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

Cadmium exposure and cancer mortality in a prospective cohort : The strong heart study

García-Esquinas, E., Pollan, M., Tellez-Plaza, M., Francesconi, K. A., Goessler, W., Guallar, E., Umans, J. G., Yeh, J., Best, L. G., & Navas-Acien, A. (n.d.).

Publication year

2014

Journal title

Environmental health perspectives

Volume

122

Issue

4

Page(s)

363-370

10.1289/ehp.1306587

Abstract

Abstract

Background: Cadmium (Cd) is a toxic metal classified as a human carcinogen by the International Agency for Research on Cancer. oBjective: We evaluated the association of long-term Cd exposure, as measured in urine, with cancer mortality in American Indians from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study during 1989-1991. Methods: The Strong Heart Study was a prospective cohort study of 3,792 men and women 45-74 years of age who were followed for up to 20 years. Baseline urinary Cd (U-Cd) was measured using inductively coupled plasma mass spectrometry. We assessed cancer events by annual mortality surveillance. results: The median (interquintile range) U-Cd concentration was 0.93 (0.55, 1.63) μg/g creatinine. After adjusting for sex, age, smoking status, cigarette pack-years, and body mass index, the adjusted hazard ratios (HRs) comparing the 80th versus the 20th percentiles of U-Cd were 1.30 (95% CI: 1.09, 1.55) for total cancer, 2.27 (95% CI: 1.58, 3.27) for lung cancer, and 2.40 (95% CI: 1.39, 4.17) for pancreatic cancer mortality. For all smoking-related cancers combined, the corresponding HR was 1.56 (95% CI: 1.24, 1.96). Cd was not significantly associated with liver, esophagus and stomach, colon and rectum, breast, prostate, kidney, or lymphatic and hematopoietic cancer mortality. On the basis of mediation analysis, we estimated that the percentage of lung cancer deaths due to tobacco smoking that could be attributed to Cd exposure was 9.0% (95% CI: 2.8, 21.8). conclusions: Low-to-moderate Cd exposure was prospectively associated with total cancer mortality and with mortality from cancers of the lung and pancreas. The implementation of population-based preventive measures to decrease Cd exposure could contribute to reducing the burden of cancer.

Cadmium exposure and clinical cardiovascular disease : A systematic review topical collection on nutrition

Tellez-Plaza, M., Jones, M. R., Dominguez-Lucas, A., Guallar, E., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Current atherosclerosis reports

Volume

15

Issue

10

10.1007/s11883-013-0356-2

Abstract

Abstract

Mounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95 % confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95 % CI: 1.11, 1.66), 1.30 (95 % CI: 1.12, 1.52), 1.18 (95 % CI: 0.86, 1.59), and 1.49 (95 % CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.

Cadmium exposure and hypertension in the 1999-2004 National Health and Nutrition Examination Survey (NHANES).

Tellez-Plaza, M., Navas-Acien, A., Crainiceanu, C. M., & Guallar, E. (n.d.).

Publication year

2008

Journal title

Environmental health perspectives

Volume

116

Issue

1

Page(s)

51-56

10.1289/ehp.10764

Abstract

Abstract

INTRODUCTION: Cadmium induces hypertension in animal models. Epidemiologic studies of cadmium exposure and hypertension, however, have been inconsistent. OBJECTIVE: We aimed to investigate the association of blood and urine cadmium with blood pressure levels and with the prevalence of hypertension in U.S. adults who participated in the 1999-2004 National Health and Nutrition Examination Survey (NHANES). METHODS: We studied participants > or = 20 years of age with determinations of cadmium in blood (n = 10,991) and urine (n = 3,496). Blood and urine cadmium were measured by atomic absorption spectrometry and inductively coupled plasma-mass spectrometry, respectively. Systolic and diastolic blood pressure levels were measured using a standardized protocol. RESULTS: The geometric means of blood and urine cadmium were 3.77 nmol/L and 2.46 nmol/L, respectively. After multivariable adjustment, the average differences in systolic and diastolic blood pressure comparing participants in the 90th vs. 10th percentile of the blood cadmium distribution were 1.36 mmHg [95% confidence interval (CI), -0.28 to 3.00] and 1.68 mmHg (95% CI, 0.57-2.78), respectively. The corresponding differences were 2.35 mmHg and 3.27 mmHg among never smokers, 1.69 mmHg and 1.55 mmHg among former smokers, and 0.02 mmHg and 0.69 mmHg among current smokers. No association was observed for urine cadmium with blood pressure levels, or for blood and urine cadmium with the prevalence of hypertension. CONCLUSIONS: Cadmium levels in blood, but not in urine, were associated with a modest elevation in blood pressure levels. The association was stronger among never smokers, intermediate among former smokers, and small or null among current smokers. Our findings add to the concern of renal and cardiovascular cadmium toxicity at chronic low levels of exposure in the general population.

