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

The effect of magnesium supplementation on blood pressure : A meta-analysis of randomized clinical trials

Jee, S. H., Miller, E. R., Guallar, E., Singh, V. K., Appel, L. J., & Klag, M. J. (n.d.).

Publication year

2002

Journal title

American Journal of Hypertension

Volume

15

Issue

8

Page(s)

691-696

10.1016/S0895-7061(02)02964-3

Abstract

Abstract

Background: An increased intake of magnesium might lower blood pressure (BP), yet evidence from clinical trials is inconsistent, perhaps as a result of small sample size or heterogeneity in study design. Methods: We performed a meta-analysis of randomized trials that tested the effects of magnesium supplementation on BP. Twenty trials meeting the inclusion criteria were identified. Random effects models and meta-regression methods were used to pool study results and to determine the dose-response relationship of magnesium to BP. Results: The 20 studies included 14 of hypertensive and 6 of normotensive persons totaling 1220 participants. The doses of magnesium ranged from 10 to 40 mmol/day (median, 15.4 mmol/day). Magnesium supplementation resulted in only a small overall reduction in BP. The pooled net estimates of BP change (95% confidence interval [CI]) were -0.6 (-2.2 to 1.0) mm Hg for systolic BP and -0.8 (-1.9 to 0.4) mm Hg for diastolic BP. However, there was an apparent dose-dependent effect of magnesium, with reductions of 4.3 mm Hg systolic BP (95% CI 6.3 to 2.2; P < .001) and of 2.3 mm Hg diastolic BP (95% CI 4.9 to 0.0; P = .09) for each 10 mmol/day increase in magnesium dose. Conclusions: Our meta-analysis detected dose-dependent BP reductions from magnesium supplementation. However, adequately powered trials with sufficiently high doses of magnesium supplements need to be performed to confirm this relationship.

Utility of blood pressure monitoring outside of the clinic setting.

Guallar, E., Appel, L. J., Robinson, K. A., Guallar, E., Erlinger, T., Masood, S. O., Jehn, M., Fleisher, L., Powe, N. R., & Bass, E. B. (n.d.).

Publication year

2002

Journal title

Evidence report/technology assessment (Summary)

Issue

63

Page(s)

1-5

Abstract

Abstract

~

Utility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery

Faraday, N., Guallar, E., Sera, V. A., Bolton, E. D., Scharpf, R. B., Cartarius, A. M., Emery, K., Concord, J., & Kickler, T. S. (n.d.).

Publication year

2002

Journal title

Anesthesiology

Volume

96

Issue

5

Page(s)

1115-1122

10.1097/00000542-200205000-00014

Abstract

Abstract

Background: A hemostatic monitor capable of rapid, accurate detection of clinical coagulopathy within the operating room could improve management of bleeding after cardiopulmonary bypass (CPB). The Clot Signature Analyzer® is a hemostatometer that measures global hemostasis in whole blood. The authors hypothesized that point-of-care hemostatometry could detect a clinical coagulopathic state in cardiac surgical patients. Methods: Fifty-seven adult patients scheduled for a variety of elective cardiac surgical procedures were studied. Anesthesia, CPB, heparin anticoagulation, protamine reversal, and transfusion for post-CPB bleeding were all managed by standardized protocol. Clinical coagulopathy was defined by the need for platelet or fresh frozen plasma transfusion. The Clot Signature Analyzer® collagen-induced thrombus formation (CITF) assay measured platelet-mediated hemostasis in vitro. The activated clotting time, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen concentration were also measured. Results: The postprotamine CITF was greater in patients who required hemostatic transfusion than in those who did not (17.6 ± 8.0 min vs. 10.5 ± 5.7 min, respectively; P < 0.01). Postprotamine CITF values were highly correlated with platelet and fresh frozen plasma transfusion (Spearman r = 0.50, P < 0.001 and r = 0.40, P < 0.005, respectively). Receiver operator characteristic curves showed a highly significant relation between the postprotamine CITF and intraoperative platelet and fresh frozen plasma transfusion (area under the curve, 0.78- 0.81, P < 0.005) with 60-80% sensitivity, specificity, positive and negative predictive values at cutoffs of 12-14 min. Logistic regression demonstrated that the CITF was independently predictive of post-CPB hemostatic transfusion, but standard hemostatic assays were not. Conclusions: The Clot Signature Analyzer® CITF detects a clinical coagulopathic state after CPB and is independently predictive of the need for hemostatic transfusion. Hemostatometry has potential utility for monitoring hemostasis in cardiac surgery.

