while for Hispanics the relative odds was equivalent (adjusted OR, 1.05; 95% CI, 0.87-1.19). Conclusion: Early gaps between ethnic groups in receipt of atypical antipsychotic prescriptions decreased throughout the 1990s but persisted for African Americans with psychotic disorders.Review : Ambulatory blood pressure monitoring predicts clinical outcomes
AbstractGuallar, E., Appel, L. J., Robinson, K. A., & Guallar, E. (n.d.).Publication year
2003Journal title
Evidence-Based MedicineVolume
8Issue
4Page(s)
120Abstract~Systolic Blood Pressure, Diastolic Blood Pressure, and Pulse Pressure : An Evaluation of Their Joint Effect on Mortality
AbstractPastor-Barriuso, R., Banegas, J. R., Damián, J., Appel, L. J., & Guallar, E. (n.d.).Publication year
2003Journal title
Annals of internal medicineVolume
139Issue
9Page(s)
731-739+I46AbstractBackground: 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.Transition models for change-point estimation in logistic regression
AbstractPastor-Barriuso, R., Guallar, E., & Coresh, J. (n.d.).Publication year
2003Journal title
Statistics in MedicineVolume
22Issue
7Page(s)
1141-1162AbstractAlthough a wide variety of change-point models are available for continuous outcomes, few models are available for dichotomous outcomes. This paper introduces transition methods for logistic regression models in which the dose-response relationship follows two different straight lines, which may intersect or may present a jump at an unknown change-point. In these models, the logit includes a differentiable transition function that provides parametric control of the sharpness of the transition at the change-point, allowing for abrupt changes or more gradual transitions between the two different linear trends, as well as for estimation of the location of the change-point. Linear-linear logistic models are particular cases of the proposed transition models. We present a modified iteratively reweighted least squares algorithm to estimate model parameters, and we provide inference procedures including a test for the existence of the change-point. These transition models are explored in a simulation study, and they are used to evaluate the existence of a change-point in the association between plasma glucose after an oral glucose tolerance test and mortality using data from the Mortality Follow-up of the Second National Health and Nutrition Examination Survey.Mercury, fish oils, and the risk of myocardial infarction
AbstractGuallar, E., Sanz-Gallardo, M. I., Van'T Veer, P., Bode, P., Aro, A., Gómez-Aracena, J., Kark, J. D., Riemersma, R. A., Martín-Moreno, J. M., & Kok, F. J. (n.d.).Publication year
2002Journal title
New England Journal of MedicineVolume
347Issue
22Page(s)
1747-1754AbstractBackground: It has been suggested that mercury, a highly reactive heavy metal with no known physiologic activity, increases the risk of cardiovascular disease. Because fish intake is a major source of exposure to mercury, the mercury content of fish may counteract the beneficial effects of its n-3 fatty acids. Methods: In a case-control study conducted in eight European countries and Israel, we evaluated the joint. association of mercury levels in toenail clippings and docosahexaenoic acid (C22:6n-3, or DHA) levels in adipose tissue with the risk of a first myocardial infarction among men. The patients were 684 men with a first diagnosis of myocardial infarction. The controls were 724 men selected to be representative of the same populations. Results: The average toenail mercury level in controls was 0.25 μg per gram. After adjustment for the DHA level and coronary risk factors, the mercury levels in the patients were 15 percent higher than those in controls (95 percent confidence interval, 5 to 25 percent). The risk-factor-adjusted odds ratio for myocardial infarction associated with the highest as compared with the lowest quintile of mercury was 2.16 (95 percent confidence interval, 1.09 to 4.29; P for trend = 0.006). After adjustment for the mercury level, the DHA level was inversely associated with the risk of myocardial infarction (odds ratio for the highest vs. the lowest quintile, 0.59; 95 percent confidence interval, 0.30 to 1.19; P for trend = 0.02). Conclusions: The toenail mercury level was directly associated with the risk of myocardial infarction, and the adipose-tissue DHA level was inversely associated with the risk. High mercury content may diminish the cardioprotective effect of fish intake.Receipt of preventive medical services at psychiatric visits by patients with severe mental illness
AbstractDaumit, G. L., Crum, R. M., Guallar, E., & Ford, D. E. (n.d.).Publication year
2002Journal title
Psychiatric ServicesVolume
53Issue
7Page(s)
884-887AbstractThe authors used data from the National Ambulatory Medical Care Survey from 1992 to 1999 on 3,198 office visits to explore the extent to which psychiatrists provide clinical preventive medical services to patients with severe mental illness. Preventive services were provided during 11 percent of the visits. A multivariate analysis showed that preventive services were more likely to have been provided for patients with a chronic medical condition, for patients who were also seen by a nurse or other health provider during the visit, in rural areas, and during longer visits. Preventive services were less likely to have been provided during visits to health maintenance organizations and visits that took place later in the study period.