Cadmium exposure and incident cardiovascular disease

Tellez-Plaza, M., Guallar, E., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Devereux, R. B., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Epidemiology

Volume

24

Issue

3

Page(s)

421-429

10.1097/EDE.0b013e31828b0631

Abstract

Abstract

BACKGROUND: Cadmium is a widespread toxic metal with potential cardiovascular effects, but no studies have evaluated cadmium and incident cardiovascular disease. We evaluated the association of urine cadmium concentration with cardiovascular disease incidence and mortality in a large population-based cohort. METHODS: We conducted a prospective cohort study of 3348 American Indian adults 45-74 years of age from Arizona, Oklahoma, and North and South Dakota, who participated in the Strong Heart Study in 1989-1991. Urine cadmium was measured using inductively coupled plasma mass spectrometry. Follow-up extended through 31 December 2008. RESULTS: The geometric mean cadmium level in the study population was 0.94 μg/g (95% confidence interval [CI] = 0.92-0.96). We identified 1084 cardiovascular events, including 400 deaths. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratios (HRs) (comparing the 80th to the 20th percentile of urine cadmium concentrations) was 1.43 for cardiovascular mortality (95% CI = 1.21-1.70) and 1.34 for coronary heart disease mortality (1.10-1.63). The corresponding HRs for incident cardiovascular disease, coronary heart disease, stroke, and heart failure were 1.24 (1.11-1.38), 1.22 (1.08-1.38), 1.75 (1.17-2.59), and 1.39 (1.01-1.94), respectively. The associations were similar in most study subgroups, including never-smokers. CONCLUSIONS: Urine cadmium, a biomarker of long-term exposure, was associated with increased cardiovascular mortality and increased incidence of cardiovascular disease. These findings support that cadmium exposure is a cardiovascular risk factor.

Cadmium exposure and incident peripheral arterial disease

Tellez-Plaza, M., Guallar, E., Fabsitz, R. R., Howard, B. V., Umans, J. G., Francesconi, K. A., Goessler, W., Devereux, R. B., & Navas-Acien, A. (n.d.).

Publication year

2013

Journal title

Circulation: Cardiovascular Quality and Outcomes

Volume

6

Issue

6

Page(s)

626-633

10.1161/CIRCOUTCOMES.112.000663

Abstract

Abstract

Background-Cadmium has been associated with peripheral arterial disease (PAD) in cross-sectional studies, but prospective evidence is lacking. Our goal was to evaluate the association of urine cadmium concentrations with incident PAD in a large population-based cohort. Methods and Results-A prospective cohort study was performed with 2864 adult American Indians 45 to 74 years of age from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2 follow-up examination visits in 1993 to 1995 and 1997 to 1999. Participants were free of PAD, defined as an ankle brachial index lt;0.9 or >1.4 at baseline, and had complete baseline information on urine cadmium, potential confounders, and ankle brachial index determinations in the follow-up examinations. Urine cadmium was measured using inductively coupled plasma mass spectrometry and corrected for urinary dilution by normalization to urine creatinine. Multivariable-adjusted hazard ratios were computed using Cox-proportional hazards models for interval-censored data. A total of 470 cases of incident PAD, defined as an ankle brachial index 1.4, were identified. After adjustment for cardiovascular disease risk factors including smoking status and pack-years, the hazard ratio comparing the 80th to the 20th percentile of urine cadmium concentrations was 1.41 (1.05-1.81). The hazard ratio comparing the highest to the lowest tertile was 1.96 (1.32-2.81). The association persisted after excluding participants with ankle brachial index >1.4 only as well as in subgroups defined by sex and smoking status. Conclusions-Urine cadmium, a biomarker of long-term cadmium exposure, was independently associated with incident PAD, providing further support for cadmium as a cardiovascular disease risk factor.