Autologous blood transfusion in the United States : Clinical and nonclinical determinants of use

Segal, J. B., Guallar, E., & Powe, N. R. (n.d.).

Publication year

2001

Journal title

Transfusion

Volume

41

Issue

12

Page(s)

1539-1547

10.1046/j.1537-2995.2001.41121539.x

Abstract

Abstract

BACKGROUND: Preoperative donation of blood lowers the risk of allogeneic RBC transfusion. The use of autologous blood is not well quantified. This study aimed at identifying the frequency and determinants of use of autologous transfusion in the United States. STUDY DESIGN AND METHODS: This national cross-sectional study, using the Nationwide Inpatient Sample, included all patients admitted to 900 hospitals in 19 states in 1996. Logistic regression with weighting yielded nationally representative results for the independent effects of clinical and nonclinical patient characteristics on autologous blood use. RESULTS: Autologous transfusion was used in 19 of 1000 hospitalizations. The procedures using autologous blood most frequently were knee arthroplasty, hip replacement, prostatectomy, spinal fusion, and hysterectomy. Blacks and Hispanics were less likely to receive autologous transfusion than were whites (OR, 0.64; 95% Cl, 0.45-0.83); patients with Medicaid were less likely than the privately insu red to receive autologous transfusions (OR, 0.29; 95% Cl, 0.200.43), with racial differences greatest among the privately insured. Women received autologous blood for cardiovascular surgeries much less often than men (OR, 0.32; 95% Cl, 0.20-0.49). CONCLUSION: Ethnic minorities, women, and patients with Medicaid appear to receive fewer autologous blood transfusions than the rest of the population. Although this could reflect either better or worse quality of care, nonclinical determinants of transfusion practice warrant attention and further investigation.

Re : "Use of two-segmented logistic regression to estimate change-points in epidemiologic studies" [1]

Guallar, E., Pastor, R., & Guallar, E. (n.d.).

Publication year

2001

Journal title

American Journal of Epidemiology

Volume

153

Issue

6

Page(s)

615

10.1093/aje/153.6.615

Abstract

Abstract

~

Relationship between systemic markers of inflammation and serum β-carotene levels

Erlinger, T. P., Guallar, E., Miller, E. R., Stolzenberg-Solomon, R., & Appel, L. J. (n.d.).

Publication year

2001

Journal title

Archives of Internal Medicine

Volume

161

Issue

15

Page(s)

1903-1908

10.1001/archinte.161.15.1903

Abstract

Abstract

Background: Low serum levels of β-carotene have been associated with increased risk of cancer and cardiovascular disease. However, in clinical trials, supplementation of the diet with β-carotene either had no benefit or caused harm. This pattern of findings raises the possibility that confounding by other factors might explain the association between serum β-carotene level and disease risk. Methods: We used data from 14470 current smokers, ex-smokers, and never smokers aged 18 years or older who participated in the Third National Health and Nutrition Examination Survey to assess the relationship between serum β-carotene and markers of inflammation (C-reactive protein and white blood cell count). Results: After adjustment for β-carotene intake and other factors, geometric mean levels of serum β-carotene for individuals with undetectable (

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

~

Does peer review predict the performance of research projects in health sciences?

Clavería, L. E., Guallar, E., Camí, J., Conde, J., Pastor, R., Ricoy, J. R., Rodríguez-Farré, E., Ruiz-Palomo, F., & Muñoz, E. (n.d.).

