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
Thyroid hormones and mortality risk in euthyroid individuals : The Kangbuk Samsung health study
AbstractZhang, Y., Chang, Y., Ryu, S., Cho, J., Lee, W. Y., Rhee, E. J., Kwon, M. J., Pastor-Barriuso, R., Rampal, S., Han, W. K., Shin, H., & Guallar, E. (n.d.).Publication year
2014Journal title
Journal of Clinical Endocrinology and MetabolismVolume
99Issue
7Page(s)
2467-2476AbstractContext: Hyperthyroidism and hypothyroidism, both overt and subclinical, are associated with all-cause and cardiovascular mortality. The association between thyroid hormones and mortality in euthyroid individuals, however, is unclear. Objective: To examine the prospective association between thyroid hormones levels within normal ranges and mortality endpoints. Setting and Design: A prospective cohort study of 212 456 middle-aged South Korean men and women who had normal thyroid hormone levels and no history of thyroid disease at baseline from January 1, 2002 to December 31, 2009. Free T4 (FT4), free T3 (FT3), and TSH levels were measured by RIA. Vital status and cause of death ascertainment were based on linkage to the National Death Index death certificate records. Results: After a median follow-up of 4.3 years, 730 participants died (335 deaths from cancer and 112 cardiovascular-related deaths). FT4 was inversely associated with all-cause mortality (HR = 0.77, 95% confidence interval 0.63-0.95,comparingthe highest vs lowest quartile of FT4; P for linear trend = .01), and FT3 was inversely associated cancer mortality (HR = 0.62,95%confidence interval 0.45-0.85; P for linear trend = .001). TSH was not associated with mortality endpoints. Conclusions: In a large cohort of euthyroid men and women, FT4 and FT3 levels within the normal range were inversely associated with the risk of all-cause mortality and cancer mortality, particularly liver cancer mortality.Toxic Metals and Subclinical Atherosclerosis in Carotid, Femoral, and Coronary Vascular Territories : The Aragon Workers Health Study
AbstractGrau-Perez, M., Caballero-Mateos, M. J., Domingo-Relloso, A., Navas-Acien, A., Gomez-Ariza, J. L., Garcia-Barrera, T., Leon-Latre, M., Soriano-Gil, Z., Jarauta, E., Cenarro, A., Moreno-Franco, B., Laclaustra, M., Civeira, F., Casasnovas, J. A., Guallar, E., & Tellez-Plaza, M. (n.d.).Publication year
2022Journal title
Arteriosclerosis, Thrombosis, and Vascular BiologyVolume
42Issue
1Page(s)
87-99AbstractOBJECTIVE: Studies evaluating the association of metals with subclinical atherosclerosis are mostly limited to carotid arteries. We assessed individual and joint associations of nonessential metals exposure with subclinical atherosclerosis in 3 vascular territories. APPROACH AND RESULTS: One thousand eight hundred seventy-three Aragon Workers Health Study participants had urinary determinations of inorganic arsenic species, barium, cadmium, chromium, antimony, titanium, uranium, vanadium, and tungsten. Plaque presence in carotid and femoral arteries was determined by ultrasound. Coronary Agatston calcium score ≥1 was determined by computed tomography scan. Median arsenic, barium, cadmium, chromium, antimony, titanium, uranium, vanadium, and tungsten levels were 1.83, 1.98, 0.27, 1.18, 0.05, 9.8, 0.03, 0.66, and 0.23 μg/g creatinine, respectively. The adjusted odds ratio (95% CI) for subclinical atherosclerosis presence in at least one territory was 1.25 (1.03-1.51) for arsenic, 1.67 (1.22-2.29) for cadmium, and 1.26 (1.04-1.52) for titanium. These associations were driven by arsenic and cadmium in carotid, cadmium and titanium in femoral, and titanium in coronary territories and mostly remained after additional adjustment for the other relevant metals. Titanium, cadmium, and antimony also showed positive associations with alternative definitions of increased coronary calcium. Bayesian Kernel Machine Regression analysis simultaneously evaluating metal associations suggested an interaction between arsenic and the joint cadmiumtitanium exposure. CONCLUSIONS: Our results support arsenic and cadmium and identify titanium and potentially antimony as atherosclerosis risk factors. Exposure reduction and mitigation interventions of these metals may decrease cardiovascular risk in individuals without clinical disease.Trace Minerals, Heavy Metals, and Preeclampsia : Findings from the Boston Birth Cohort