Cadmium levels in urine and mortality among U.S. adults

Menke, A., Muntner, P., Silbergeld, E. K., Platz, E. A., & Guallar, E. (n.d.).

Publication year

2009

Journal title

Environmental health perspectives

Volume

117

Issue

2

Page(s)

190-196

10.1289/ehp.11236

Abstract

Abstract

Background: Cadmium exposure has been associated with increased all-cause, cancer, and cardiovascular disease mortality. However, studies investigating this association have included participants with considerably higher levels of cadmium than those found in the general population. Objective: We aimed to evaluate the association of creatinine-corrected urinary cadmium levels with all-cause and cause-specific mortality in the U.S. general population. Methods: We analyzed the relationship between cadmium measured in 13,958 adults who participated in the Third National Health and Nutrition Examination Survey in 1988-1994 and were followed through 31 December 2000, and all-cause, cancer, cardiovascular disease, and coronary heart disease mortality. Results: The geometric mean levels of urinary cadmium per gram of urinary creatinine in study participants were 0.28 and 0.40 μg/g for men and women, respectively (p < 0.001). After multivariable adjustment, including smoking, a major source of cadmium exposure in nonoccupationally exposed populations, the hazard ratios [95% confidence interval (CI)] for all-cause, cancer, cardiovascular disease, and coronary heart disease mortality associated with a 2-fold higher creatinine-corrected urinary cadmium were, respectively, 1.28 (95% CI, 1.15-1.43), 1.55 (95% CI, 1.21-1.98), 1.21 (95% CI, 1.07-1.36), and 1.36 (95% CI, 1.11-1.66) for men and 1.06 (95% CI, 0.96-1.16), 1.07 (95% CI, 0.85-1.35), 0.93 (95% CI, 0.84-1.04), and 0.82 (95% CI, 0.76-0.89) for women. Conclusions: Environmental cadmium exposure was associated with an increased risk of all-cause, cancer, and cardiovascular disease mortality among men, but not among women. Additional efforts are warranted to fully explain gender differences on the impact of environmental cadmium exposure.

Cancer incidence in a sample of Maryland residents with serious mental illness

McGinty, E. E., Zhang, Y., Guallar, E., Ford, D. E., Steinwachs, D., Dixon, L. B., Keating, N. L., & Daumit, G. L. (n.d.).

Publication year

2012

Journal title

Psychiatric Services

Volume

63

Issue

7

Page(s)

714-717

10.1176/appi.ps.201100169

Abstract

Abstract

Objective: Persons with serious mental illness have an increased mortality rate and a higher burden of many medical conditions compared with persons without serious mental illness. Cancer risk in the population with serious mental illness is uncertain, and its incidence was examined by race, sex, and cancer site in a community-based cohort of adults with schizophrenia or bipolar disorder. Methods: The authors calculated standardized incidence ratios of total and site-specific cancers in a cohort of 3,317 Maryland Medicaid adult beneficiaries with schizophrenia or bipolar disorder followed from 1994 through 2004 for comparison with the U.S. population. Results: Total cancer incidence for adults with schizophrenia or bipolar disorder was 2.6 times higher in the cohort. Elevated risk was greatest for cancer of the lung. No differences in risk were found for African-American versus white Medicaid beneficiaries with serious mental illness. Conclusions: These findings suggest that there is a heightened risk of cancer among adults with schizophrenia or bipolar disorder. Clinicians should promote appropriate cancer screening and work to reduce modifiable risk factors, such as smoking, among persons with serious mental illness.