Publication year

2000

Journal title

Scientometrics

Volume

47

Issue

1

Page(s)

11-23

10.1023/A:1005609624130

Abstract

Abstract

Peer review is a basic component of the scientific process, but its performance has seldom been evaluated systematically. To determine whether pre-approval characteristics of research projects predicted the performance of projects, we conducted a retrospective cohort study of all 2744 single-centre research projects financed by the Spanish Health Research Fund since 1938 and completed before 1996. Peer review scores of grant applications were significant predictors of performance of funded projects, and the likelihood of production was also higher for projects with a basic research component, longer duration, higher budget or a financed research fellow. Funding agencies should monitor their selection process and assess the performance of funded projects to design future strategies in supporting health sciences research.

Cost-benefit analysis of Haemophilus influenzae type b vaccination in children in Spain

Jiménez, F. J., Guallar-Castillón, P., Terrés, C. R., & Guallar, E. (n.d.).

Publication year

1999

Journal title

PharmacoEconomics

Volume

15

Issue

1

Page(s)

75-83

10.2165/00019053-199915010-00005

Abstract

Abstract

Objective: Invasive disease caused by Haemophilus influenzae type b (Hib), including meningitis, pneumonia, sepsis and epiglottitis, is associated with high mortality and serious neurological sequelae in children under 5 years of age. The availability of an efficacious vaccine suggests the need to perform an economic evaluation of its use. The objective of this study was to evaluate the costs and benefits of introducing a universal vaccination programme for children under 1 year of age in Spain. Design & Setting: A cost-benefit analysis (CBA) was conducted over a 5-year period from the societal perspective in the Spanish healthcare setting. Both direct and indirect costs were included in the analysis [using 1996 Spanish pesetas (Pta); Pta 126.5 = $US1 in April 1996]. Patients and participants: The target population used for cost and benefit estimation was the 384 883 Spaniards aged 1 year or less in the last Spanish Population and Housing Census of 1991. Main outcome measures and results: The introduction of the universal Hib vaccination programme would imply vaccinating 346 395 children under 1 year of age, with a global expense of Pta2 444 855 910. For an average incidence of 15 cases of invasive disease per 100 000 children per year nationwide, the programme would prevent 219 cases of invasive disease and 8 deaths over a 5-year period, with a benefit of Pta2 182 868 907, a net benefit (i.e. benefit minus cost) of -Pta261 987 003, a benefit/cost ratio of 0.89 and a benefit per case prevented of -Pta1 196 288. Benefit/cost ratios above 1 would be obtained in the regions of highest incidence of invasive disease. Conclusion: The decision to implement a universal vaccination programme should not be based only on economic factors, but our results suggest that the economic returns of the programme for children under 1 year of age in Spain would be at least of a similar magnitude as its expenses.

Determinants of p, p'-Dichlorodiphenyldichloroethane (DDE) Concentration in Adipose Tissue in Women from Five European Cities

Sanz-gallardo, M. I., Guallar, E., Martín-moreno, J. M., Van 'T Veer, P., Kok, F. J., Longnecker, M. P., Strain, J. J., Martin, B. C., Kardinaal, A. F., Fernández-Crehuet, J., Thamm, M., & Kohlmeier, L. (n.d.).

Publication year

1999

Journal title

Archives of Environmental Health

Volume

54

Issue

4

Page(s)

277-283

10.1080/00039899909602486

Abstract

Abstract

To identify the determinants of p, p'-dichlorodiphenyldichloroethane (p, p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p, p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p, p'-DDE concentration was 1.66 μg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p, p'-DDE) were center of recruitment (p

Ecuestas alimentarias en los niños españoles de edad escolar : Análisis del período 1984-1994

Gorgojo Jiménez, L., Guallar, E., Martín-Moreno, J. M., Löpez-Nomdedeu, C., Vázquez, C., Martí-Henneberg, C., & Serrano-Ríos, M. (n.d.).

