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

Association of geography and ambient air pollution with urine metal concentrations in six us cities : The multi-ethnic study of atherosclerosis

Pang, Y., Jones, M. R., Tellez-Plaza, M., Guallar, E., Vaidya, D., Post, W. S., Kaufman, J. D., Delaney, J. A., & Navas-Acien, A. (n.d.).

Publication year

2016

Journal title

International journal of environmental research and public health

Volume

13

Issue

3

10.3390/ijerph13030324

Abstract

Abstract

We investigated the associations of urinary concentrations of antimony, cadmium, tungsten and uranium with geographic locations and with ambient air pollution in 304 adults in the Multi-Ethnic Study of Atherosclerosis from six US cities. After adjustment for sociodemographics, body mass index, and smoking status, urinary cadmium was the highest in Winston-Salem among all study sites (the geometric mean [GM] in Winston-Salem was 0.84 µg/L [95% confidence interval (CI) 0.57–1.22]). The adjusted GMs of urinary tungsten and uranium were highest in Los Angeles (0.11 µg/L [95% CI 0.08–0.16] and 0.019 µg/L [95% CI 0.016–0.023], respectively). The adjusted GM ratio comparing fine particulate matter (PM2.5) tertiles 2 and 3 with the lowest tertile were 1.64 (95% CI 1.05–2.56) and 3.55 (95% CI 2.24–5.63) for tungsten, and 1.18 (95% CI 0.94–1.48) and 1.70 (95% CI 1.34–2.14) for uranium. The results for tungsten remained similar after adjustment for study site. Urinary cadmium, tungsten and uranium concentrations differed by geographic locations in MESA (Multi-Ethnic Study of Atherosclerosis) communities. PM2.5 levels could contribute to geographic differences in tungsten exposure. These findings highlight the need to implement preventive strategies to decrease toxic metal exposure and to evaluate the health effects of chronic exposure to those metals.

Association of global DNA methylation and global DNA hydroxymethylation with metals and other exposures in human blood DNA samples

Tellez-Plaza, M., Tang, W. Y., Shang, Y., Umans, J. G., Francesconi, K. A., Goessler, W., Ledesma, M., Leon, M., Laclaustra, M., Pollak, J., Guallar, E., Cole, S. A., Fallin, M. D., & Navas-Acien, A. (n.d.).

Publication year

2014

Journal title

Environmental health perspectives

Volume

122

Issue

9

Page(s)

946-954

10.1289/ehp.1306674

Abstract

Abstract

Background: The association between human blood DNA global methylation and global hydroxymethylation has not been evaluated in population-based studies. No studies have evaluated environmental determinants of global DNA hydroxymethylation, including exposure to metals. Objective: We evaluated the association between global DNA methylation and global DNA hydroxymethylation in 48 Strong Heart Study participants for which selected metals had been measured in urine at baseline and DNA was available from 1989-1991 (visit 1) and 1998-1999 (visit 3). Methods: We measured the percentage of 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) in samples using capture and detection antibodies followed by colorimetric quantification. We explored the association of participant characteristics (i.e., age, adiposity, smoking, and metal exposure) with both global DNA methylation and global DNA hydroxymethylation. Results: The Spearman's correlation coefficient for 5-mC and 5-hmC levels was 0.32 (p = 0.03) at visit 1 and 0.54 (p < 0.001) at visit 3. Trends for both epigenetic modifications were consistent across potential determinants. In cross-sectional analyses, the odds ratios of methylated and hydroxymethylated DNA were 1.56 (95% CI: 0.95, 2.57) and 1.76 (95% CI: 1.07, 2.88), respectively, for the comparison of participants above and below the median percentage of dimethylarsinate. The corresponding odds ratios were 1.64 (95% CI: 1.02, 2.65) and 1.16 (95% CI: 0.70, 1.94), respectively, for the comparison of participants above and below the median cadmium level. Arsenic exposure and metabolism were consistently associated with both epigenetic markers in cross-sectional and prospective analyses. The positive correlation of 5-mC and 5-hmC levels was confirmed in an independent study population. Conclusions: Our findings support that both epigenetic measures are related at the population level. The consistent trends in the associations between these two epigenetic modifications and the characteristics evaluated, especially arsenic exposure and metabolism, suggest the need for understanding which of the two measures is a better biomarker for environmental epigenetic effects in future large-scale epidemiologic studies.

Association of High-Sensitivity Troponin with Cardiac CT Angiography Evidence of Myocardial and Coronary Disease in a Primary Prevention Cohort of Men : Results from MACS

Rahman, F., Zhang, Z., Zhao, D., Budoff, M. J., Palella, F. J., Witt, M. D., Evans, R. W., Jacobson, L. P., Korley, F. K., Guallar, E., Post, W. S., & McEvoy, J. W. (n.d.).

Publication year

2019

Journal title

Journal of Applied Laboratory Medicine

Volume

4

Issue

3

Page(s)

355-369

10.1373/jalm.2018.028860

Abstract

Abstract

Background: High-sensitivity cardiac troponin (hs-cTn) elevations are associated with incident cardiovascular disease events in primary prevention samples. However, the mechanisms underlying this association remain unclear. Methods: We studied 458 men without known cardiovascular disease who participated in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study and had cardiac CT angiography. We used multivariable linear and logistic regression models to examine the cross-sectional associations between coronary artery stenosis, coronary artery plaque, indexed left ventricular mass (LVMi), and the outcome of hs-cTnI. We also evaluated the associations between HIV serostatus or use of highly active antiretroviral therapy (HAART) and hs-cTnI. Results: The mean age was 54 years, 54% were white, and 61% were HIV infected. In multivariable-adjusted logistic models, comparing the highest quartile of LVMi with the lowest quartile, the odds ratio (OR) of hs-cTnI ≥75th percentile was 2.59 (95% CI, 1.20 -5.75). There was no significant association between coronary stenosis severity or plaque type and hs-cTnI in linear models; however, in logistic regression models, coronary artery stenosis =70% (8% of sample) was marginally associated with a higher likelihood (OR, 2.75 [95% CI, 1.03, 7.27]) of having hs-cTnI ≥75th percentile. There were no associations between HIV serostatus or HAART use and hs-cTnI in either linear or logistic models. Conclusion: Among primary prevention men with or at risk for HIV, hs-cTnI concentrations were strongly associated with LVMi but were not associated with HIV infection or treatment status or with coronary plaque type or stenosis until the extremes of severity (=70% stenosis).