Cardiovascular disease prevention in women : A rapidly evolving scenario

Guallar, E., Stranges, S., & Guallar, E. (n.d.).

Publication year

2012

Journal title

Nutrition, Metabolism and Cardiovascular Diseases

Volume

22

Issue

12

Page(s)

1013-1018

10.1016/j.numecd.2012.10.001

Abstract

Abstract

The past decade has witnessed a long overdue recognition of the importance of CVD in women, accompanied by an increasing awareness of gender differences in risk factors, natural history, preventive strategies, treatment, and prognosis of CVD. Reflecting the disease burden and the specific aspects of CVD in women, the American Heart Association has developed women-specific evidence-based guidelines and consensus documents for CVD prevention. The most recent update of these guidelines, published in 2011, is a milestone in the field and shows the rapidly evolving scenario of CVD prevention in women. We discuss some novel aspects of the 2011 update. The new guidelines change the focus from evidence-based to effectiveness-based, with consideration of both benefits and harms/costs of preventive interventions. The guidelines also introduce " ideal cardiovascular health" as the lowest category of risk, which implies the need of communitywide preventive, educational and policy initiatives to promote healthy lifestyles in the general population. Furthermore, the guidelines emphasize long-term overall CVD risk rather than short-term coronary risk. We also address several barriers and open questions in the evaluation and implementation of these guidelines, including how to increase the small proportion of women with ideal cardiovascular health; how to increase implementation and compliance with the recommendations; how to provide effectiveness-based recommendations for lifetime prevention goals based on short-term trials; how to obtain the best possible evidence in women; how to identify subgroups of women with different cardiovascular risk profiles or who may require tailored preventive strategies; and how to adapt current guidelines to international settings, particularly to low- and middle-income countries.

Cardiovascular Event Prediction by Machine Learning : The Multi-Ethnic Study of Atherosclerosis

Ambale-Venkatesh, B., Yang, X., Wu, C. O., Liu, K., Gregory Hundley, W., McClelland, R., Gomes, A. S., Folsom, A. R., Shea, S., Guallar, E., Bluemke, D. A., & Lima, J. A. (n.d.).

Publication year

2017

Journal title

Circulation research

Volume

121

Issue

9

Page(s)

1092-1101

10.1161/CIRCRESAHA.117.311312

Abstract

Abstract

Rationale: Machine learning may be useful to characterize cardiovascular risk, predict outcomes, and identify biomarkers in population studies. Objective: To test the ability of random survival forests, a machine learning technique, to predict 6 cardiovascular outcomes in comparison to standard cardiovascular risk scores. Methods and Results: We included participants from the MESA (Multi-Ethnic Study of Atherosclerosis). Baseline measurements were used to predict cardiovascular outcomes over 12 years of follow-up. MESA was designed to study progression of subclinical disease to cardiovascular events where participants were initially free of cardiovascular disease. All 6814 participants from MESA, aged 45 to 84 years, from 4 ethnicities, and 6 centers across the United States were included. Seven-hundred thirty-five variables from imaging and noninvasive tests, questionnaires, and biomarker panels were obtained. We used the random survival forests technique to identify the top-20 predictors of each outcome. Imaging, electrocardiography, and serum biomarkers featured heavily on the top-20 lists as opposed to traditional cardiovascular risk factors. Age was the most important predictor for all-cause mortality. Fasting glucose levels and carotid ultrasonography measures were important predictors of stroke. Coronary Artery Calcium score was the most important predictor of coronary heart disease and all atherosclerotic cardiovascular disease combined outcomes. Left ventricular structure and function and cardiac troponin-T were among the top predictors for incident heart failure. Creatinine, age, and ankle-brachial index were among the top predictors of atrial fibrillation. TNF-α (tissue necrosis factor-α) and IL (interleukin)-2 soluble receptors and NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) levels were important across all outcomes. The random survival forests technique performed better than established risk scores with increased prediction accuracy (decreased Brier score by 10%-25%). Conclusions: Machine learning in conjunction with deep phenotyping improves prediction accuracy in cardiovascular event prediction in an initially asymptomatic population. These methods may lead to greater insights on subclinical disease markers without apriori assumptions of causality. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00005487.