Publication year

1999

Journal title

Medicina Clinica

Volume

112

Issue

10

Page(s)

368-374

Abstract

Abstract

OBJECTIVE: To review available data on the usual dietary intake of school-age Spanish children, by analyzing the nutritional surveys carried out during the period 1984-1994. METHODS: Systematic and comprehensive search of surveys with dietary data in Spanish children aged 6 to 16 years collected during the period 1984-1994 and published after January 1997. The search of bibliographic databases (MEDLINE, IME, ISBN and Teseo), was completed with an extensive search of the gray literature and of unpublished studies through contact with public and private institutions which may fund such studies. The quality of the original surveys was assessed, and the data of the studies fulfilling pre-established quality requirements were summarized and tabulated. RESULTS: We located 65 nutritional surveys in children and adolescents performed between 1984 and 1994, which generated 91 documents. Most surveys (76.9%) were local, while 18.5% of them studied provinces or regions and 3.1% studied more than one region. Only 4 studies (6.2%) met the quality requirements, but the methods or the presentation of the results of these surveys were too heterogeneous. In spite of that, the available data tends to show a certain lack of balance of macronutrient intakes in relation to the usual dietary recomendations. CONCLUSIONS: Available data on nutritional intake of Spanish school-age children during 1984-1994 were too heterogeneous to be comparable, even if the analysis was restricted to high-quality surveys. Furthermore, there are no repeated surveys monitoring changes in intake in representative samples of children performed during the study period. This should be taken into account in future research endeavours which should contemplate a well defined sampling framework and the appropriate methodology to assure the proper interpretation of the eventual results.

Omega-3 fatty acids in adipose tissue and risk of myocardial infarction : The EURAMIC study

Guallar, E., Aro, A., Jiménez, F. J., Martín-Moreno, J. M., Salminen, I., Van't Veer, P., Kardinaal, A. F., Gömez-Aracena, J., Martin, B. C., Kohlmeier, L., Kark, J. D., Mazaev, V. P., Ringstad, J., Guillén, J., Riemersma, R. A., Huttunen, J. K., Thamm, M., & Kok, F. J. (n.d.).

Publication year

1999

Journal title

Arteriosclerosis, Thrombosis, and Vascular Biology

Volume

19

Issue

4

Page(s)

1111-1118

10.1161/01.ATV.19.4.1111

Abstract

Abstract

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (±SD) proportion of α-linolenic acid was 0.77% (±0.19) of fatty acids in cases and 0.80% (±0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of α-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (±0.13) of fatty acids in cases and 0.25% (±0.13) of fatty acids in controls (P=0.14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of α-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

El placebo en ensayos clinicos con medicamentos

Guallar, E., Laporte, J. R., Garcia Alonso, F., Guallar, E., Bakke, O., & Carne, X. (n.d.).

Publication year

1998

Journal title

Medicina Clinica

Volume

111

Issue

14

Page(s)

558

Abstract

Abstract

~

Previous disability as a predictor of outcome in a geriatric rehabilitation unit

Valderrama-Gama, E., Damián, J., Guallar, E., & Rodríguez-Mañas, L. (n.d.).

Publication year

1998

Journal title

Journals of Gerontology - Series A Biological Sciences and Medical Sciences

Volume

53

Issue

5

Page(s)

M405-M409

10.1093/gerona/53A.5.M405

Abstract

Abstract

Background. Functional status at admission has been shown consistently to predict rehabilitation results, but the impact of previous disability has been seldom considered. Methods. A prospective follow-up study of elderly patients admitted to a geriatric rehabilitation unit in Madrid Spain, was carried out. The study population comprised 135 subjects aged 65 years or older, who were consecutively admitted during a 7-month period. Outcome variables included the Barthel Index (BI) at discharge, the improvement in BI from admission to discharge, the achieved percentage of potential gain, and the efficiency of gains. Previous BI, admission BI, diagnosis, source (hospital/others), mental status, age, and gender were examined as explanatory variables. Results. In multiple regression analysis, previous BI was the only significant independent predictor for all the outcome variables. For each 5-point increase in previous BI, the increase in BI at discharge was 1.7 (p = .007). Corresponding values for the achieved percentage of potential gain and for the efficiency of galas were 0105 (p = .01) and 0.05 (p = .04), respectively. Except for the achieved percentage of potential gain, admission BI and source of referral were also independent significant predictors of outcome. Conclusions. Previous functional situation of elderly people is important to predict rehabilitation outcome, even after taking into account information on disability at admission. As a consequence, a measure of the achieved percentage of potential gain corrected by the preadmission functional status is proposed, especially in the case of elderly patients.

Use and abuse of placebo in phase III trials

Guallar, E., García-Alonso, F., Guallar, E., Bakke, O. M., & Carné, X. (n.d.).