Association of Liver Fibrosis with Cardiovascular Diseases in the General Population : The Multi-Ethnic Study of Atherosclerosis (MESA)

Ostovaneh, M. R., Ambale-Venkatesh, B., Fuji, T., Bakhshi, H., Shah, R., Murthy, V. L., Tracy, R. P., Guallar, E., Wu, C. O., Bluemke, D. A., & Lima, J. A. (n.d.).

Publication year

2018

Journal title

Circulation: Cardiovascular Imaging

Volume

11

Issue

3

10.1161/CIRCIMAGING.117.007241

Abstract

Abstract

Background - The association of cardiovascular diseases (CVD) with liver fibrosis is poorly understood. We aim to assess the association of liver fibrosis by T1-mapping magnetic resonance imaging and CVD in MESA (Multi-Ethnic Study of Atherosclerosis). Methods and Results - MESA enrolled 6814 participants free of clinical CVD at baseline (2000-2002). A subsample of participants underwent T1-mapping magnetic resonance imaging 10 years after the baseline (Y10 MESA exam, 2010-2012). Liver T1 maps were generated avoiding vessels and biliary ducts from which native T1 (n=2087) and extracellular volume fraction (ECV, n=1234) were determined. Higher ECV and native T1 were indicators of liver fibrosis. Linear regression analysis evaluated the cross-sectional relationship between liver native T1 and ECV at Y10 MESA exam with a history of CVD events (atrial fibrillation, heart failure, and coronary heart disease [CHD]). Of the 2087 participants (68.7±9.1 years; 46% females), 153 had prior CVD events (78 atrial fibrillation, 25 heart failure, and 78 CHD). History of CVD events was associated with 18.5 ms higher liver native T1 (P

Association of low-moderate arsenic exposure and arsenic metabolism with incident diabetes and insulin resistance in the strong heart family study

Grau-Perez, M., Kuo, C. C., Gribble, M. O., Balakrishnan, P., Spratlen, M. J., Vaidya, D., Francesconi, K. A., Goessler, W., Guallar, E., Silbergeld, E. K., Umans, J. G., Best, L. G., Lee, E. T., Howard, B. V., Cole, S. A., & Navas-Acien, A. (n.d.).

Publication year

2017

Journal title

Environmental health perspectives

Volume

125

Issue

12

10.1289/EHP2566

Abstract

Abstract

BACKGROUND: High arsenic exposure has been related to diabetes, but at low-moderate levels the evidence is mixed. Arsenic metabolism, which is partly genetically controlled and may rely on certain B vitamins, plays a role in arsenic toxicity. OBJECTIVE: We evaluated the prospective association of arsenic exposure and metabolism with type 2 diabetes and insulin resistance. METHODS: We included 1,838 American Indian men and women free of diabetes (median age, 36 y). Arsenic exposure was assessed as the sum of inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) urine concentrations (RAs). Arsenic metabolism was evaluated by the proportions of iAs, MMA, and DMA over their sum (iAs%, MMA%, and DMA%). Homeostasis model assessment for insulin resistance (HOMA2-IR) was measured at baseline and follow-up visits. Incident diabetes was evaluated at follow-up. RESULTS: Median RAs, iAs%, MMA%, and DMA% was 4:4 lg=g creatinine, 9.5%, 14.4%, and 75.6%, respectively. Over 10,327 person-years of follow-up, 252 participants developed diabetes. Median HOMA2-IR at baseline was 1.5. The fully adjusted hazard ratio [95% confidence interval (CI)] for incident diabetes per an interquartile range increase in RAs was 1.57 (95% CI: 1.18, 2.08) in participants without prediabetes at baseline. Arsenic metabolism was not associated with incident diabetes. RAs was positively associated with HOMA2-IR at baseline but negatively with HOMA2-IR at follow-up. Increased MMA% was associated with lower HOMA2-IR when either iAs% or DMA% decreased. The association of arsenic metabolism with HOMA2-IR differed by B-vitamin intake and AS3MT genetics variants. CONCLUSIONS: Among participants without baseline prediabetes, arsenic exposure was associated with incident diabetes. Low MMA% was cross-sectional and prospectively associated with higher HOMA2-IR. Research is needed to confirm possible interactions of arsenic metabolism with B vitamins and AS3MT variants on diabetes risk. https://doi.org/10.1289/EHP2566.

Association of low-moderate urine arsenic and QT interval : Cross-sectional and longitudinal evidence from the Strong Heart Study

Moon, K. A., Zhang, Y., Guallar, E., Francesconi, K. A., Goessler, W., Umans, J. G., Best, L. G., Howard, B. V., Devereux, R. B., Okin, P. M., & Navas-Acien, A. (n.d.).

Publication year

2018

Journal title

Environmental Pollution

Volume

240

Page(s)

894-902

10.1016/j.envpol.2018.04.129

Abstract

Abstract

Epidemiologic studies suggest that chronic exposure to arsenic is related to cardiovascular disease (CVD), but the pathophysiological link remains uncertain. We evaluated the association of chronic low-moderate arsenic exposure and arsenic metabolism with baseline difference and annual change in ECG measures (QT interval, JT interval, PR interval, QRS duration, and QT dispersion) using linear mixed models in the Strong Heart Study main cohort (N = 1174, median age 55 years) and family study (N = 1695 diabetes-free, median age 36 years). At baseline, arsenic exposure was measured as the sum of inorganic and methylated species in urine (ΣAs) and arsenic metabolism was measured as the relative percentage of arsenic species. Median ΣAs and Bazett heart rate-corrected QT interval (QTc) were 8.6 μg/g creatinine and 424 ms in the main cohort and 4.3 μg/g and 414 ms in the family study, respectively. In the main cohort, a comparison of the highest to lowest ΣAs quartile (>14.4 vs. 7.1 vs.