Carotenoids and the risk of developing lung cancer : A systematic review

Gallicchio, L., Boyd, K., Matanoski, G., Tao, X., Chen, L., Lam, T. K., Shiels, M., Hammond, E., Robinson, K. A., Caulfield, L. E., Herman, J. G., Guallar, E., & Alberg, A. J. (n.d.).

Publication year

2008

Journal title

American Journal of Clinical Nutrition

Volume

88

Issue

2

Page(s)

372-383

10.1093/ajcn/88.2.372

Abstract

Abstract

Background: Carotenoids are thought to have anti-cancer properties, but findings from population-based research have been inconsistent. Objective: We aimed to conduct a systematic review of the associations between carotenoids and lung cancer. Design: We searched electronic databases for articles published through September 2007. Six randomized clinical trials examining the efficacy of β-carotene supplements and 25 prospective observational studies assessing the associations between carotenoids and lung cancer were analyzed by using random-effects meta-analysis. Results: The pooled relative risk (RR) for the studies comparing β-carotene supplements with placebo was 1.10 (95% confidence limits: 0.89, 1.36; P = 0.39). Among the observational studies that adjusted for smoking, the pooled RRs comparing highest and lowest categories of total carotenoid intake and of total carotenoid serum concentrations were 0.79 (0.71, 0.87; P < 0.001) and 0.70 (0.44, 1.11; P = 0.14), respectively. For β-carotene, highest compared with lowest pooled RRs were 0.92 (0.83, 1.01; P = 0.09) for dietary intake and 0.84 (0.66, 1.07; P = 0.15) for serum concentrations. For other carotenoids, the RRs comparing highest and lowest categories of intake ranged from 0.80 for β-cryptoxanthin to 0.89 for α-carotene and lutein-zeaxanthin; for serum concentrations, the RRs ranged from 0.71 for lycopene to 0.95 for lutein-zeaxanthin. Conclusions: β-Carotene supplementation is not associated with a decrease in the risk of developing lung cancer. Findings from prospective cohort studies suggest inverse associations between carotenoids and lung cancer; however, the decreases in risk are generally small and not statistically significant. These inverse associations may be the result of carotenoid measurements' function as a marker of a healthier lifestyle (higher fruit and vegetable consumption) or of residual confounding by smoking.

Carotid artery wall thickness and incident cardiovascular events : A comparison between US and MRI in the multi-ethnic study of atherosclerosis (MESA)

Zhang, Y., Guallar, E., Malhotra, S., Astor, B. C., Polak, J. F., Qiao, Y., Gomes, A. S., Herrington, D. M., Sharrett, A. R., Bluemke, D. A., & Wasserman, B. A. (n.d.).

Publication year

2018

Journal title

Radiology

Volume

289

Issue

3

Page(s)

649-657

10.1148/radiol.2018173069

Abstract

Abstract

Purpose: To compare common carotid artery (CCA) wall thickness measured manually by using US and semiautomatically by using MRI, and to examine their associations with incident coronary heart disease and stroke. Materials and Methods: This prospective study enrolled 698 participants without a history of clinical cardiovascular disease (CVD) from the Multi-Ethnic Study of Atherosclerosis (MESA) from July 2000 to December 2013 (mean age, 63 years; range, 45 to 84 years; same for men and women). All participants provided written informed consent. CCA wall thickness was measured with US as well as both noncontrast proton-density–weighted and intravenous gadolinium-enhanced MRI. Cox proportional hazards models were used to assess the associations between wall thickness measurements by using US and MRI with CVD outcomes. Results: The adjusted hazard ratios for coronary heart disease, stroke, and CVD associated with per standard deviation increase in intima-media thickness were 1.10, 1.08, and 1.14, respectively. The corresponding associations for mean wall thickness measured with proton-density–weighted MRI were 1.32, 1.48, and 1.37, and for mean wall thickness measured with gadolinium-enhanced MRI were 1.27, 1.58, and 1.38. When included simultaneously in the same model, MRI wall thickness, but not intima-media thickness, remained associated with outcomes. Conclusion: For individuals without known cardiovascular disease at baseline, wall thickness measurements by using MRI were more consistently associated with incident cardiovascular disease, particularly stroke, than were intima-media thickness by using US.

