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
Proton pump inhibitor use increases pyogenic liver abscess risk : A Nationwide Cohort study
AbstractOh, J. H., Kang, D., Kang, W., Guallar, E., Cho, J., & Min, Y. W. (n.d.).Publication year
2021Journal title
Journal of Neurogastroenterology and MotilityVolume
27Issue
4Page(s)
555-564AbstractBackground/Aims Proton pump inhibitors (PPIs) increase gastric pH and alter the gut microbiome. An increased risk for infectious diseases has been reported in PPI users. However, little is known about the association of PPI use with pyogenic liver abscess (PLA) incidence risk. Methods We conducted a population-based cohort study using data from a nationwide representative sample of the Korean general population followed up for 10 years (January 1, 2003 to December 31, 2013). We identified PPI prescriptions and considered PPI as a timevarying variable. Proportional hazards regression model was used for incident PLA comparing PPI use versus non-use. Propensity score matching was also conducted. Results During the 4 209 229 person-years of follow-up, 58 595 participants had at least 1 PPI prescription and 541 patients developed liver abscess. The age-, sex-, residential area-, and income-adjusted hazard ratio for PLA incidence with PPI use was 4.19 (95% CI, 2.54- 6.92). The association was observed in fully adjusted models (hazard ratio 3.88; 95% CI, 2.33-6.44). The positive association between PPI use and PLA was consistent in all subgroups analyzed and in propensity score matching group. Conclusion The present data indicate that PPI use is associated with an increased PLA risk. Therefore, it is necessary to prescribe PPIs with clear indication and to avoid improper use of PPIs.Risk of non-Hodgkin lymphoma in breast cancer survivors : a nationwide cohort study
AbstractKang, D., Yoon, S. E., Shin, D., Lee, J., Hong, Y. S., Lee, S. K., Lee, J. E., Park, Y. H., Ahn, J. S., Guallar, E., Kim, W. S., Lee, J., Kim, S. J., & Cho, J. (n.d.).Publication year
2021Journal title
Blood Cancer JournalVolume
11Issue
12AbstractSeveral studies have suggested that estrogens have a protective function against lymphomagenesis. The treatment of breast cancer is driven by subtype classification, and the assessment of hormone receptor status is important for treatment selection. Thus, we evaluated the association between breast cancer and the incidence of NHL. We conducted a retrospective cohort study using a population-based nationwide registry in South Korea. We selected all women with newly diagnosed breast cancer between January 1st, 2002 and December 31st, 2016 who received curative treatment (N = 84,969) and a 1:10 sample of age-matched non-breast cancer controls (N = 1,057,674). Incident breast cancer (time-varying exposure) was the exposure and development of any type of NHL, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), mature T/NK-cell lymphomas, anaplastic large cell lymphoma (ALCL), and unspecified types of NHL, was the outcome. During follow-up, 1564 incident cases of NHL occurred. The fully adjusted Hazard Ratio (HR) for NHL associated with the development of breast cancer was 1.64 (95% CI = 1.34–2.00) after adjusting for body mass index, alcohol intake, physical activity, smoking, income, and comorbidity. The adjusted HR for NHL was much higher in participants who were agedStages of menopause and abnormal lung function : a cross-sectional study of middle-aged women
AbstractHong, Y. S., Park, H. Y., Chang, Y., Jang, E. H., Zhao, D., Kim, S., Guallar, E., Kim, H., Cho, J., & Ryu, S. (n.d.).Publication year
2021Journal title
MenopauseVolume
28Issue
7Page(s)
811-818AbstractObjective:Whether hormonal changes during menopausal transition postmenopause stages influence pulmonary function is not clearly understood. We evaluated the association between each stage of menopause and the prevalence of abnormal lung function in healthy middle-aged women. We hypothesized that the prevalence of abnormal lung function would increase from the late menopausal transition stage during menopausal transition postmenopause stages.Methods:The study population included women 40 to 65 years of age who underwent comprehensive health screening examination at the Kangbuk Samsung Hospital Total Healthcare Centers from January 2015 to December 2017. Stages of menopause (premenopausal, early menopausal transition, late menopausal transition, and postmenopausal) were defined using the 2011 Stages of Reproductive Aging Workshop (STRAW + 10) criteria. Abnormal lung function was defined based on spirometry as forced expiratory volume in 1 second/forced