Association of mitochondrial DNA copy number with cardiovascular disease

Ashar, F. N., Zhang, Y., Longchamps, R. J., Lane, J., Moes, A., Grove, M. L., Mychaleckyj, J. C., Taylor, K. D., Coresh, J., Rotter, J. I., Boerwinkle, E., Pankratz, N., Guallar, E., & Arking, D. E. (n.d.).

Publication year

2017

Journal title

JAMA Cardiology

Volume

2

Issue

11

Page(s)

1247-1255

10.1001/jamacardio.2017.3683

Abstract

Abstract

IMPORTANCE: Mitochondrial dysfunction is a core component of the aging process and may play a key role in atherosclerotic cardiovascular disease. Mitochondrial DNA copy number (mtDNA-CN), which represents the number of mitochondria per cell and number of mitochondrial genomes per mitochondrion, is an indirect biomarker of mitochondrial function. OBJECTIVE: To determine whether mtDNA-CN, measured in an easily accessible tissue (buffy coat/circulating leukocytes), can improve risk classification for cardiovascular disease (CVD) and help guide initiation of statin therapy for primary prevention of CVD. DESIGN, SETTING, AND PARTICIPANTS: Prospective, population-based cohort analysis including 21 870 participants (20 163 free from CVD at baseline) from 3 studies: Cardiovascular Health Study (CHS), Atherosclerosis Risk in Communities Study (ARIC), and Multiethnic Study of Atherosclerosis (MESA). The mean follow-up was 13.5 years. The study included 11 153 participants from ARIC, 4830 from CHS, and 5887 from MESA. Analysis of the data was conducted from March 10, 2014, to January 29, 2017. EXPOSURES: Mitochondrial DNA-CN measured from buffy coat/circulating leukocytes. MAIN OUTCOMES AND MEASURES: Incident CVD, which combines coronary heart disease, defined as the first incident myocardial infarction or death owing to coronary heart disease, and stroke, defined as the first nonfatal stroke or death owing to stroke. RESULTS: Of the 21 870 participants, the mean age was 62.4 years (ARIC, 57.9 years; MESA, 62.4 years; and CHS, 72.5 years), and 54.7% of participants were women. The hazard ratios for incident coronary heart disease, stroke, and CVD associated with a 1-SD decrease in mtDNA-CN were 1.29 (95% CI, 1.24-1.33), 1.11 (95% CI, 1.06-1.16), and 1.23 (95% CI, 1.19-1.26). The associations persisted after adjustment for traditional CVD risk factors. Addition of mtDNA-CN to the 2013 American College of Cardiology/American Heart Association Pooled Cohorts Equations for estimating 10-year hard atherosclerosis CVD risk was associated with improved risk classification (continuous net reclassification index, 0.194; 95% CI, 0.130-0.258; P < .001). Mitochondrial DNA-CN further improved sensitivity and specificity for the 2013 American College of Cardiology/American Heart Association recommendations on initiating statin therapy for primary prevention of ASCVD (net 221 individuals appropriately downclassified and net 15 individuals appropriately upclassified). CONCLUSIONS AND RELEVANCE: Mitochondrial DNA-CN was independently associated with incident CVD in 3 large prospective studies and may have potential clinical utility in improving CVD risk classification.

Association of multivitamin and mineral supplementation and risk of cardiovascular disease : A systematic review and meta-analysis

Kim, J., Choi, J., Kwon, S. Y., McEvoy, J. W., Blaha, M. J., Blumenthal, R. S., Guallar, E., Zhao, D., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

Circulation: Cardiovascular Quality and Outcomes

Volume

11

Issue

7

10.1161/CIRCOUTCOMES.117.004224

Abstract

Abstract

Background: Multiple studies have attempted to identify the association between multivitamin/mineral (MVM) supplementation and cardiovascular disease (CVD) outcomes, but the benefits remain controversial. We performed a systematic review and meta-analysis of the associations between MVM supplementation and various CVD outcomes, including coronary heart disease (CHD) and stroke. Methods and Results: We conducted a comprehensive search of Medline, Embase, and the Cochrane Library for studies published between January 1970 and August 2016. We included clinical trials and prospective cohort studies in the general population evaluating associations between MVM supplementation and CVD outcomes. Data extraction and quality assessment were independently conducted by 2 authors, and a third author resolved discrepancies. Eighteen studies with 2 019 862 participants and 18 363 326 person-years of follow-up were included in the analysis. Five studies specified the dose/type of MVM supplement and the rest did not. Overall, there was no association between MVM supplementation and CVD mortality (relative risk [RR], 1.00; 95% confidence interval [CI], 0.97-1.04), CHD mortality (RR, 1.02; 95% CI, 0.92-1.13), stroke mortality (RR, 0.95; 95% CI, 0.82-1.09), or stroke incidence (RR, 0.98; 95% CI, 0.91-1.05). There was no association between MVM supplements and CVD or CHD mortality in prespecified subgroups categorized by mean follow-up period, mean age, period of MVM use, sex, type of population, exclusion of patients with history of CHD, and adjustment for diet, adjustment for smoking, adjustment for physical activity, and study site. In contrast, MVM use did seem to be associated with a lower risk of CHD incidence (RR, 0.88; 95% CI, 0.79-0.97). However, this association did not remain significant in the pooled subgroup analysis of randomized controlled trials (RR, 0.97; 95% CI, 0.80-1.19). Conclusions: Our meta-analysis of clinical trials and prospective cohort studies demonstrates that MVM supplementation does not improve cardiovascular outcomes in the general population.

