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

Peripheral arterial disease and metals in urine and blood (multiple letters) [3]

Plusquin, M., Nawrot, T. S., Staessen, J. A., Navas-Acien, A., Silbergeld, E. K., & Guallar, E. (n.d.).

Publication year

2005

Journal title

Environmental health perspectives

Volume

113

Issue

8

Page(s)

A510-A511

10.1289/ehp.113-a510b

Abstract

Abstract

~

Physical activity, APOE genotype, and dementia risk : Findings from the Cardiovascular Health Cognition Study

Podewils, L. J., Guallar, E., Kuller, L. H., Fried, L. P., Lopez, O. L., Carlson, M., & Lyketsos, C. G. (n.d.).

Publication year

2005

Journal title

American Journal of Epidemiology

Volume

161

Issue

7

Page(s)

639-651

10.1093/aje/kwi092

Abstract

Abstract

Physical 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

Nasir, K., Guallar, E., Navas-Acien, A., Criqui, M. H., & Lima, J. A. (n.d.).

Publication year

2005

Journal title

Arteriosclerosis, Thrombosis, and Vascular Biology

Volume

25

Issue

9

Page(s)

1966-1971

10.1161/01.ATV.0000175296.02550.e4

Abstract

Abstract

Background - 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 ABI

The efficacy of sirolimus- and paclitaxel-eluting stents : A meta-analysis of randomized controlled trials

Kittleson, M. M., Needham, D. M., Kim, S. J., Ravindran, B. K., Solomon, S. S., & Guallar, E. (n.d.).

Publication year

2005

Journal title

Canadian Journal of Cardiology

Volume

21

Issue

7

Page(s)

581-587

Abstract

Abstract

Background: 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 (P

Lead, cadmium, smoking, and increased risk of peripheral arterial disease.

Navas-Acien, A., Selvin, E., Sharrett, A. R., Calderon-Aranda, E., Silbergeld, E., & Guallar, E. (n.d.).

Publication year

2004

Journal title

Circulation

Volume

109

Issue

25

Page(s)

3196-3201

10.1161/01.CIR.0000130848.18636.B2

Abstract

Abstract

BACKGROUND: 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 index

Preoperative acute normovolemic hemodilution : A meta-analysis

Segal, J. B., Blasco-Colmenares, E., Norris, E. J., & Guallar, E. (n.d.).

Publication year

2004

Journal title

Transfusion

Volume

44

Issue

5

Page(s)

632-644

10.1111/j.1537-2995.2004.03353.x

Abstract

Abstract

BACKGROUND: 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

Jehn, M., Clark, J. M., & Guallar, E. (n.d.).

Publication year

2004

Journal title

Diabetes Care

Volume

27

Issue

10

Page(s)

2422-2428

10.2337/diacare.27.10.2422

Abstract

Abstract

OBJECTIVE - 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)

Plante, 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

2003

Journal title

New England Journal of Medicine

Volume

348

Issue

21

Page(s)

2151-2154

10.1056/NEJM200305223482119

Abstract

Abstract

~

Meta-Analysis of Randomized Educational and Behavioral Interventions in Type 2 Diabetes

Gary, T. L., Genkinger, J. M., Guallar, E., Peyrot, M., & Brancati, F. L. (n.d.).

Publication year

2003

Journal title

The Diabetes Educator

Volume

29

Issue

3

Page(s)

488-501

10.1177/014572170302900313

Abstract

Abstract

PURPOSE 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

Daumit, G. L., Crum, R. M., Guallar, E., Powe, N. R., Primm, A. B., Steinwachs, D. M., & Ford, D. E. (n.d.).

Publication year

2003

Journal title

Archives of General Psychiatry

Volume

60

Issue

2

Page(s)

121-128

10.1001/archpsyc.60.2.121

Abstract

Abstract

Background: 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

Appel, L. J., Robinson, K. A., Guallar, E., & Guallar, E. (n.d.).

Publication year

2003

Journal title

Evidence-Based Medicine

Volume

8

Issue

4

Page(s)

120

10.1136/ebm.8.4.120

Abstract

Abstract

~

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

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

Publication year

2003

Journal title

Annals of internal medicine

Volume

139

Issue

9

Page(s)

731-739+I46

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

Abstract

Abstract

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

Transition models for change-point estimation in logistic regression

Pastor-Barriuso, R., Guallar, E., & Coresh, J. (n.d.).

Publication year

2003

Journal title

Statistics in Medicine

Volume

22

Issue

7

Page(s)

1141-1162

10.1002/sim.1045

Abstract

Abstract

Although 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

Guallar, 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

2002

Journal title

New England Journal of Medicine

Volume

347

Issue

22

Page(s)

1747-1754

10.1056/NEJMoa020157

Abstract

Abstract

Background: 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

Daumit, G. L., Crum, R. M., Guallar, E., & Ford, D. E. (n.d.).

Publication year

2002

Journal title

Psychiatric Services

Volume

53

Issue

7

Page(s)

884-887

10.1176/appi.ps.53.7.884

Abstract

Abstract

The 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.

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.

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

Pastor, R., Guallar, E., & 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