vital capacity less than70% or forced vital capacity less than 80% predicted. Prevalence ratios (PRs) for abnormal lung function by stages of menopause were estimated from logistic regression models adjusted for age, anthropometric measurements, lifestyle factors, medical history, lipid and inflammatory biomarkers, and reproductive factors.Results:Among 43,822 participants, there were 4,615 participants (10.5%) with restrictive ventilatory disorder and 653 participants (1.5%) with obstructive ventilatory disorder. The fully adjusted PRs (95% confidence interval) for abnormal ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stage to premenopausal stage were 1.01 (0.94-1.08), 1.13 (1.03-1.22), and 1.10 (0.98-1.22), respectively. The fully adjusted PRs for restrictive ventilatory disorder comparing early menopausal transition, late menopausal transition, and postmenopausal stages to premenopausal stage were 1.02 (0.94-1.11), 1.18 (1.06-1.30), and 1.15 (1.00-1.31), respectively. There was, however, no clear association between stages of menopause and obstructive ventilatory disorder.Conclusions:In this large study of middle-aged women, the fully adjusted prevalence of abnormal lung function, particularly that of restrictive ventilatory disorder, was higher in women in late menopausal transition and menopausal stages compared to women in premenopausal stage.Survival in untreated hepatocellular carcinoma : A national cohort study
AbstractKim, Y. A., Kang, D., Moon, H., Sinn, D., Kang, M., Woo, S. M., Chang, Y. J., Park, B., Kong, S. Y., Guallar, E., Shin, S. Y., Gwak, G., Back, J. H., Lee, E. S., & Cho, J. (n.d.).Publication year
2021Journal title
PloS oneVolume
16Issue
2 FebruaryAbstractThis study aimed to analyze the proportion, characteristics and prognosis of untreated hepatocellular carcinoma (HCC) patients in a large representative nationwide study. A cohort study was conducted using the National Health Insurance Service (NHIS) database in Korea. A total of 63,668 newly-diagnosed HCC patients between January 2008 and December 2013 were analyzed. Patients were categorized into treatment group and no treatment group using claim codes after HCC diagnosis. The proportion of untreated HCC patients was 27.6%, decreasing from 33.4% in 2008 to 24.8% in 2013. Compared to treated patients, untreated patients were more likely to be older (P< 0.001), female (P< 0.01), to have a distant SEER stage (P< 0.001), severe liver disease (P< 0.001), and lower income (P< 0.001). The fully-Adjusted hazard ratio for all-cause mortality comparing untreated to treated patients was 3.11 (95% CI, 3.04 3.18). The risk of mortality was higher for untreated patients in all pre-defined subgroups, including those with distant SEER stage and those with severe liver disease. About one fourth of newly diagnosed HCC patients did not receive any HCC-specific treatment. Untreated patients showed higher risk of mortality compared to treated patients in all subgroups. Further studies are needed to identify obstacles for HCC treatment and to improve treatment rates.The Relationship between Breast Density Change during Menopause and the Risk of Breast Cancer in Korean Women
AbstractKang, D., Kim, J. Y., Kim, J. Y., Mun, H. S., Yoon, S. J., Lee, J., Han, G., Im, Y. H., Shin, S. Y., Lee, S. K., Yu, J. H., Lee, K. H., Kim, M., Park, D., Choi, Y. H., Jeong, O. S., Lee, J. H., Jekal, S. Y., Choi, J. S., … Kang, M. (n.d.).Publication year
2021Journal title
Cancer Prevention ResearchVolume
14Issue
12Page(s)
1119-1128AbstractBackground: The aim of this study was to investigate the relationship between changes in breast density during menopause and breast cancer risk. Methods: This study was a retrospective, longitudinal cohort study for women over 30 years of age who had undergone breast mammography serially at baseline and postmenopause during regular health checkups at Samsung Medical Center. None of the participants had been diagnosed with breast cancer at baseline. Mammographic breast density was measured using the American College of Radiology Breast Imaging Reporting and Data System. Results: During 18,615 person-years of follow-up (median follow-up 4.8 years; interquartile range 2.8-7.5 years), 45 participants were diagnosed with breast cancer. The prevalence of dense breasts was higher in those who were younger, underweight, had low parity or using contraceptives. The cumulative incidence of breast cancer increased 4 years after menopause in participants, and the consistently extremely dense group had a significantly higher cumulative incidence (CI) of breast cancer compared with other groups [CI of extremely dense vs. others (incidence rate per 100,000 person-years): 375 vs. 203, P < 0.01]. Conclusion: Korean women whose breast density was extremely dense before menopause and who maintained this density after menopause were at two-fold greater risk of breast cancer. _2021 American Association for Cancer Research.The role of masks in mitigating the sars-cov-2 pandemic : Another piece of the puzzle