Association of parathyroid hormone with 20-year cognitive decline

Kim, S. M., Zhao, D., Schneider, A. L., Korada, S. K., Lutsey, P. L., Guallar, E., Alonso, A., Gwen Windham, B., Gottesman, R. F., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Neurology

Volume

89

Issue

9

Page(s)

918-926

10.1212/WNL.0000000000004290

Abstract

Abstract

Objective: We hypothesized that elevated parathyroid hormone (PTH) levels will be independently associated with 20-year cognitive decline in a large population-based cohort. Methods: We studied 12,964 middle-aged white and black ARIC participants without a history of prior stroke who, in 1990-1992 (baseline), had serum PTH levels measured and cognitive function testing, with repeat cognitive testing performed at up to 2 follow-up visits. Cognitive testing included the Delayed Word Recall, the Digit Symbol Substitution, and the Word Fluency tests, which were summed as a global Z score. Using mixed-effects models, we compared the relative decline in individual and global cognitive scores between each of the top 3 quartiles of PTH levels to the reference bottom quartile. We adjusted for demographic variables, education, vascular risk factors, and levels of calcium, phosphate, and vitamin D. We imputed missing covariate and follow-up cognitive data to account for attrition. Results: The mean (SD) age of our cohort was 57 (6) years, 57% were women, and 24% were black. There was no cross-sectional association of elevated PTH with cognitive global Z score at baseline (p > 0.05). Over a median of 20.7 years, participants in each PTH quartile showed a decline in cognitive function. However, there was no significant difference in cognitive decline between each of the top 3 quartiles and the lowest reference quartile (p > 0.05). In a subset, there was also no association of higher mid-life PTH levels with late-life prevalent adjudicated dementia (p > 0.05). Conclusions: Our work does not support an independent influence of PTH on cognitive decline in this population-based cohort study.

Association of single and joint metals with albuminuria and estimated glomerular filtration longitudinal change in middle-aged adults from Spain : The Aragon workers health study

Grau-Perez, M., Domingo-Relloso, A., Garcia-Barrera, T., Gomez-Ariza, J. L., Leon-Latre, M., Casasnovas, J. A., Moreno-Franco, B., Laclaustra, M., Guallar, E., Navas-Acien, A., Pastor-Barriuso, R., Redon, J., & Tellez-Plaza, M. (n.d.).

Publication year

2023

Journal title

Environmental Pollution

Volume

318

10.1016/j.envpol.2022.120851

Abstract

Abstract

The nephrotoxicity of low-chronic metal exposures is unclear, especially considering several metals simultaneously. We assessed the individual and joint association of metals with longitudinal change in renal endpoints in Aragon Workers Health Study participants with available measures of essential (cobalt [Co], copper [Cu], molybdenum [Mo] and zinc [Zn]) and non-essential (As, barium [Ba], Cd, chromium [Cr], antimony [Sb], titanium [Ti], uranium [U], vanadium [V] and tungsten [W]) urine metals and albumin-to-creatinine ratio (ACR) (N = 707) and estimated glomerular filtration rate (eGFR) (N = 1493) change. Median levels were 0.24, 7.0, 18.6, 295, 3.1, 1.9, 0.28, 1.16, 9.7, 0.66, 0.22 μg/g for Co, Cu, Mo, Zn, As, Ba, Cd, Cr, Sb, Ti, V and W, respectively, and 52.5 and 27.2 ng/g for Sb and U, respectively. In single metal analysis, higher As, Cr and W concentrations were associated with increasing ACR annual change. Higher Zn, As and Cr concentrations were associated with decreasing eGFR annual change. The shape of the longitudinal dose-responses, however, was compatible with a nephrotoxic role for all metals, both in ACR and eGFR models. In joint metal analysis, both higher mixtures of Cu–Zn–As–Ba–Ti–U–V–W and Co–Cd–Cr–Sb–V–W showed associations with increasing ACR and decreasing eGFR annual change. As and Cr were main drivers of the ACR change joint metal association. For the eGFR change joint metal association, while Zn and Cr were main drivers, other metals also contributed substantially. We identified potential interactions for As, Zn and W by other metals with ACR change, but not with eGFR change. Our findings support that Zn, As, Cr and W and suggestively other metals, are nephrotoxic at relatively low exposure levels. Metal exposure reduction and mitigation interventions may improve prevention and decrease the burden of renal disease in the population.

Association of statin therapy with clinical outcomes in patients with vasospastic angina : Data from Korean health insurance review and assessment service

Park, S. J., Park, H., Kang, D., Park, T. K., Park, J., Cho, J., Chung, C. R., Jeon, K., Guallar, E., Cho, J., Suh, G. Y., & Yang, J. H. (n.d.).

Publication year

2019

Journal title

PloS one

Volume

14

Issue

1

10.1371/journal.pone.0210498

Abstract

Abstract

There is conflicting evidence for the clinical benefit of statin therapy in patients with vasospastic angina (VSA). We investigated the association of statin therapy with clinical outcomes in relatively large populations with clinically suspected VSA from a nationwide population-based database. Data were collected from the Health Insurance Review and Assessment database records of 4,099 patients that were in an intensive care unit with VSA between January 1, 2008 and May 31, 2015. We divided the patients into a statin group (n = 1,795) and a non-statin group (n = 2,304). The primary outcome was a composite of cardiac arrest and acute myocardial infarction (AMI). The median follow-up duration was 3.8 years (interquartile range: 2.2 to 5.8 years). Cardiac arrest or AMI occurred in 120 patients (5.2%) in the statin group, and 97 patients (5.4%) in the non-statin group (P = 0.976). With inverse probability of treatment weighting, there was no significant difference in the rate of cardiac arrest or AMI between the two groups (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.76–1.30; P = 0.937), or even between the non-statin group and high-intensity statin group (adjusted HR, 1.08; 95% CI, 0.69–1.70; P = 0.75). The beneficial association of statin use with the primary outcome was consistently lacking across the various comorbidity types. Statin therapy was not associated with reduced cardiac arrest or AMI in patients with VSA, regardless of statin intensity. Prospective, randomized trials will be needed to confirm our findings.