AbstractLiu, T., Zhang, M., Guallar, E., Wang, G., Hong, X., Wang, X., & Mueller, N. T. (n.d.).Publication year
2019Journal title
Journal of the American Heart AssociationVolume
8Issue
16AbstractBackground: Preeclampsia is a leading contributor to maternal and perinatal morbidity and mortality. In mice experiments, manganese (Mn) and selenium (Se) are protective whereas cadmium (Cd) is promotive for preeclampsia. Epidemiologic findings on these chemical elements have been inconsistent. To confirm experimental findings in mice, we examined associations of trace minerals (Mn and Se) and heavy metals (Cd, lead [Pb], and mercury [Hg]) with preeclampsia in a birth cohort. Methods and Results: A total of 1274 women from the Boston Birth Cohort (enrolled since 1998) had complete data on the exposures and outcome. We measured Mn, Se, Cd, Pb, and Hg from red blood cells collected within 24 to 72 hours after delivery. We ascertained preeclampsia diagnosis from medical records. We used Poisson regression with robust variance models to estimate prevalence ratios (PRs) and 95% CIs. A total of 115 (9.0%) women developed preeclampsia. We observed evidence of a dose–response trend for Mn (P for trendTransition 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.Urine arsenic and hypertension in US adults : The 2003-2008 national health and nutrition examination survey
AbstractJones, M. R., Tellez-Plaza, M., Sharrett, A. R., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2011Journal title
EpidemiologyVolume
22Issue
2Page(s)
153-161AbstractBackground: High chronic exposure to inorganic arsenic may contribute to the development of hypertension. Limited information is available, however, on the association of low to moderate exposure to inorganic arsenic with blood pressure levels and hypertension. We investigated the association of exposure to inorganic arsenic (as measured in urine) with systolic and diastolic blood pressure levels and the prevalence of hypertension in US adults. Methods: We studied 4167 adults 20 years of age or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 through 2008 and for whom total arsenic, dimethylarsinate (DMA), and arsenobetaine had been assessed in urine. Results: The median (interquartile range) urine concentrations were 8.3 μg/L (4.2-17.1) for total arsenic, 3.6 μg/L (2.0-6.0) for DMA, and 1.4 μg/L (0.3-6.3) for arsenobetaine. The weighted prevalence of hypertension in the study population was 36%. After multivariable adjustment, a 2-fold increase in total arsenic was associated with a hypertension odds ratio of 0.98 (95% confidence interval = 0.86-1.11). A doubling of total arsenic minus arsenobetaine was associated with a hypertension OR of 1.03 (0.94-1.14) and a doubling of DMA concentrations was associated with a hypertension OR of 1.11 (0.99-1.24). Total arsenic, total arsenic minus arsenobetaine, or DMA levels were not associated with systolic or diastolic blood pressure. Conclusions: At the low to moderate levels, typical of the US population, total arsenic, total arsenic minus arsenobetaine, and DMA concentrations in urine were not associated with the prevalence of hypertension or with systolic or diastolic blood pressure levels. A weak association of DMA with hypertension could not be ruled out.Urine arsenic and prevalent albuminuria : Evidence from a population-based study
AbstractZheng, L. Y., Umans, J. G., Tellez-Plaza, M., Yeh, F., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Guallar, E., Howard, B. V., Weaver, V. M., & Navas-Acien, A. (n.d.).Publication year
2013Journal title
American Journal of Kidney DiseasesVolume
61Issue
3Page(s)