AbstractLaine, C., Goodman, S. N., & Guallar, E. (n.d.).Publication year
2021Journal title
Annals of internal medicineVolume
174Issue
3Page(s)
419-420Abstract~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-CWeight change and resolution of fatty liver in normal weight individuals with nonalcoholic fatty liver disease
AbstractSinn, D. H., Kang, D., Cho, S. J., Paik, S. W., Guallar, E., Cho, J., & Gwak, G. Y. (n.d.).Publication year
2021Journal title
European Journal of Gastroenterology and HepatologyVolume
33Issue
1Page(s)
E529-E534AbstractObjectives Obesity is a well-known risk factor for nonalcoholic fatty liver disease (NAFLD), and weight reduction is primarily recommended for managing the disease. However, some NAFLD patients have a normal weight (lean NAFLD), and whether weight reduction is also recommendable for lean NAFLD patients remains unclear. Methods We conducted a longitudinal study of 16 738 adults (average age, 50.5 years; lean NAFLD, 2383 participants) with NAFLD at baseline who underwent repeated health check-up examinations, including bodyweight measurements and abdominal ultrasonography from January 2003 through December 2013. Results During 68 389 person-years of follow-up (median follow-up of 3.00 years), 5819 patients had a fatty liver resolution. Compared with participants who had no weight reduction or increased weight, the fully adjusted hazard ratios for fatty liver resolution in participants with 0-4.9, 5-9.9 and 10% or more weight reduction were 1.67 [95% confidence interval (CI), 1.57-1.77], 3.36 (95% CI, 3.09-3.65) and 5.50 (95% CI, 4.83-6.27), respectively. The association between weight reduction and the fatty liver resolution was stronger in overweight/obese NAFLD participants but was also evident in lean NAFLD participants in a dose-dependent manner. In spline regression models, the association between weight change and the fatty liver resolution was linear among participants with normal weight. Conclusion There was a dose-dependent association between weight reduction and fatty liver resolution in both lean and overweight/obese NAFLD patients. This finding suggests weight reduction as a primary recommendation for lean NAFLD patients as in overweight/obese NAFLD patients.Aflatoxin B 1 exposure and liver cirrhosis in Guatemala : A case-control study
AbstractAlvarez, C. S., Hernández, E., Escobar, K., Villagrán, C. I., Kroker-Lobos, M. F., Rivera-Andrade, A., Smith, J. W., Egner, P. A., Lazo, M., Freedman, N. D., Guallar, E., Dean, M., Graubard, B. I., Groopman, J. D., Ramírez-Zea, M., & McGlynn, K. A. (n.d.).Publication year
2020Journal title
BMJ Open GastroenterologyVolume
7Issue
1AbstractObjective In Guatemala, cirrhosis is among the 10 leading causes of death, and mortality rates have increased lately. The reasons for this heavy burden of disease are not clear as the prevalence of prominent risk factors, such as hepatitis B virus, hepatitis C virus and heavy alcohol consumption, appears to be low. Aflatoxin B 1 (AFB 1) exposure, however, appears to be high, and thus could be associated with the high burden of cirrhosis. Whether AFB 1 increases the risk of cirrhosis in the absence of viral infection, however, is not clear. Design Cirrhosis cases (n=100) from two major referral hospitals in Guatemala City were compared with controls (n=200) from a cross-sectional study. Logistic regression was used to estimate the ORs and 95% CIs of cirrhosis and quintiles of AFB 1 in crude and adjusted models. A sex-stratified analysis was also conducted. Results The median AFB 1 level was significantly higher among the cases (11.4 pg/mg) than controls (5.11 pg/mg). In logistic regression analyses, higher levels of AFB 1 was associated with cirrhosis (quintile 5 vs quintile 1, OR: 11.55; 95% CI 4.05 to 32.89). No attenuation was observed with adjustment by sex, ethnicity, hepatitis B virus status, and heavy alcohol consumption. A significantly increasing trend in association was observed in both models (p trendAlcoholic and Nonalcoholic Fatty Liver Disease and Incident Hospitalization for Liver and Cardiovascular Diseases
AbstractChang, Y., Cho, J., Cho, Y. K., Cho, A., Hong, Y. S., Zhao, D., Ahn, J., Sohn, C. I., Shin, H., Guallar, E., & Ryu, S. (n.d.).Publication year