Associations between aflatoxin B1-albumin adduct levels with metabolic conditions in Guatemala : A cross-sectional study

Alvarez, C. S., Rivera-Andrade, A., Kroker-Lobos, M. F., Florio, A. A., Smith, J. W., Egner, P. A., Freedman, N. D., Lazo, M., Guallar, E., Dean, M., Graubard, B. I., Ramírez-Zea, M., McGlynn, K. A., & Groopman, J. D. (n.d.).

Publication year

2022

Journal title

Health Science Reports

Volume

5

Issue

1

10.1002/hsr2.495

Abstract

Abstract

Background and Aims: Metabolic conditions such as obesity, type 2 diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) are highly prevalent in Guatemala and increase the risk for a number of disorders, including hepatocellular carcinoma (HCC). Aflatoxin B1 (AFB1) levels are also notably elevated in the population and are known to be associated with HCC risk. Whether AFB1 also contributes to the high prevalence of the metabolic disorders has not been previously examined. Therefore, the purpose of this study was to assess the association between AFB1 and the metabolic conditions. Methods: Four-hundred twenty-three individuals were included in the study, in which AFB1-albumin adduct levels were measured in sera. Metabolic conditions included diabetes, obesity, central obesity, metabolic syndrome, and NAFLD. Crude and adjusted prevalence odds ratios (PORs) and 95% confidence intervals (95% CI) were estimated for the associations between the metabolic conditions and AFB1-albumin adduct levels categorized into quartiles. Results: The study found a significant association between AFB1-albumin adduct levels and diabetes (Q4 vs Q1 POR = 3.74, 95%CI: 1.71-8.19; P-trend.003). No associations were observed between AFB1-albumin adduct levels and the other conditions. Conclusions: As diabetes is the metabolic condition most consistently linked to HCC, the possible association between AFB1 exposure and diabetes may be of public health importance. Further studies are warranted to replicate the findings and examine potential mechanisms.

Associations between Helicobacter pylori with nonalcoholic fatty liver disease and other metabolic conditions in Guatemala

Alvarez, C. S., Florio, A. A., Butt, J., Rivera-Andrade, A., Kroker-Lobos, M. F., Waterboer, T., Camargo, M. C., Freedman, N. D., Graubard, B. I., Lazo, M., Guallar, E., Groopman, J. D., Ramírez-Zea, M., & McGlynn, K. A. (n.d.).

Publication year

2020

Journal title

Helicobacter

Volume

25

Issue

6

10.1111/hel.12756

Abstract

Abstract

Background: Previous studies have suggested an association between Helicobacter pylori (H pylori) and nonalcoholic fatty liver disease (NAFLD). The aim of the current study was to examine the association in Guatemala, a region with elevated prevalences of both H pylori and NAFLD. Associations between H pylori and other metabolic conditions were also examined, as were associations between H hepaticus and H bilis and the metabolic conditions. Materials & Methods: The analysis included 424 participants from a cross-sectional study in Guatemala. H pylori seropositivity was defined as positivity for ≥ 4 antigens. Seropositivities for H bilis and H hepaticus were defined as positivity for ≥ 2 antigens. NAFLD was estimated using the Fatty Liver Index and the Hepatic Steatosis Index. Other conditions examined were obesity, central obesity, hypercholesterolemia, low HDL, diabetes and metabolic syndrome (MetSyn). Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were estimated. Results: No overall associations between H pylori, H hepaticus, or H bilis and NAFLD or related metabolic conditions were found. Seropositivity for H pylori antigens CagA and VacA and H hepaticus antigen HH0713 was each significantly associated with NAFLD, however. In addition, associations were observed between the H pylori antigens HyuA, HP1564, and UreA and specified metabolic conditions. Conclusions: While no overall associations between H pylori or Helicobacter species with NAFLD or related conditions were observed, some selected Helicobacter spp. antigens were associated with NAFLD. Further research is warranted to examine whether H. species are associated with any metabolic condition.

Associations between scar characteristics by cardiac magnetic resonance and changes in left ventricular ejection fraction in primary prevention defibrillator recipients

Zhang, Y., Guallar, E., Weiss, R. G., Stillabower, M., Gerstenblith, G., Tomaselli, G. F., & Wu, K. C. (n.d.).

Publication year

2016

Journal title

Heart Rhythm

Volume

13

Issue

8

Page(s)

1661-1666

10.1016/j.hrthm.2016.04.013

Abstract

Abstract

Background Left ventricular ejection fraction (LVEF) improves over time in 25%–40% of patients with cardiomyopathy with primary prevention implantable cardioverter-defibrillator (ICD). The determinants of LVEF improvement, however, are not well characterized. Objectives We sought to examine the associations of clinical risk factors and cardiac imaging markers with changes in LVEF after ICD implantation. Methods We conducted a retrospective analysis of cardiac magnetic resonance images in 202 patients who underwent primary prevention ICD implantation to quantify the amount of heterogeneous myocardial tissue (gray zone), dense core, and total scar. LVEF was reassessed at least once after ICD implantation. Results Over a mean follow-up of 3 years, LVEF decreased in 43 (21.3%), improved in 88 (43.6%), and was unchanged in 71 (35.1%) of the patients. Baseline LVEF and myocardial scar characteristics were the strongest determinants of LVEF trajectory with high scar burden and increasing lack of myocardial viability associated with a greater decline in LVEF. There was a trend toward an association between both changes in LVEF and scar extent with subsequent appropriate ICD shock. Changes in LVEF were also strongly associated with heart failure hospitalizations. Conclusion Scar burden and characteristics were strong determinants, independent of baseline LVEF and other traditional cardiovascular risk factors, of changes in LVEF. Both worsened LVEF and high scar extent were associated with a trend toward increased risk of appropriate shock. These findings suggest that baseline cardiac magnetic resonance imaging of the myocardial substrate may provide important prognostic information on subsequent left ventricular remodeling and adverse events.