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

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

Publication year

1997

Journal title

Neuroepidemiology

Volume

16

Issue

3

Page(s)

116-123

10.1159/000109680

Abstract

Abstract

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

Changes in acute kidney injury epidemiology in critically ill patients : a population-based cohort study in Korea

Hwang, S., Park, H., Kim, Y., Kang, D., Ku, H. S., Cho, J., Lee, J. E., Huh, W., Guallar, E., Suh, G. Y., & Jang, H. R. (n.d.).

Publication year

2019

Journal title

Annals of Intensive Care

Volume

9

Issue

1

10.1186/s13613-019-0534-7

Abstract

Abstract

Background: Although no specific treatment facilitates renal tubular regeneration in acute kidney injury (AKI), the rapid increase in aging populations with more comorbidities and advances in critical care management are expected to change the epidemiology of AKI. However, few recent studies dissected the current epidemiologic characteristics of critically ill patients with AKI. We investigated recent epidemiologic changes in severe AKI in critically ill patients. Methods: All adult admissions to intensive care units (ICUs) in Korea from 2008 to 2015 were screened using the national health insurance review and assessment database, and 1,744,235 patients were included. Clinical characteristics and changes in AKI incidence and mortality rate were analyzed. Results: The incidence of AKI increased from 7.4% in 2008 to 8.3% in 2015 (p for trend < 0.001). Age-standardized AKI rate was 7018.6 per 100,000 person-years. In-hospital mortality significantly decreased from 39.1% in 2008 to 37.2% in 2015 (p for trend < 0.001) with 2427.6 deaths per 100,000 person-years. Patients with AKI showed higher in-hospital mortality, prolonged ICU length of stay, and higher total cost. Multivariable analysis showed increased risk of in-hospital mortality (adjusted odds ratio [OR] 3.74), mechanical ventilation (OR 2.87), ECMO (OR 6.99), and vasopressor requirement (OR 2.75) in patients with AKI. Conclusions: Recent advances in medical management for AKI have improved in-hospital mortality of critically ill patients with AKI despite increases in the elderly population and AKI incidence.

Changes in follow-up left ventricular ejection fraction associated with outcomes in primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy device recipients

Zhang, Y., Guallar, E., Blasco-Colmenares, E., Butcher, B., Norgard, S., Nauffal, V., Marine, J. E., Eldadah, Z., Dickfeld, T., Ellenbogen, K. A., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2015

Journal title

Journal of the American College of Cardiology

Volume

66

Issue

5

Page(s)

524-531

10.1016/j.jacc.2015.05.057

Abstract

Abstract

Background Heart failure patients with primary prevention implantable cardioverter-defibrillators (ICD) may experience an improvement in left ventricular ejection fraction (LVEF) over time. However, it is unclear how LVEF improvement affects subsequent risk for mortality and sudden cardiac death. Objectives This study sought to assess changes in LVEF after ICD implantation and the implication of these changes on subsequent mortality and ICD shocks. Methods We conducted a prospective cohort study of 538 patients with repeated LVEF assessments after ICD implantation for primary prevention of sudden cardiac death. The primary endpoint was appropriate ICD shock defined as a shock for ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality. Results Over a mean follow-up of 4.9 years, LVEF decreased in 13.0%, improved in 40.0%, and was unchanged in 47.0% of the patients. In the multivariate Cox models comparing patients with an improved LVEF with those with an unchanged LVEF, the hazard ratios were 0.33 (95% confidence interval: 0.18 to 0.59) for mortality and 0.29 (95% confidence interval: 0.11 to 0.78) for appropriate shock. During follow-up, 25% of patients showed an improvement in LVEF to >35% and their risk of appropriate shock decreased but was not eliminated. Conclusions Among primary prevention ICD patients, 40.0% had an improved LVEF during follow-up and 25% had LVEF improved to >35%. Changes in LVEF were inversely associated with all-cause mortality and appropriate shocks for ventricular tachyarrhythmias. In patients whose follow-up LVEF improved to >35%, the risk of an appropriate shock remained but was markedly decreased.