385-394AbstractBackground: Long-term arsenic exposure is a major global health problem. However, few epidemiologic studies have evaluated the association of arsenic with kidney measures. Our objective was to evaluate the cross-sectional association between inorganic arsenic exposure and albuminuria in American Indian adults from rural areas of Arizona, Oklahoma, and North and South Dakota. Study Design: Cross-sectional. Setting & Partipants: Strong Heart Study locations in Arizona, Oklahoma, and North and South Dakota. 3,821 American Indian men and women aged 45-74 years with urine arsenic and albumin measurements. Predictor: Urine arsenic. Outcomes: Urine albumin-creatinine ratio and albuminuria status. Measurements: Arsenic exposure was estimated by measuring total urine arsenic and urine arsenic species using inductively coupled plasma mass spectrometry (ICPMS) and high-performance liquid chromatography-ICPMS, respectively. Urine albumin was measured by automated nephelometric immunochemistry. Results: The prevalence of albuminuria (albumin-creatinine ratio ≥30 mg/g) was 30%. Median value for the sum of inorganic and methylated arsenic species was 9.7 (IQR, 5.8-15.6) μg per gram of creatinine. Multivariable-adjusted prevalence ratios of albuminuria (albumin-creatinine ratio ≥30 mg/g) comparing the 3 highest to lowest quartiles of the sum of inorganic and methylated arsenic species were 1.16 (95% CI, 1.00-1.34), 1.24 (95% CI, 1.07-1.43), and 1.55 (95% CI, 1.35-1.78), respectively (P for trendUrine arsenic concentrations and species excretion patterns in American Indian communities over a 10-year period : The strong heart study
AbstractNavas-Acien, A., Umans, J. G., Howard, B. V., Goessler, W., Francesconi, K. A., Crainiceanu, C. M., Silbergeld, E. K., & Guallar, E. (n.d.).Publication year
2009Journal title
Environmental health perspectivesVolume
117Issue
9Page(s)
1428-1433AbstractBackground: Arsenic exposure in drinking water disproportionately affects small communities in some U.S. regions, including American Indian communities. In U.S. adults with no seafood intake, median total urine arsenic is 3.4 μg/L. Objective: We evaluated arsenic exposure and excretion patterns using urine samples collected over 10 years in a random sample of American Indians from Arizona, Oklahoma, and North and South Dakota who participated in a cohort study from 1989 to 1999. Methods: We measured total urine arsenic and arsenic species [inorganic arsenic (arsenite and arsenate), methylarsonate (MA), dimethylarsinate (DMA), and arsenobetaine] concentrations in 60 participants (three urine samples each, for a total of 180 urine samples) using inductively coupled plasma/mass spectrometry (ICPMS) and high-performance liquid chromatography/ICPMS, respectively. Results: Median (10th, 90th percentiles) urine concentration for the sum of inorganic arsenic, MA, and DMA at baseline was 7.2 (3.1, 16.9) μg/g creatinine; the median was higher in Arizona (12.5 μg/g), intermediate in the Dakotas (9.1 μg/g), and lower in Oklahoma (4.4 μg/g). The mean percentage distribution of arsenic species over the sum of inorganic and methylated species was 10.6% for inorganic arsenic, 18.4% for MA, and 70.9% for DMA. The intraclass correlation coefficient for three repeated arsenic measurements over a 10-year period was 0.80 for the sum of inorganic and methylated species and 0.64, 0.80, and 0.77 for percent inorganic arsenic, percent MA, and percent DMA, respectively. Conclusions: This study found low to moderate inorganic arsenic exposure and confirmed long-term constancy in arsenic exposure and urine excretion patterns in American Indians from three U.S. regions over a 10-year period. Our findings support the feasibility of analyzing arsenic species in large population-based studies with stored urine samples.Urine arsenic levels and hypertension in U.S. adults
AbstractGuallar, E., Jones, M. R., Tellez-Plaza, M., Guallar, E., & Navas-Acien, A. (n.d.).Publication year
2010Page(s)
260-261Abstract~Use and abuse of placebo in phase III trials
AbstractGuallar, E., García-Alonso, F., Guallar, E., Bakke, O. M., & Carné, X. (n.d.).Publication year
1998Journal title
European Journal of Clinical PharmacologyVolume
54Issue
2Page(s)
101-105Abstract~Use of gadoxetic acid–enhanced liver MRI and mortality in more than 30000 patients with hepatocellular Carcinoma : A nationwide analysis
AbstractKang, T. W., Kong, S. Y., Kang, D., Kang, M. W., Kim, Y. K., Kim, S. H., Sinn, D. H., Kim, Y. A., Choi, K. S., Lee, E. S., Woo, S. M., Back, J. H., Guallar, E., & Cho, J. (n.d.).Publication year