Associations Between the Cyclic Guanosine Monophosphate Pathway and Cardiovascular Risk Factors : MESA

Ying, W., Zhao, D., Ouyang, P., Subramanya, V., Vaidya, D., Ndumele, C. E., Guallar, E., Sharma, K., Shah, S. J., Kass, D. A., Hoogeveen, R. C., Lima, J. A., Heckbert, S. R., Defilippi, C. R., Post, W. S., & Michos, E. D. (n.d.).

Publication year

2019

Journal title

Journal of the American Heart Association

Volume

8

Issue

24

10.1161/JAHA.119.013149

Abstract

Abstract

Background-—cGMP mediates numerous cardioprotective functions and is a potential therapeutic target for cardiovascular disease. Preclinical studies suggest that plasma cGMP is reflective of natriuretic peptide stimulation. Epidemiologic associations between cGMP and natriuretic peptide, as well as cardiovascular disease risk factors, are unknown. Methods and Results-—We measured plasma cGMP in 542 men and 496 women free of cardiovascular disease and heart failure in MESA (Multi-Ethnic Study of Atherosclerosis). Cross-sectional associations of N-terminal pro-B type natriuretic peptide, sex hormones, and cardiovascular disease/heart failure risk factors with log(cGMP) were analyzed using multivariable linear regression models. Mean (SD) cGMP was 4.7 (2.6) pmol/mL, with no difference between the sexes. After adjusting for cardiovascular risk factors, N-terminal pro-B type natriuretic peptide was significantly positively associated with cGMP (P

Associations of blood lead with estimated glomerular filtration rate using MDRD, CKD-EPI and serum cystatin C-based equations

Spector, J. T., Navas-Acien, A., Fadrowski, J., Guallar, E., Jaar, B., & Weaver, V. M. (n.d.).

Publication year

2011

Journal title

Nephrology Dialysis Transplantation

Volume

26

Issue

9

Page(s)

2786-2792

10.1093/ndt/gfq773

Abstract

Abstract

Background. Low-level lead exposure is widespread and has been implicated as a chronic kidney disease (CKD) risk factor. However, studies evaluating associations of lead dose with newer, potentially more accurate, estimates of kidney function, in participants with a wide range of glomerular filtration rates (GFRs), are scarce.Methods. We compared associations of blood lead and estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C single variable, multivariable and combined creatinine/cystatin C equations in 3941 adults who participated in the 1999-2002 National Health and Nutrition Examination Survey cystatin C subsample.Results. Geometric mean blood lead was 1.7 μg/dL. After multivariable adjustment, differences [95% confidence interval (CI)] in mean eGFR for a doubling of blood lead were-1.9 (-3.2,-0.7),-1.7 (-3.0,-0.5) and-1.4 (-2.3,-0.5) mL/min/1.73 m 2, using the cystatin C single variable, multivariable and combined creatinine/cystatin C equations, respectively, reflecting lower eGFR with increased blood lead. The corresponding differences (95% CI) were-0.9 (-1.9, 0.02) and-0.9 (-1.8, 0.01) using the creatinine-based MDRD and CKD-EPI equations, respectively. In participants aged ≥60 years, differences in mean eGFR ranged from-3.0 to-4.5 mL/min/1.73 m 2, and odds of reduced eGFR (

Associations of Coffee, Tea, and Caffeine Intake with Coronary Artery Calcification and Cardiovascular Events

Miller, P. E., Zhao, D., Frazier-Wood, A. C., Michos, E. D., Averill, M., Sandfort, V., Burke, G. L., Polak, J. F., Lima, J. A., Post, W. S., Blumenthal, R. S., Guallar, E., & Martin, S. S. (n.d.).

Publication year

2017

Journal title

American Journal of Medicine

Volume

130

Issue

2

Page(s)

188-197.e5

10.1016/j.amjmed.2016.08.038

Abstract

Abstract

Background Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain. Methods We examined 6508 ethnically diverse participants with available coffee and tea data from the Multi-Ethnic Study of Atherosclerosis. Intake for each was classified as never, occasional (

Associations of Lipoprotein(a) levels with incident atrial fibrillation and Ischemic Stroke : The ARIC (Atherosclerosis Risk in Communities) study

Aronis, K. N., Di Zhao, Z., Hoogeveen, R. C., Alonso, A., Ballantyne, C. M., Guallar, E., Jones, S. R., Martin, S. S., Nazarian, S., Steffen, B. T., Virani, S. S., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Journal of the American Heart Association

Volume

6

Issue

12

10.1161/JAHA.117.007372

Abstract

Abstract

Background--Lipoprotein(a) (Lp[a]) is proatherosclerotic and prothrombotic, causally related to coronary disease, and associated with other cardiovascular diseases. The association of Lp(a) with incident atrial fibrillation (AF) and with ischemic stroke among individuals with AF remains to be elucidated. Methods and Results--In the community-based ARIC (Atherosclerosis Risk in Communities) study cohort, Lp(a) levels were measured by a Denka Seiken assay at visit 4 (1996-1998). We used multivariable-adjusted Cox models to compare AF and ischemic stroke risk across Lp(a) levels. First, we evaluated incident AF in 9908 participants free of AF at baseline. AF was ascertained by electrocardiography at study visits, hospital International Statistical Classification of Diseases, 9th Revision (ICD-9) codes, and death certificates. We then evaluated incident ischemic stroke in 10 127 participants free of stroke at baseline. Stroke was identified by annual phone calls, hospital ICD-9 Revision codes, and death certificates. The baseline age was 62.7±5.6 years. Median Lp(a) levels were 13.3 mg/dL (interquartile range, 5.2-39.7 mg/dL). Median follow-up was 13.9 and 15.8 years for AF and stroke, respectively. Lp(a) was not associated with incident AF (hazard ratio, 0.98; 95% confidence interval, 0.82-1.17), comparing those with Lp(a) ≥50 with those with Lp(a) < 10 mg/dL. High Lp(a) was associated with a 42% relative increase in stroke risk among participants without AF (hazard ratio, 1.42; 95% confidence interval, 1.07-1.90) but not in those with AF (hazard ratio, 1.06; 95% confidence interval, 0.70-1.61 [P interaction for AF=0.25]). There were no interactions by race or sex. No association was found for cardioembolic stroke subtype. Conclusions--High Lp(a) levels were not associated with incident AF. Lp(a) levels were associated with increased ischemic stroke risk, primarily among individuals without AF but not in those with AF.