Publication year

1998

Journal title

European Journal of Clinical Pharmacology

Volume

54

Issue

2

Page(s)

101-105

10.1007/s002280050429

Abstract

Abstract

~

Use of two-segmented logistic regression to estimate change-points in epidemiologic studies

Pastor, R., & Guallar, E. (n.d.).

Publication year

1998

Journal title

American Journal of Epidemiology

Volume

148

Issue

7

Page(s)

631-642

10.1093/aje/148.7.631

Abstract

Abstract

In many epidemiologic data, the dose-response relation between a continuous exposure and the risk of disease abruptly changes when the exposure variable reaches an unknown threshold level, the so-called change- point. Although several methods are available for dose-response assessment with dichotomous outcomes, none of them provide inferential procedures to estimate change-points. In this paper, we describe a two-segmented logistic regression model, in which the linear term associated with a continuous exposure in standard logistic regression is replaced by a two-segmented polynomial function with unknown change-point, which is also estimated. A modified, iteratively reweighted least squares algorithm is presented to obtain parameter estimates and confidence intervals, and the performance of this model is explored through simulation. Finally, a two-segmented logistic regression model is applied to a case-control study of the association of alcohol intake with the risk of myocardial infarction and compared with alternative analyses. The ability of two-segmented logistic regression to estimate and provide inferences for the location of change-points and for the magnitude of other parameters of effect will make this model a useful complement to other methods of dose-response analysis in epidemiologic studies.

A graphical display useful for meta-analysis

Jiménez, F. J., Guallar, E., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

European Journal of Public Health

Volume

7

Issue

1

Page(s)

101-105

10.1093/eurpub/7.1.101

Abstract

Abstract

Graphical methods are frequently used in meta-analysis to summarize their results and to explore potential sources of heterogeneity across studies. In this paper, we illustrate a graphical method for meta-analysis of studies with dichotomous exposures and outcomes that complements other graphical and analytical approaches to meta-analysis. In prospective studies, the proportion of cases among the unexposed is plotted on the horizontal axis versus the proportion of cases among the exposed on the vertical axis. Contour lines for equal values of relative risk, odds ratio or risk difference and for the combined estimate of effect and its confidence interval are then superimposed on the graph. In case-control studies, the proportion of exposed controls is plotted on the horizontal axis versus the proportion of exposed cases on the vertical axis, although only the contour lines of equal odds ratios yield direct epidemiological interpretation. In these graphs, the distribution of the individual estimates of effect with respect to the contour lines offers a clue as to the adequacy of the scale of measurement used (additive or multiplicative). This graphical method also permits direct inspection of the range of disease frequency in follow-up studies and of the range of exposure in case-control studies. Its use is illustrated with the aid of 3 examples derived from the literature.

Alcohol intake and risk of breast cancer : The euramic study

Guallar, E., Royo-Bordonada, M. A., Martín-Moreno, J. M., Guallar, E., Gorgojo, L., Van't Veer, P., Mendez, M., Huttunen, J. K., Martin, B. C., Kardinaal, A. F., Fernández-Crehuet, J., Thamm, M., Strain, J. J., Kok, F. J., & Kohlmeier, L. (n.d.).

Publication year

1997

Journal title

Neoplasma

Volume

44

Issue

3

Page(s)

150-156

Abstract

Abstract

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.

Cerebrovascular disease mortality in Spain, 1955-1992 : An age-period-cohort analysis

Castillón, P. G., Artalejo, F. R., Banegas Banegas, J. R., Guallar, E., & del Rey Calero, J. (n.d.).