2020Journal title
Clinical Gastroenterology and HepatologyVolume
18Issue
1Page(s)
205-215.e7AbstractBackground & Aims: We compared the associations of nonalcoholic fatty liver disease (NAFLD) and alcohol-associated fatty liver disease (AFLD) with risk of incident hospitalization for liver and cardiovascular diseases. Methods: We collected data from the Kangbuk Samsung Health Study on 218,030 men and women in Korea who underwent a health examination from 2011 through 2016. Fatty liver disease (FLD) was detected by ultrasound during the initial examination. The Fibrosis-4 index was used to identify individuals with liver fibrosis. Participants were followed up for as long as 5.9 years and data on hospitalizations for liver and cardiovascular diseases were collected. Results: The prevalence of NAFLD was 22.0% and the prevalence of AFLD was 6.4%. Over a median follow-up period of 4.2 years, we observed 51 and 1097 incident cases of liver disease– or cardiovascular disease–related hospitalizations, respectively. After adjustment for potential confounders, the multivariable-adjusted hazard ratios for liver disease–related hospitalization, comparing NAFLD and AFLD with the reference category (no excessive alcohol intake and no FLD), were 1.73 (95% CI, 0.76–3.96) and 5.00 (95% CI, 2.12–11.83), respectively. The corresponding hazard ratios for cardiovascular disease hospitalization were 1.20 (95% CI, 1.02–1.40) and 1.08 (95% CI, 0.86–1.34), respectively. Among participants with FLD, the risk of liver disease–related hospitalization increased with high Fibrosis-4 index scores, whereas the risk of incident cardiovascular disease did not. Conclusions: In a large cohort study, we found an increased risk of liver disease–related hospitalizations for patients with NAFLD or AFLD, especially among those with Fibrosis-4 index scores. An increased risk of cardiovascular disease–associated hospitalization was observed in patients with NAFLD but not AFLD.Ambient air pollution as a mediator in the pathway linking race/ethnicity to blood pressure elevation : The multi-ethnic study of atherosclerosis (MESA)
AbstractSong, L., Smith, G. S., Adar, S. D., Post, W. S., Guallar, E., Navas-Acien, A., Kaufman, J. D., & Jones, M. R. (n.d.).Publication year
2020Journal title
Environmental ResearchVolume
180AbstractBackground: Racial/ethnic disparities in blood pressure and hypertension have been evident in previous studies, as were associations between race/ethnicity with ambient air pollution and those between air pollution with hypertension. The role of air pollution exposure to racial/ethnic differences in hypertension has not been explored. Objective: To assess the potential mediating effects of ambient air pollution on the association between race/ethnicity and blood pressure levels. Methods: We studied 6,463 White, Black, Hispanic and Chinese adults enrolled across 6 US cities. Systolic (SBP) and diastolic blood pressure (DBP) were measured at Exam 1 (2000–2002) and Exam 2 (2002–2004). Household-level annual average concentrations of fine particulate matter (PM2.5), oxides of nitrogen (NOX), and ozone (O3) for the year 2000 were estimated for participants. Results: The difference in SBP levels by race/ethnicity that was related to higher PM2.5 concentrations compared with White men (“indirect associations”) was 0.3 (95% CI: 0.1, 0.6) mmHg for Black men, 0.3 (95% CI: 0.1, 0.6) mmHg for Hispanic men and 1.0 (95% CI: 0.2, 1.8) mmHg for Chinese men. Findings were similar although not statistically significant for women. PM2.5 did not mediate racial/ethnic differences in DBP. Indirect associations were significant for O3 for SBP among women and men and for DBP among men. In contrast, racial/ethnic disparities were attenuated due to exposure to NOX. Conclusion: Racial disparities in blood pressure were reduced after accounting for PM2.5 and ozone while increased after accounting for NOX.Associations between Helicobacter pylori with nonalcoholic fatty liver disease and other metabolic conditions in Guatemala
AbstractAlvarez, 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
2020Journal title
HelicobacterVolume
25Issue
6AbstractBackground: 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.Atrial fibrillation burden and subsequent heart failure events in patients with cardiac resynchronization therapy devices
AbstractTanawuttiwat, T., Lande, J., Smeets, P., Gerritse, B., Nazarian, S., Guallar, E., & Cheng, A. (n.d.).Publication year
2020Journal title
Journal of Cardiovascular ElectrophysiologyVolume
31Issue
6Page(s)