2020Journal title
RadiologyVolume
295Issue
1Page(s)
114-124AbstractBackground: The impact on survival of gadoxetic acid–enhanced MRI in addition to multiphase contrast material–enhanced CT for initial staging in patients with hepatocellular carcinoma (HCC) is unknown. Purpose: To compare all-cause mortality in patients with HCC who underwent CT only, CT plus non–gadoxetic acid–enhanced MRI, or CT plus gadoxetic acid–enhanced MRI as part of their initial diagnostic work-up. Materials and Methods: The authors performed a nationwide retrospective cohort study of patients diagnosed with HCC in South Korea between January 2008 and December 2010. Follow-up extended through December 2014. The primary outcome was all-cause mortality. Cox proportional hazards regression model with adjustment of confounding factors was used to estimate hazard ratios (HRs) for all-cause mortality. Results: Among 30 023 patients with HCC (mean age 6 standard deviation, 58.5 years 6 10.7, 23 978 men), the proportions of patients in whom HCC was diagnosed using CT only, CT plus non–gadoxetic acid–enhanced MRI, and CT plus gadoxetic acid–enhanced MRI were 56.1%, 12.9%, and 31.0%, respectively. In adjusted analysis using CT only as the reference category, the HR for mortality for CT plus gadoxetic acid–enhanced MRI was 0.64 (95% confidence interval [CI]: 0.62, 0.67; P , .001), and the HR for CT plus non–gadoxetic acid–enhanced MRI was 0.71 (95% CI: 0.68, 0.75; P , .001). Use of CT plus gadoxetic acid–enhanced MRI was associated with lower mortality compared with CT plus non–gadoxetic acid–enhanced MRI (adjusted HR, 0.90; 95% CI: 0.85, 0.95; P , .001), but this survival advantage was restricted to patients with localized disease. Conclusion: In patients with hepatocellular carcinoma, additional use of contrast-enhanced MRI was associated with lower mortality. Furthermore, CT plus gadoxetic acid–enhanced MRI was associated with better survival than CT plus non–gadoxetic acid–enhanced MRI but only in patients with localized disease.Use of proton pump inhibitors and the risk of cholangitis : a nationwide cohort study
AbstractMin, Y. W., Kang, D., Shin, J. Y., Kang, M., Park, J. K., Lee, K. H., Lee, J. K., Lee, K. T., Rhee, P. L., Kim, J. J., Guallar, E., Cho, J., & Lee, H. (n.d.).Publication year
2019Journal title
Alimentary Pharmacology and TherapeuticsVolume
50Issue
7Page(s)
760-768AbstractBackground: Proton pump inhibitor (PPI) use may alter the gut microbiome and increase the risk of cholangitis. However, the association of PPI use with the risk of incident cholangitis has not been evaluated. Aim: To evaluate whether PPI use was associated with a higher risk of cholangitis. Methods: This cohort study included a nationwide representative sample of the Korean general population followed up for 10 years (1 January 2003 to 31 December 2013). PPI use was identified from treatment claims and considered as a time-varying variable. Incident cholangitis was identified from hospitalisation and out-patient visit claims. Results: During 4 212 003 person-years of follow-up, 58,863 participants had at least one PPI prescription and 1 834 participants developed cholangitis. The age-, sex-, residential area- and income-adjusted hazard ratio (HR) for incident cholangitis comparing PPI use with non-use was 6.06 (95% CI, 4.64-7.91). The association was essentially unchanged in fully adjusted models (HR 5.75; 95% CI, 4.39-7.54). The risk was highest during PPI treatment and decreased gradually after PPI discontinuation (PtrendUse of two-segmented logistic regression to estimate change-points in epidemiologic studies
AbstractPastor, R., & Guallar, E. (n.d.).Publication year
1998Journal title
American Journal of EpidemiologyVolume
148Issue
7Page(s)
631-642AbstractIn 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.Usefulness of Lipoprotein-Associated Phospholipase A 2 Activity and C-Reactive Protein in Identifying High-Risk Smokers for Atherosclerotic Cardiovascular Disease (from the Atherosclerosis Risk in Communities Study)
AbstractTibuakuu, M., Kianoush, S., DeFilippis, A. P., McEvoy, J. W., Zhao, D., Guallar, E., Ballantyne, C. M., Hoogeveen, R. C., Blaha, M. J., & Michos, E. D. (n.d.).Publication year