Chronic arsenic exposure and risk of carotid artery disease : The Strong Heart Study

Mateen, F. J., Grau-Perez, M., Pollak, J. S., Moon, K. A., Howard, B. V., Umans, J. G., Best, L. G., Francesconi, K. A., Goessler, W., Crainiceanu, C., Guallar, E., Devereux, R. B., Roman, M. J., & Navas-Acien, A. (n.d.).

Publication year

2017

Journal title

Environmental Research

Volume

157

Page(s)

127-134

10.1016/j.envres.2017.05.020

Abstract

Abstract

Background Inorganic arsenic exposure from naturally contaminated groundwater is related to vascular disease. No prospective studies have evaluated the association between arsenic and carotid atherosclerosis at low-moderate levels. We examined the association of long-term, low-moderate inorganic arsenic exposure with carotid arterial disease. Methods American Indians, 45–74 years old, in Arizona, Oklahoma, and North and South Dakota had arsenic concentrations (sum of inorganic and methylated species, μg/g urine creatinine) measured from baseline urine samples (1989–1991). Carotid artery ultrasound was performed in 1998–1999. Vascular disease was assessed by the carotid intima media thickness (CIMT), the presence of atherosclerotic plaque in the carotid, and by the number of segments containing plaque (plaque score). Results 2402 participants (mean age 55.3 years, 63.1% female, mean body mass index 31.0 kg/m2, diabetes 45.7%, hypertension 34.2%) had a median (interquintile range) urine arsenic concentration of 9.2 (5.00, 17.06) µg/g creatinine. The mean CIMT was 0.75 mm. 64.7% had carotid artery plaque (3% with >50% stenosis). In fully adjusted models comparing participants in the 80th vs. 20th percentile in arsenic concentrations, the mean difference in CIMT was 0.01 (95% confidence interval (95%CI): 0.00, 0.02) mm, the relative risk of plaque presence was 1.04 (95%CI: 0.99, 1.09), and the geometric mean ratio of plaque score was 1.05 (95%CI: 1.01, 1.09). Conclusions Urine arsenic was positively associated with CIMT and increased plaque score later in life although the association was small. The relationship between urinary arsenic and the presence of plaque was not statistically significant when adjusted for other risk factors. Arsenic exposure may play a role in increasing the severity of carotid vascular disease.

Chronic obstructive pulmonary disease and lung cancer incidence in never smokers : A cohort study

Park, 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

2020

Journal title

Thorax

Volume

75

Issue

6

Page(s)

506-509

10.1136/thoraxjnl-2019-213732

Abstract

Abstract

There 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.

Circulating bile acid concentrations and non-alcoholic fatty liver disease in Guatemala

Rivera-Andrade, A., Petrick, J. L., Alvarez, C. S., Graubard, B. I., Florio, A. A., Kroker-Lobos, M. F., Parisi, D., Freedman, N. D., Lazo, M., Guallar, E., Groopman, J. D., Ramirez-Zea, M., & McGlynn, K. A. (n.d.).

Publication year

2022

Journal title

Alimentary Pharmacology and Therapeutics

Volume

56

Issue

2

Page(s)