1519-1526AbstractBackground: 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.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)
AbstractKang, D., Zhao, D., Ryu, S., Guallar, E., Cho, J., Lazo, M., Shin, H., Chang, Y., & Sung, E. (n.d.).Publication year
2020Journal title
Scientific reportsVolume
10Issue
1AbstractThis 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.”Chronic obstructive pulmonary disease and lung cancer incidence in never smokers : A cohort study
AbstractPark, H. Y., Kang, D., Shin, S. H., Yoo, K. H., Rhee, C. K., Suh, G. Y., Kim, H., Shim, Y. M., Guallar, E., Cho, J., & Kwon, O. J. (n.d.).Publication year
2020Journal title
ThoraxVolume
75Issue
6Page(s)
506-509AbstractThere has been limited evidence for the association between chronic obstructive pulmonary disease (COPD) and the incidence of lung cancer among never smokers. We aimed to estimate the risk of lung cancer incidence in never smokers with COPD, and to compare it with the risk associated with smoking. This cohort study involved 338 548 subjects, 40 to 84 years of age with no history of lung cancer at baseline, enrolled in the National Health Insurance Service National Sample Cohort. During 2 355 005 person-years of follow-up (median follow-up 7.0 years), 1834 participants developed lung cancer. Compared with never smokers without COPD, the fully-adjusted hazard ratios (95% CI) for lung cancer in never smokers with COPD, ever smokers without COPD, and ever smokers with COPD were 2.67 (2.09 to 3.40), 1.97 (1.75 to 2.21), and 6.19 (5.04 to 7.61), respectively. In this large national cohort study, COPD was also a strong independent risk factor for lung cancer incidence in never smokers, implying that COPD patients are at high risk of lung cancer, irrespective of smoking status.Coffee and tea consumption in the early adult lifespan and left ventricular function in middle age : the CARDIA study
AbstractNwabuo, C. C., Betoko, A. S., Reis, J. P., Moreira, H. T., Vasconcellos, H. D., Guallar, E., Cox, C., Sidney, S., Ambale-Venkatesh, B., Lewis, C. E., Schreiner, P. J., Lloyd-Jones, D., Kiefe, C. I., Gidding, S. S., & Lima, J. A. (n.d.).Publication year
2020Journal title
ESC heart failureVolume
7Issue
4Page(s)
1510-1519AbstractAims: The long-term impact of coffee or tea consumption on subclinical left ventricular (LV) systolic or diastolic function has not been previously studied. We examined the association between coffee or tea consumption beginning in early adulthood and cardiac function in midlife. Methods and results: We investigated 2735 Coronary Artery Risk Development in Young Adults (CARDIA) study participants with long-term total caffeine intake, coffee, and tea consumption data from three visits over a 20 year interval and available echocardiography indices at the CARDIA Year-25 exam (2010–2011). Linear regression models were used to assess the association between caffeine intake, tea, and coffee consumption (independent variables) and echocardiography outcomes [LV mass, left atrial volume, and global longitudinal strain (GLS), LV ejection fraction (LVEF), and transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e´)]. Models were adjusted for standard cardiovascular risk factors, socioeconomic status, physical activity, alcohol use, and dietary factors (calorie intake, whole and refined grain intake, and fruit and vegetable consumption). Mean (standard deviation) age was 25.2 (3.5) years at the CARDIA Year-0 exam (1985–1986), 57.4% were women, and 41.9% were African-American. In adjusted multivariable linear regression models assessing the relationship between coffee consumption and GLS, beta coefficients when comparing coffee drinkers of 4 cups/day with non-coffee drinkers were β = −0.30%, P < 0.05; β = −0.35%, P < 0.05; β = −0.32%, P < 0.05; β = −0.40%, P > 0.05; respectively (more negative values implies better systolic function). In adjusted multivariable linear regression models assessing the relationship between coffee consumption and E/e´, beta coefficients when comparing coffee drinkers of 4 cups/day with non-coffee drinkers were β = −0.29, P < 0.05; β = −0.38, P < 0.01; β = −0.20, P >.05; and β = −0.37, P > 0.05, respectively (more negative values implies better diastolic function). High daily coffee consumption (>4 cups/day) was associated with worse LVEF (β = −1.69, P < 0.05). There were no associations between either tea drinking or total caffeine intake and cardiac function (P > 0.05 for all). Conclusions: Low-to-moderate daily coffee consumption from early adulthood to middle age was associated with better LV systolic and diastolic function in midlife. High daily coffee consumption (>4cups/day) was associated with worse LV function. There was no association between caffeine or tea intake and cardiac function.Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events : the ARIC Study