2018Journal title
American Journal of CardiologyVolume
121Issue
9Page(s)
1056-1064AbstractDespite the causal role of cigarette smoking in atherosclerotic cardiovascular disease (ASCVD), the underlying mechanisms are not fully understood. We evaluated the joint relation between smoking and inflammatory markers with ASCVD risk. We tested cross-sectional associations of self-reported smoking status (never, former, current) and intensity (packs/day) with lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) activity and high-sensitivity C-reactive protein (hsCRP) in 10,506 Atherosclerosis Risk in Communities participants at Visit 4 (1996 to 1998). Using Cox hazard models adjusted for demographic and traditional ASCVD risk factors, we examined the associations of smoking status and intensity with incident adjudicated ASCVD events (n = 1,745 cases) over an average of 17 years, stratified by Lp-PLA 2 and hsCRP categories. Greater packs/day smoked was linearly associated with higher levels of both Lp-PLA 2 and hsCRP among current smokers. Compared with never smokers, the hazard ratio for incident ASCVD in current smokers was 2.04 (95% CI 1.76 to 2.35). Among current smokers, the risk for ASCVD per 1 pack/day greater was 1.39 (1.10 to 1.76). Both Lp-PLA 2 activity ≥253 nmol/min/ml and hsCRP >3 mg/L identified current smokers at the highest risk for incident ASCVD, with similar hazard ratios. hsCRP risk-stratified current smokers better based on intensity. Among current smokers, hsCRP improved ASCVD prediction beyond traditional risk factors better than Lp-PLA 2 (C-statistic 0.675 for hsCRP vs 0.668 for Lp-PLA2, p = 0.001). In this large cohort with long follow-up, we found a dose-response relation between smoking intensity with Lp-PLA 2 activity, hsCRP, and ASCVD events. Although both Lp-PLA 2 activity and hsCRP categories identified high risk among current smokers, hsCRP may better stratify risk of future ASCVD.Utility of blood pressure monitoring outside of the clinic setting.
AbstractGuallar, 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
2002Journal title
Evidence report/technology assessment (Summary)Issue
63Page(s)
1-5Abstract~Utility of multimodal longitudinal imaging data for dynamic prediction of cardiovascular and renal disease : the CARDIA study
AbstractNguyen, H., Vasconcellos, H. D., Keck, K., Carr, J., Launer, L. J., Guallar, E., Lima, J. A., & Ambale-Venkatesh, B. (n.d.).Publication year
2024Journal title
Frontiers in RadiologyVolume
4AbstractBackground: Medical examinations contain repeatedly measured data from multiple visits, including imaging variables collected from different modalities. However, the utility of such data for the prediction of time-to-event is unknown, and only a fraction of the data is typically used for risk prediction. We hypothesized that multimodal longitudinal imaging data could improve dynamic disease prognosis of cardiovascular and renal disease (CVRD). Methods: In a multi-centered cohort of 5,114 CARDIA participants, we included 166 longitudinal imaging variables from five imaging modalities: Echocardiography (Echo), Cardiac and Abdominal Computed Tomography (CT), Dual-Energy x-ray Absorptiometry (DEXA), Brain Magnetic Resonance Imaging (MRI) collected from young adulthood to mid-life over 30 years (1985–2016) to perform dynamic survival analysis of CVRD events using machine learning dynamic survival analysis (Dynamic-DeepHit, LTRCforest, and Extended Cox for Time-varying Covariates). Risk probabilities were continuously updated as new data were collected. Model performance was assessed using integrated AUC and C-index and compared to traditional risk factors. Results: Longitudinal imaging data, even when being irregularly collected with high missing rates, improved CVRD dynamic prediction (0.03 in integrated AUC, up to 0.05 in C-index compared to traditional risk factors; best model's C-index = 0.80–0.83 up to 20 years from baseline) from young adulthood followed up to midlife. Among imaging variables, Echo and CT variables contributed significantly to improved risk estimation. Echo measured in early adulthood predicted midlife CVRD risks almost as well as Echo measured 