Associations of urinary isoprostanes with measures of subclinical atherosclerosis : The Multi-Ethnic Study of Atherosclerosis (MESA)

Wallace, R. L., Ogunmoroti, O., Zhao, D., Vaidya, D., Heravi, A., Guallar, E., Ndumele, C. E., Lima, J. A., Ouyang, P., Budoff, M. J., Allison, M., Thomas, I., Fashanu, O. E., Hoogeveen, R., Post, W. S., & Michos, E. D. (n.d.).

Publication year

2023

Journal title

Atherosclerosis Plus

Volume

51

Page(s)

13-21

10.1016/j.athplu.2022.12.002

Abstract

Abstract

Background: Urinary isoprostanes are markers of systemic oxidative stress, which is implicated in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC), thoracic aortic calcium (TAC) and carotid plaque are measure subclinical atherosclerosis and prognosticate ASCVD risk. We examined the associations between urinary isoprostane levels and measures of plaque prevalence, burden, incidence and progression across three vascular beds in a cohort from the Multi-Ethnic Study of Atherosclerosis. Methods: Urinary levels of 8-isoprostane and 2,3-dinor-8-F2-isoprostane were measured in 1089 participants (mean ± SD 62 ± 8 years, 48% women) at baseline. Participants underwent computed tomography for CAC and TAC, and duplex ultrasound for carotid plaque. TAC and CAC were reassessed at 2.4 and 10 years, respectively. Regression models were adjusted for CVD risk factors. Results: In adjusted models, there were no significant associations between isoprostane levels with CAC prevalence or progression. Highest versus lowest tertile of 8-isoprostane was associated with 28% lower prevalence of descending TAC at baseline [prevalence ratio (PR) 0.72 95% CI (0.56, 0.94)], while 1-SD higher 2,3-dinor-8-F2-isoprostane was associated with 96% higher incident ascending TAC at follow-up [Relative Risk 1.96 (1.24, 3.09)]. Highest versus lowest tertile of isoprostane measures were associated with 22% higher prevalence of carotid plaque [(PR 1.22 (1.04, 1.45)] and 14% difference [3,26] in greater extent of carotid plaque at baseline. Conclusions: Higher urinary isoprostanes were inconsistently associated with some measures of subclinical atherosclerosis by imaging. This suggests a limited role of urinary isoprostane levels as a prognostic marker for the development of ASCVD. Trial registration: The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.

Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices

Tanawuttiwat, T., Lande, J., Smeets, P., Gerritse, B., Nazarian, S., Guallar, E., & Cheng, A. (n.d.).

Publication year

2020

Journal title

Journal of Cardiovascular Electrophysiology

Volume

31

Issue

6

Page(s)

1519-1526

10.1111/jce.14444

Abstract

Abstract

Background: Atrial fibrillation (AF) and heart failure (HF) often coexist but little is known on how AF burden associates with subsequent episodes of HF. Objective: The aim of this study was to quantitatively assess the short- and long-term association of AF burden with subsequent episodes of HF events in patients with reduced ejection fraction. Methods: Patients with cardiac resynchronization therapy (CRT) devices with at least 90 days of device data were included in the study. Time-dependent Cox regression with a 7-day window was used to evaluate the association of short- and long-term AF burden with subsequent HF events. Each patient with HF was matched to two control patients without an HF event based on age, gender, year of implant and CRT defibrillation capability. Results: In our cohort with 2:1 matching (N = 549), 183 patients developed HF events and 275 (50.1%) had AF over an average follow-up of 24 ± 11 months. A 1-hour increase in short-term AF burden was associated with a 3% increased risk of HF events (HR, 1.034; 95% confidence interval [CI], 1.012-1.056; P =.01; HR for 24-hour = 2.23). In contrast, the association between long-term AF burden and subsequent HF events was not statistically significant (HR, 1.009; 95% CI, 0.992-1.026; P =.373). Conclusion: A 24-hour increase in AF burden is associated with a more than two-fold increased risk of HF events over the subsequent week while the long-term AF burden is not significantly associated with HF events.

Attitudes toward cancer and cancer patients in an Urban Iranian population

Badihian, S., Choi, E. K., Kim, I. R., Parnia, A., Manouchehri, N., Badihian, N., Tanha, J. M., Guallar, E., & Cho, J. (n.d.).