AbstractZhao, D., Guallar, E., Vaidya, D., Ndumele, C. E., Ouyang, P., Post, W. S., Lima, J. A., Ying, W., Kass, D. A., Hoogeveen, R. C., Shah, S. J., Subramanya, V., & Michos, E. D. (n.d.).Publication year
2020Journal title
Journal of the American Heart AssociationVolume
9Issue
2AbstractBackground: Cyclic guanosine monophosphate (cGMP) is a second messenger regulated through natriuretic peptide and nitric oxide pathways. Stimulation of cGMP signaling is a potential therapeutic strategy for heart failure with preserved ejection fraction (HFpEF) and atherosclerotic cardiovascular disease (ASCVD). We hypothesized that plasma cGMP levels would be associated with lower risk for incident HFpEF, any HF, ASCVD, and coronary heart disease (CHD). Methods and Results: We conducted a case–cohort analysis nested in the ARIC (Atherosclerosis Risk in Communities) study. Plasma cGMP was measured in 875 participants at visit 4 (1996–1998), with oversampling of incident HFpEF cases. We used Cox proportional hazard models to assess associations of cGMP with incident HFpEF, HF, ASCVD (CHD+stroke), and CHD. The mean (SD) age was 62.4 (5.6) years and median (interquartile interval) cGMP was 3.4 pmol/mL (2.4–4.6). During a median follow-up of 9.9 years, there were 283 incident cases of HFpEF, 329 any HF, 151 ASCVD, and 125 CHD. In models adjusted for CVD risk factors, the hazard ratios (95% CI) associated with the highest cGMP tertile compared with lowest for HFpEF, HF, ASCVD, and CHD were 1.88 (1.17–3.02), 2.18 (1.18–4.06), 2.84 (1.44–5.60), and 2.43 (1.19–5.00), respectively. In models further adjusted for N-terminal-proB-type natriuretic peptide, associations were attenuated for HFpEF and HF but remained statistically significant for ASCVD (2.56 [1.26–5.20]) and CHD (2.25 [1.07–4.71]). Conclusions: Contrary to our hypothesis, higher cGMP levels were associated with incident CVD in a community-based cohort. The associations of cGMP with HF or HFpEF may be explained by N-terminal-proB-type natriuretic peptide, but not for ASCVD and CHD.Diabetes mellitus is associated with an increased risk of gastric cancer : a cohort study
AbstractYang, H. J., Kang, D., Chang, Y., Ahn, J., Ryu, S., Cho, J., Guallar, E., & Sohn, C. I. (n.d.).Publication year
2020Journal title
Gastric CancerVolume
23Issue
3Page(s)
382-390AbstractBackground: Diabetes mellitus (DM) has been considered a potential risk factor for gastric cancer, but the evidence is conflicting. We evaluated the association of DM with incident gastric cancer in a large cohort of men and women with endoscopic assessment at baseline and during follow-up. Methods: We performed a retrospective cohort study of 195,312 adult men and women who underwent upper endoscopy at baseline and during follow-up between 2003 and 2014. DM was defined as fasting serum glucose ≥ 126 mg/dL, self-reported history of DM or current use of antidiabetic medications. Gastric cancer was confirmed histologically. Results: The prevalence of DM at baseline was 3.0% (n = 5774). Over 865,511 person-years of follow-up, 198 participants developed gastric cancer. The fully adjusted hazard ratio (HR) for incident gastric cancer comparing participants with and without DM at baseline was 1.76 [95% confidence interval (CI) 1.04–2.97; P = 0.033). When we evaluated DM as a time-varying covariate, the fully adjusted HR was 1.66 (95% CI 1.04–2.68; P = 0.036). The association between DM and incident gastric cancer did not differ by the presence of intestinal metaplasia (P for interaction = 0.61). Conclusions: In this large cohort with endoscopic follow-up, DM was independently associated with increased gastric cancer incidence. The increased risk was independent of mucosal atrophy and intestinal metaplasia and was consistent in participants with newly developed DM during follow-up. Patients with DM may require more intensive endoscopic follow-up for gastric cancer screening.Erratum : Risk factors control for primary prevention of cardiovascular disease in men: Evidence from the Aragon Workers Health Study (AWHS) (PLoS ONE (2018) 13:2 0e0193541) DOI: 10.1371/journal.pone.0193541)
AbstractAguilar-Palacio, I., Malo, S., Feja, C., Lallana, M., León-Latre, M., Casasnovas, J. A., Rabanaque, M., & Guallar, E. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