10–15 years later (0.01 C-index difference). The most recent CT exam provided the most accurate prediction for short-term risk estimation. Brain MRI markers provided additional information from cardiac Echo and CT variables that led to a slightly improved prediction. Conclusions: Longitudinal multimodal imaging data readily collected from follow-up exams can improve CVRD dynamic prediction. Echocardiography measured early can provide a good long-term risk estimation, while CT/calcium scoring variables carry atherosclerotic signatures that benefit more immediate risk assessment starting in middle-age.Utility of non-HDL-C and apoB targets in the context of new more aggressive lipid guidelines
AbstractQuispe, R., Brownstein, A. J., Sathiyakumar, V., Park, J., Chang, B., Sajja, A., Guallar, E., Lazo, M., Jones, S. R., & Martin, S. S. (n.d.).Publication year
2021Journal title
American Journal of Preventive CardiologyVolume
7AbstractObjective: Major guidelines recommend the use of secondary targets, such as non-HDL-C and apoB, to further reduce cardiovascular risk. We aimed to evaluate the proportion at which newer, more aggressive secondary lipid targets are exceeded in patients with LDL-C < 70 mg/dL estimated by Friedewald (LDLf-C) and Martin/Hopkins equations (LDLm-C). Methods: We analyzed patients from the Very Large Database of Lipids with fasting lipids and estimated LDL-CUtility of whole blood hemostatometry using The Clot Signature Analyzer® for assessment of hemostasis in cardiac surgery
AbstractFaraday, 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
2002Journal title
AnesthesiologyVolume
96Issue
5Page(s)
1115-1122AbstractBackground: 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.Utilización de los años potenciales de vida perdidos entre las edades de 1 y 64 años como un indicador de mortalidad prematura ocurrida en Aragón.
AbstractGuallar, E., Guallar, E., Rué, M., & Borrell, C. (n.d.).Publication year
1993Journal title
Medicina ClinicaVolume
100Issue
3Page(s)
115Abstract~Validation of the IASLC Residual Tumor Classification in Patients with Stage III-N2 Non-Small Cell Lung Cancer Undergoing Neoadjuvant Chemoradiotherapy Followed by Surgery
AbstractLee, J., Lee, J., Hong, Y. S., Lee, G., Kang, D., Yun, J., Jeon, Y. J., Shin, S., Cho, J. H., Choi, Y. S., Kim, J., Zo, J. I., Shim, Y. M., Guallar, E., Cho, J., & Kim, H. K. (n.d.).Publication year
2023Journal title
Annals of SurgeryVolume
277Issue
6Page(s)
E1355-E1363AbstractObjective: The aim of this study was to validate the International Association for the Study of Lung Cancer (IASLC) residual tumor classification in patients with stage III-N2 non-small cell lung cancer (NSCLC) undergoing neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgery. Background: As adequate nodal assessment is crucial for determining prognosis in patients with clinical N2 NSCLC undergoing nCCRT followed by surgery, the new classification may have better prognostic implications. Methods: Using a registry for thoracic cancer surgery at a tertiary hospital in Seoul, Korea, between 2003 and 2019, we analyzed 910 patients with stage III-N2 NSCLC who underwent nCCRT followed by surgery. We classified resections using IASLC criteria: complete (R0), uncertain (R[un]), and incomplete resection (R1/R2). Recurrence and mortality were compared using adjusted subdistribution hazard model and Cox-proportional hazards model, respectively. Results: Of the 96.3% (n = 876) patients who were R0 by Union for International Cancer Control (UICC) criteria, 34.5% (n = 3O2) remained R0 by IASLC criteria and 37.6% (n = 329) and 28% (n = 245) migrated to R(un) and R1, respectively. Most of the migration from UICC-R0 to lASLC-R(un) and IASLC-R1/R2 occurred due to inadequate nodal assessment (85.5%) and extracapsular nodal extension (77.6%), respectively. Compared to R0, the adjusted hazard ratios in R(un) and R1/R2 were 1.20 (95% confidence interval, 0.94-1.52), 1.50 (1.17-1.52) (P fortrend =.001) for recurrence and 1.18 (0.93-1.51) and 1.51 (1.17-1.96) for death (P for trend =.002). Conclusions: The IASLC R classification has prognostic relevance in patients with stage III-N2 NSCLC undergoing nCCRT followed by surgery. The IASLC classification will improve the thoroughness of intraoperative nodal assessment and the completeness of resection.Vasomotor and other menopause symptoms and the prevalence of ideal cardiovascular health metrics among premenopausal stage women