Publication year

2017

Journal title

Oncologist

Volume

22

Issue

8

Page(s)

944-950

10.1634/theoncologist.2017-0073

Abstract

Abstract

Background. Because of the significant incidence and mortality of cancer in Iran, a Comprehensive National Cancer Control Program for the prevention and early detection of cancer was launched in 2007. However, cancer awareness and screening rates in Iran did not improve. This study aimed to evaluate public attitudes toward cancer and cancer patients in Iran. Materials and Methods.We conducted a cross-sectional survey among 953 non-institutionalized individuals in Isfahan, Iran, from November 2014 to February 2015. We collected data on attitudes toward cancer in three domains (impossibility of recovery, cancer stereotypes, and discrimination), as well as questions on willingness to disclose a cancer diagnosis. Results. Among all participants, 33.9% agreed that it is very difficult to regain one’s health after a cancer diagnosis, 17.4% felt uncomfortable with a cancer patient, and 26.9% said that they would avoid marrying people whose family members had cancer. While 88.9% of study participants said that cancer patients deserve to be protected in society, 53.3% and 48.4% of participants agreed that they would not disclose a cancer diagnosis to neighbors and coworkers, respectively. Conclusion. Negative attitudes with respect to impossibility of recovery and discrimination toward cancer and cancer patients were common among urban Iranians. Most people would not disclose a cancer diagnosis to others in spite of advancements in cancer diagnosis and treatment, reflecting unfavorable attitudes toward cancer and cancer patients in society. Successful implementation of cancer awareness and prevention programs in Iran may require social changes based on adequate information on cancer and cancer patients.

Author Correction : Non-alcoholic fatty liver disease and cerebral small vessel disease in Korean cognitively normal individuals (Scientific Reports, (2019), 9, 1, (1814), 10.1038/s41598-018-38357-x)

Jang, H., Kang, D., Chang, Y., Kim, Y., Lee, J. S., Kim, K. W., Jang, Y. K., Kim, H. J., Na, D. L., Shin, H. Y., Kang, M., Guallar, E., Cho, J., & Seo, S. W. (n.d.).

Publication year

2019

Journal title

Scientific reports

Volume

9

Issue

1

10.1038/s41598-019-51401-8

Abstract

Abstract

The Acknowledgements section of this Article is incomplete. “This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2017R1A2B2005081) and the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2016M3C7A1913844).” should read: “This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (NRF-2017R1A2B2005081), the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2016M3C7A1913844), and a fund (2018-ER6203-00) by Research of Korea Centers for Disease Control and Prevention.”

Author Correction : Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease: a cohort study (Scientific Reports, (2018), 8, 1, (4718), 10.1038/s41598-018-23014-0)

Jang, H. R., Kang, D., Sinn, D. H., Gu, S., Cho, S. J., Lee, J. E., Huh, W., Paik, S. W., Ryu, S., Chang, Y., Shafi, T., Lazo, M., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).

Publication year

2021

Journal title

Scientific reports

Volume

11

Issue

1

10.1038/s41598-021-90150-5

Abstract

Abstract

The original version of this Article contained a repeated error in Affiliations 1,2,3,4 and 5 where “Kangbuk Samsung Hospital” was incorrectly given as the Organisational name. The correct affiliations are listed below: Affiliation 1 Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea Affiliation 2 Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea Affiliation 3 Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea Affiliation 4 Center for Health Promotion, Samsung Medical Center, Seoul, South Korea Affiliation 5 Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, South Korea The original Article has been corrected.

Author Correction : Perceived stress and non-alcoholic fatty liver disease in apparently healthy men and women (Scientific Reports, (2020), 10, 1, (38), 10.1038/s41598-019-57036-z)

Kang, D., Zhao, D., Ryu, S., Guallar, E., Cho, J., Lazo, M., Shin, H., Chang, Y., & Sung, E. (n.d.).

Publication year

2020

Journal title

Scientific reports

Volume

10

Issue

1

10.1038/s41598-020-78911-0

Abstract

Abstract

This Article contains an error in the Figure legends of Figure 1, Figure 2 and Figure 3. The legends of these Figures were inadvertently switched. The legend of Figure 1: “Flowchart of study participants.” should read: “Multivariable-adjusted odds ratios (95% CI) for non-alcoholic fatty liver disease (NAFLD) by PSI stress score. The curves represent adjusted odds ratios (solid line) and their 95% confidence intervals (dashed lines) for NAFLD based on restricted cubic splines for PSI stress score with knots at the 5th, 35th, 65th and 95th percentiles (PSI scores 9, 13, 18, and 31, respectively) of their sample distributions. The reference value (diamond dot) was set at the 50th percentile (PSI score 15). The model was adjusted for age, sex, study center, education, marital status, year of visit, smoking, vigorous exercise, alcohol, body mass index, systolic blood pressure, total and HDL cholesterol, triglycerides, and fasting glucose.” The legend of Figure 2: “Multivariable-adjusted odds ratios (95% CI) for non-alcoholic fatty liver disease (NAFLD) by PSI stress score. The curves represent adjusted odds ratios (solid line) and their 95% confidence intervals (dashed lines) for NAFLD based on restricted cubic splines for PSI stress score with knots at the 5th, 35th, 65th and 95th percentiles (PSI scores 9, 13, 18, and 31, respectively) of their sample distributions. The reference value (diamond dot) was set at the 50th percentile (PSI score 15). The model was adjusted for age, sex, study center, education, marital status, year of visit, smoking, vigorous exercise, alcohol, body mass index, systolic blood pressure, total and HDL cholesterol, triglycerides, and fasting glucose.” should read: “Multivariable-adjusted odds ratios (95% confidence interval) comparing the 90th vs the 10th percentiles of PSI stress score (27 vs. 10) by clinically relevant subgroups. Logistic regression models were adjusted for age, sex, study center, education, marital status, year of visit, smoking, vigorous exercise, alcohol, body mass index, systolic blood pressure, total and HDL cholesterol, triglycerides, and fasting glucose.” The legend of Figure 3: “Multivariable-adjusted odds ratios (95% confidence internal) comparing the 90th vs the 10th percentiles of PSI stress score (27 vs. 10) by clinically relevant subgroups. PSI scores were modeled as restricted cubic splines with knots at the 5th, 35th, 65th and 95th percentiles of the sample distribution. Logistic regression models were adjusted for age, sex, study center, education, marital status, year of visit, smoking, vigorous exercise, alcohol, body mass index, systolic blood pressure, total and HDL cholesterol, triglycerides, and fasting glucose.” should read: “Flowchart of study participants.”

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.