2AbstractIn the Funding section, the information provided is incomplete. The complete, correct Funding section is: This work was supported by the Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER). PI13/01668 (http://www.isciii.es).Evaluation of mitochondrial DNA copy number estimation techniques
AbstractLongchamps, R. J., Castellani, C. A., Yang, S. Y., Newcomb, C. E., Sumpter, J. A., Lane, J., Grove, M. L., Guallar, E., Pankratz, N., Taylor, K. D., Rotter, J. I., Boerwinkle, E., & Arking, D. E. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
1AbstractMitochondrial DNA copy number (mtDNA-CN), a measure of the number of mitochondrial genomes per cell, is a minimally invasive proxy measure for mitochondrial function and has been associated with several aging-related diseases. Although quantitative real-time PCR (qPCR) is the current gold standard method for measuring mtDNA-CN, mtDNA-CN can also be measured from genotyping microarray probe intensities and DNA sequencing read counts. To conduct a comprehensive examination on the performance of these methods, we use known mtDNA-CN correlates (age, sex, white blood cell count, Duffy locus genotype, incident cardiovascular disease) to evaluate mtDNA-CN calculated from qPCR, two microarray platforms, as well as whole genome (WGS) and whole exome sequence (WES) data across 1,085 participants from the Atherosclerosis Risk in Communities (ARIC) study and 3,489 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). We observe mtDNA-CN derived from WGS data is significantly more associated with known correlates compared to all other methods (p < 0.001). Additionally, mtDNA-CN measured from WGS is on average more significantly associated with traits by 5.6 orders of magnitude and has effect size estimates 5.8 times more extreme than the current gold standard of qPCR. We further investigated the role of DNA extraction method on mtDNA-CN estimate reproducibility and found mtDNA-CN estimated from cell lysate is significantly less variable than traditional phenol-chloroform-isoamyl alcohol (p = 5.44x10-4) and silica-based column selection (p = 2.82x10-7). In conclusion, we recommend the field moves towards more accurate methods for mtDNA-CN, as well as re-analyze trait associations as more WGS data becomes available from larger initiatives such as TOPMed.Finding the pathway : Mediation analyses in randomized controlled trials
AbstractLocalio, A. R., Meibohm, A. R., & Guallar, E. (n.d.).Publication year
2020Journal title
Annals of internal medicineVolume
172Issue
8Page(s)
553-557Abstract~Hyperglycemia, duration of diabetes, and intracranial atherosclerotic stenosis by magnetic resonance angiography : The ARIC-NCS study
AbstractFujiyoshi, A., Suri, M. F., Alonso, A., Selvin, E., Chu, H., Guallar, E., Qiao, Y., Zhang, Y., Wasserman, B. A., & Folsom, A. R. (n.d.).Publication year
2020Journal title
Journal of Diabetes and its ComplicationsVolume
34Issue
9AbstractAims: The association of hyperglycemia and duration of diabetes with intracranial atherosclerotic stenosis (ICAS) in the general population is not well documented. We examined whether elevated glucose and longer diabetes duration is independently associated with ICAS in a community-based sample. Methods: We cross-sectionally analyzed 1644 participants (age 67–90 years) of the Atherosclerosis Risk in Communities Study who underwent cerebrovascular magnetic resonance angiography in 2011–13. We applied multivariable ordinal logistic regression to evaluate the association of ICAS category (“no stenosis”, “stenosisImpact of a topical lotion, CG428, on permanent chemotherapy-induced alopecia in breast cancer survivors : a pilot randomized double-blind controlled clinical trial (VOLUME RCT)
AbstractKang, D., Kim, I. R., Park, Y. H., Im, Y. H., Zhao, D., Guallar, E., Ahn, J. S., & Cho, J. (n.d.).Publication year
2020Journal title
Supportive Care in CancerVolume
28Issue
4Page(s)
1829-1837AbstractPurpose: This study aimed to evaluate the impact of a topical lotion (CG428) on hair thickness and density in breast cancer survivors with permanent chemotherapy-induced alopecia (PCIA). Methods: The study was a double-blind, randomized controlled trial which conducted from February 2016 to December 2016 at the Samsung Comprehensive Cancer Center in Seoul, South Korea. Breast cancer patients with PCIA were randomized on average of 3.5 years after chemotherapy. Topical lotion (Batch DT023) is a botanical drug under development containing a novel patented blend of 4 botanical ingredients: citrus, cocoa, guarana, and onion. Participants were asked to self-apply the study product or placebo twice per day for 6 months. Changes in hair density and thickness were assessed using a noninvasive