AbstractChoi, H. R., Chang, Y., Kim, Y., Cho, Y., Kwon, M. J., Kang, J., Kwon, R., Lim, G. Y., Kim, K. H., Kim, H., Hong, Y. S., Park, J., Zhao, D., Cho, J., Guallar, E., Park, H. Y., & Ryu, S. (n.d.).Publication year
2023Journal title
MenopauseVolume
30Issue
7Page(s)
750-757AbstractObjective We examined the association between menopause symptoms and the prevalence of ideal cardiovascular health (CVH) metrics among premenopausal women. Methods This cross-sectional study comprised 4,611 premenopausal women aged 42 to 52 years. Data for CVH metrics were collected during health screening examinations. Menopause symptoms were measured using the Korean version of the Menopause-Specific Quality of Life questionnaire. For vasomotor, psychosocial, physical, and sexual symptoms, participants were divided into absent or symptomatic groups, further divided into tertiles (range, 0-7; 7 being the most bothersome). Ideal CVH metrics were defined according to the American Heart Association Life Simple 7 metrics, except dietary component. Cardiovascular health metrics were scored from 0 (unhealthy) to 6 (healthy) and classified as poor (0-2), intermediate (3-4), and ideal (5-6). Multinomial logistic regression models were used to estimate the prevalence ratios for intermediate and poor CVH metrics using ideal CVH as the reference. Results The overall and 4 menopause-specific quality of life domain scores were significantly associated with poorer CVH metrics scores in a dose-response manner (P < 0.05). After adjusting for age, parity, education level, anti-Mullerian hormone levels, and alcohol intake, women with the most bothersome degree for vasomotor, psychosocial, physical, and sexual symptoms had significantly higher prevalence of poor CVH metrics, with corresponding prevalence ratios (95% confidence interval) of 2.90 (1.95-4.31), 2.07 (1.36-3.15), 3.01 (1.19-7.65), and 1.66 (1.15-2.39), respectively, compared with those without each vasomotor, psychosocial, physical, and sexual symptom. Conclusions Premenopausal stage women with either vasomotor or nonvasomotor menopausal symptoms have significantly higher prevalence of poor CVH metrics, compared with those without any menopausal symptoms.Vessel Wall Imaging Features of Spontaneous Intracranial Carotid Artery Dissection
AbstractWasserman, B. A., Qiao, Y., Yang, W., Guallar, E., Romero, M. E., Virmani, R., & Zeiler, S. R. (n.d.).Publication year
2024Journal title
NeurologyVolume
102Issue
12AbstractBackground and ObjectivesIntracranial dissection is an important cause of stroke often with nonspecific angiographic features. Vessel wall imaging (VWI) can detect dissections, but intracranial applications remain unvalidated by pathologic specimens. We sought to determine the ability of VWI to identify the rarely reported spontaneous intracranial carotid dissection (sICD) guided by postmortem validation.MethodsVWI features of sICD, validated by postmortem specimen analysis in 1 patient, included luminal enhancement within a hypoenhancing outer wall, narrowing the mid to distal ophthalmic (C6) segment, relatively sparing the communicating (C7) segment. VWI examinations were reviewed to identify patients (1) with matching imaging features, (2) no evidence of other vasculopathies (i.e., inflammatory, intracranial atherosclerotic disease [ICAD]), and (3) adequate image quality. These sICD VWI features were compared with those in patients with known ICAD causing similar narrowing of C6 and relative sparing of C7 by a Fisher exact test accounting for multiple samples.ResultsAmong 407 VWI examinations, 8 patients were identified with 14 sICDs, all women aged 30-56 years, 6 (75%) bilateral. All patients with sICD had risk factors of dissection (e.g., recently postpartum, fibromuscular dysplasia, and hypertension) and 3 (37.5%) had intracranial dissections elsewhere. Seven (87.5%) were diagnosed as moyamoya syndrome on initial angiography. Enhancing lesions