Publication year

1997

Journal title

Neuroepidemiology

Volume

16

Issue

3

Page(s)

116-123

10.1159/000109680

Abstract

Abstract

The purpose of this study was to assess the contributions of period and birth cohort effects to changes in cerebrovascular disease (CVD) mortality in Spain over the period 1955–1992. Poisson regression models were fitted to age- and sex-specific CVD mortality rates obtained from National Vital Statistics. In the period 1955–1975, CVD mortality remained stable. In the period 1975–1992, CVD mortality declined by 54% (rate ratio, RR: 0.46; 95% confidence interval, Cl: 0.43–0.49) in males and 62% (RR: 0.38; 95% Cl: 0.34–0.42) in females. The cohort effect was very small up to the generation born in 1905, moving clearly downward thereafter. CVD mortality for subjects born in the period 1945–1949 was lower than for those born in the period 1905–1909 by 68% (RR: 0.32; 95% Cl: 0.16–0.63) in males and 82% (RR: 0.18; 95% Cl: 0.07–0.45) in females. Among the possible partial explanations for these effects are the decline in ischemic heart disease and rheumatic fever mortality, the drop in salt and alcohol intake, the reduction in smoking among males and blood pressure among females, and the widespread use of antihypertensive treatments in Spain over the last 20 years.

DDT (dicophane) and postmenopausal breast cancer in Europe : Case-control study

Van 'T Veer, P., Lobbezoo, I. E., Martín-Moreno, J. M., Guallar, E., Gómez-Aracena, J., Kardinaal, A. F., Kohlmeier, L., Martin, B. C., Strain, J. J., Thamm, M., Van Zoonen, P., Baumann, B. A., Huttunen, J. K., & Kok, F. J. (n.d.).

Publication year

1997

Journal title

British Medical Journal

Volume

315

Issue

7100

Page(s)

81-85

10.1136/bmj.315.7100.81

Abstract

Abstract

Objective: To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane DDT), and breast cancer. Design: Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. Setting: Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. Subjects: 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. Main outcome measure: Adipose DDE concentration. Results: Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentration. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. Conclusions: The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.

Drug and alcohol use in Spain : Consumption habits, attitudes and opinions

Guallar, E., Royo-Bordonada, M. A., Cid-Ruzafa, J., Martin-Moreno, J. M., & Guallar, E. (n.d.).

Publication year

1997

Journal title

Public Health

Volume

111

Issue

5

Page(s)

277-284

10.1016/S0033-3506(97)00054-1

Abstract

Abstract

To estimate the lifetime prevalence of drug and alcohol use and its sociodemographic determinants and to investigate opinions towards drug use in Spain, we examined a representative nation-wide sample of 2495 adult Spaniards, males and females, aged 18 y or older, selected by a multistaged random strategy during 1989. Information was obtained by at-home interviews using a structured closed questionnaire. Participants were asked for their lifetime prevalence of use of cannabis, sedatives and sleeping pills, alcohol, amphetamines, inhalants, cocaine and heroin, as well as for their sociodemographic characteristics and their opinions towards drug use. Alcohol had the highest lifetime prevalence of consumption (55.7%), followed by cannabis (12.3%), sedatives and sleeping pills (12.0%), amphetamines (4.3%), cocaine (3.0%), inhalants (0.8%) and heroin (0.6%). Being male, young, separated or divorced, and unemployed were the main determinants of alcohol and drug use. A higher use of illicit drugs was also observed in the higher socioeconomic groups. Regular use of any drug was considered a risky health habit by more than 80% of the sample. We conclude that the consumption of drugs and alcohol is a rather extended habit in Spain. Drug users tend to share some common sociodemographic characteristics (being male, young, separated or divorced, and unemployed) which may help target intervention programs.

El placebo en ensayos clínicos con medicamentos

García-Alonso, F., Guallar, E., Bakke, O. M., & Carné, X. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

109

Issue

20

Page(s)

797-801

Abstract

Abstract

~

Guía para la evaluación de proyectos de investigación en ciencias de la salud

Guallar, E., Conde, J., De La Cal, M. A., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

108

Issue

12

Page(s)

460-471

Abstract

Abstract

~

La regresión a la media en la investigación y práctica clínica

Guallar, E., Jiménez, F. J., García-Alonso, F., & Bakke, O. M. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

109

Issue

1

Page(s)

23-26

Abstract

Abstract

~

Metaanálisis y revisiones sistemáticas en cardiología

Guallar, E., Damián, J., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

Revista Espanola de Cardiologia

Volume

50

Issue

5

Page(s)

345-354

10.1016/S0300-8932(97)73232-9

Abstract

Abstract

Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selection, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.