bioengineering device, and patient-reported outcomes were evaluated at 3 and 6 months after randomization. Results: A total of 35 patients were randomized to intervention (N = 18) or placebo (N = 17). Patients in the intervention group were older than those in the placebo group (52.1 vs. 41.6 years; P < 0.001). The mean hair density (SD) at baseline was 97.6 (6.4) and 126.8 (30.3) hairs/cm2 in the intervention and placebo group, respectively (P = 0.005). The corresponding values for hair thickness were 49.9 (12.7) and 48.1 (8.4) μm, respectively. After 6 months, hair density had increased by 34.7 and 24.9% compared with baseline in the intervention and control groups, respectively (P = 0.37). Corresponding values for hair thickness were 19.8 and 35.6%, respectively (P = 0.23). Similar findings were observed after age adjustment. Discussion: In this pilot randomized clinical trial, we observed safety, tolerability, and a trend toward the efficacy of CG428 vs. placebo, especially regarding hair density and self-reported improvement.Impact of fear of cancer recurrence on survival among lymphoma patients
AbstractKim, S. J., Kang, D., Kim, I. R., Yoon, S. E., Kim, W. S., Butow, P. N., Guallar, E., & Cho, J. (n.d.).Publication year
2020Journal title
Psycho-OncologyVolume
29Issue
2Page(s)
364-372AbstractObjective: This study aimed to evaluate fear of cancer recurrence (FCR) among lymphoma patients who completed treatment and its impact on survival and quality of life (QOL). Methods: In this prospective cohort study, 467 lymphoma patients were included who completed treatment with curative intent between February 2012 and March 2017. FCR was measured using a question from the Korean version of the QOL in Cancer Survivors Questionnaire. QOL and general health and functioning were measured using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. Participants were actively followed up for all-cause and disease-specific mortality. Results: In total, 16.3% of the patients had severe FCR. The adjusted hazard ratio (HR) for all-cause mortality comparing participants with and without severe FCR was 2.52 (95% CI = 1.15-5.54), and the association was stronger in indolent non-Hodgkin lymphoma (NHL) (HR = 6.77; 95% CI = 1.04-43.92). Participants with severe FCR were also at higher risk of lymphoma-specific mortality (HR = 2.62; 95% CI = 1.13-6.05) than patients without severe FCR. Patients with severe FCR had significantly worse general health status (64.3 vs 71.0, P =.03) and physical (82.4 vs 76.7, PImpact of serum lipid on breast cancer recurrence
AbstractJung, S. M., Kang, D., Guallar, E., Yu, J., Lee, J. E., Kim, S. W., Nam, S. J., Cho, J., & Lee, S. K. (n.d.).Publication year
2020Journal title
Journal of Clinical MedicineVolume
9Issue
9Page(s)
1-14AbstractThe association between serum lipid level and prognosis of breast cancer is controversial. The purpose of this study was to evaluate the impact of serum lipid level in breast cancer recurrence. We analyzed a total of 4190 patients with operable breast cancer who had baseline serum lipid profiles; total cholesterol (TC), triglycerides (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), apolipoprotein A-1, and apolipoprotein B. Recurrence-free survival is defined as the elapsed time from the date of curative surgery to the detection of any recurrence, and recurrence includes locoregional recurrence, distant metastasis, or both local and distant metastasis. Cox-proportional hazard analysis was used to estimate hazard ratios with 95% confidence intervals (CI) for study outcomes comparing the three lowest quartiles of each lipid parameter to the highest quartile adjusting for age, body mass index (BMI), and pathologic stage, estrogen receptor (ER), progesterone receptor (PR), comorbidities (hypertension, diabetes, or vascular event) at time of breast cancer diagnosis. Patients with dyslipidemia (high bad cholesterol and low good cholesterol level) had worse prognostic factors (i.e., negative hormone receptor status, positive human epidermal growth factor receptor 2 (HER2) expression, higher nuclear grade). After adjusting for these poor prognostic factors, the patients with dyslipidemia showed good prognosis for breast cancer recurrence. Our study showed that baseline high lipid level could be a good prognostic factor of breast cancer. This study indicates that desirable changes in lipid profile for cardiovascular disease risk are not always beneficial for patients with breast cancer. However, as proper control of lipid level has advantages for cardiovascular disease, these findings require careful interpretation.