varied from thin flap-like defects (n = 6) to thick tissue along the superolateral wall of the internal carotid artery, within the hypoenhancing outer wall. Compared with 10 intracranial carotid plaques in 8 patients with ICAD, sICD demonstrated stronger (84.6% vs 20.0%, p = 0.003-0.025) and more homogeneous (61.5% vs 0.0%, p = 0.005-0.069) enhancement and less positive remodeling (0.0% vs 60.0%, p = 0.004-0.09). T1 hyperintensity was identified in 5 sICDs in 3 patients but not identified in ICAD. Three patients with serial imaging (8- to 39.8-month maximum intervals) revealed little to no changes in stenosis, wall thickening, or enhancement.DiscussionsICD is distinguishable on VWI from ICAD by enhancement characteristics, less positive remodeling, and clinical parameters. These VWI features should raise suspicion especially in young women with risk factors of dissection. Temporal stability and a lack of T1 hyperintensity should not discourage diagnosing sICD.Vitamin D deficiency is associated with inferior survival of patients with extranodal natural killer/T-cell lymphoma
AbstractKim, S. J., Shu, C., Ryu, K. J., Kang, D., Cho, J., Ko, Y. H., Lee, S. Y., Guallar, E., Zhao, W., & Kim, W. S. (n.d.).Publication year
2018Journal title
Cancer ScienceVolume
109Issue
12Page(s)
3971-3980AbstractVitamin D deficiency is a common health issue; however, the effect of vitamin D deficiency on the survival of T-cell lymphoma is still not clear. We evaluated the impact of serum vitamin D level of patients with peripheral T-cell lymphoma (PTCL) and extranodal natural killer/T-cell lymphoma (ENKTL) on survival outcome. Pretreatment levels of 25-hydroxyvitamin D [25(OH)D] and inflammatory cytokines were measured in serum samples that were archived at diagnosis, and we evaluated their association with survival in newly diagnosed patients with PTCL (n = 137) and ENKTL (n = 114) at a university-based hospital in Korea. An independent cohort from Rui Jin Hospital (Shanghai, China) was used for validation. The median 25(OH)D serum level was 12.0 ng/mL (1.3-60.0 ng/mL), and 40% had less than 10 ng/mL, which was defined as vitamin D deficiency. Median serum 25(OH)D levels were similar between PTCL (11.5 ng/mL) and ENKTL (12.9 ng/mL); however, vitamin D deficiency was associated with inferior survival in ENKTL but not with PTCL. The independent validation cohort (n = 115) also showed a significant association of vitamin D deficiency with poor survival in ENKTL. The 25(OH)D level had an inverse relation with inflammatory cytokines; this association had a negative effect only on survival of ENKTL, and not on PTCL. In conclusion, vitamin D deficiency was associated with inferior survival outcome of patients with ENKTL.Vitamin D deficiency is independently associated with greater prevalence of erectile dysfunction : The National Health and Nutrition Examination Survey (NHANES) 2001–2004
AbstractFarag, Y. M., Guallar, E., Zhao, D., Kalyani, R. R., Blaha, M. J., Feldman, D. I., Martin, S. S., Lutsey, P. L., Billups, K. L., & Michos, E. D. (n.d.).Publication year
2016Journal title
AtherosclerosisVolume
252Page(s)
61-67AbstractBackground and aims Erectile dysfunction (ED) and atherosclerotic cardiovascular disease (ASCVD) share many common risk factors, and vascular ED is a marker for increased ASCVD risk. Low 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with increased ASCVD risk, but less is known regarding the relationship of low 25(OH)D with ED. We determined whether 25(OH)D deficiency is associated with ED independent of ASCVD risk factors. Methods We performed cross-sectional analyses of 3390 men aged ≥20 years free of ASCVD who participated in NHANES 2001–2004. Serum 25(OH)D was measured by the DiaSorin radioimmunoassay; deficiency was defined as levelsVitamin D supplementation in the age of lost innocence
AbstractGuallar, E., Miller, E. R., Ordovas, J. M., & Stranges, S. (n.d.).Publication year
2010Journal title
Annals of internal medicineVolume
152Issue
5Page(s)
327-329Abstract~Vitamin E supplementation : What's the harm in that?
AbstractMiller, E. R., & Guallar, E. (n.d.).Publication year
2009Journal title
Clinical TrialsVolume
6Issue
1Page(s)
47-49Abstract~