321-329

10.1111/apt.16948

Abstract

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is a major liver disease worldwide. Bile acid dysregulation may be a key feature in its pathogenesis and progression. Aims: To characterise the relationship between bile acid levels and NAFLD at the population level. Methods: We conducted a cross-sectional study in Guatemala in 2016 to examine the prevalence of NAFLD. Participants (n = 415) completed questionnaires, donated blood samples and had a brief medical exam. NAFLD was determined by calculation of the fatty liver index. The levels of 15 circulating bile acids were determined by LC–MS/MS. Adjusted prevalence odds ratios (PORadj) and 95% CI were calculated to examine the relationships between bile acid levels (in tertiles) and NAFLD. Results: Persons with NAFLD had significantly higher levels of the conjugated primary bile acids glycocholic acid (GCA) (PORadj T3 vs T1 = 1.85), taurocholic acid (TCA) (PORadj T3 vs T1 = 2.45) and taurochenodeoxycholic acid (TCDCA) (PORadj T3 vs T1 = 2.10), as well as significantly higher levels the unconjugated secondary bile acid, deoxycholic acid (DCA) (PORadj T3 vs T1 = 1.78) and its conjugated form, taurodeoxycholic acid (TDCA) (PORadj T3 vs T1 = 1.81). Conclusions: The bile acid levels of persons with and without NAFLD differed significantly. Among persons with NAFLD, higher levels of the conjugated forms of CA (i.e. GCA, TCA) and the secondary bile acids that derive from CA (i.e. DCA, TDCA) may indicate there is hepatic overproduction of CA, which may affect the liver via aberrant signalling mediated by the bile acids.

Clinical and serum-based markers are associated with death within 1 year of de novo implant in primary prevention ICD recipients

Zhang, Y., Guallar, E., Blasco-Colmenares, E., Dalal, D., Butcher, B., Norgard, S., Tjong, F. V., Eldadah, Z., Dickfeld, T., Ellenbogen, K. A., Marine, J. E., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2015

Journal title

Heart Rhythm

Volume

12

Issue

2

Page(s)

360-366

10.1016/j.hrthm.2014.10.034

Abstract

Abstract

Background Implantable cardioverter-defibrillator (ICD) implantation is contraindicated in those with

Clinical characteristics and evaluation of LDL-cholesterol treatment of the Spanish Familial Hypercholesterolemia Longitudinal Cohort Study (SAFEHEART)

Mata, N., Alonso, R., Badimán, L., Padrá, T., Fuentes, F., Mũiz, O., Perez-Jiménez, F., Lápez-Miranda, J., Díaz, J. L., Vidal, J. I., Barba, A., Piedecausa, M., Sanchez, J. F., Irigoyen, L., Guallar, E., Ordovas, J. M., & Mata, P. (n.d.).

Publication year

2011

Journal title

Lipids in Health and Disease

Volume

10

10.1186/1476-511X-10-94

Abstract

Abstract

Abstract. Aim. Familial hypercholesterolemia (FH) patients are at high risk for premature coronary heart disease (CHD). Despite the use of statins, most patients do not achieve an optimal LDL-cholesterol goal. The aims of this study are to describe baseline characteristics and to evaluate Lipid Lowering Therapy (LLT) in FH patients recruited in SAFEHEART. Methods and Results. A cross-sectional analysis of cases recruited in the Spanish FH cohort at inclusion was performed. Demographic, lifestyle, medical and therapeutic data were collected by specific surveys. Blood samples for lipid profile and DNA were obtained. Genetic test for FH was performed through DNA-microarray. Data from 1852 subjects (47.5% males) over 19 years old were analyzed: 1262 (68.1%, mean age 45.6 years) had genetic diagnosis of FH and 590 (31.9%, mean age 41.3 years) were non-FH. Cardiovascular disease was present in 14% of FH and in 3.2% of non-FH subjects (P < 0.001), and was significantly higher in patients carrying a null mutation compared with those carrying a defective mutation (14.87% vs. 10.6%, respectively, P < 0.05). Prevalence of current smokers was 28.4% in FH subjects. Most FH cases were receiving LLT (84%). Although 51.5% were receiving treatment expected to reduce LDL-c levels at least 50%, only 13.6% were on maximum statin dose combined with ezetimibe. Mean LDL-c level in treated FH cases was 186.5 mg/dl (SD: 65.6) and only 3.4% of patients reached and LDL-c under 100 mg/dl. The best predictor for LDL-c goal attainment was the use of combined therapy with statin and ezetimibe. Conclusion: Although most of this high risk population is receiving LLT, prevalence of cardiovascular disease and LDL-c levels are still high and far from the optimum LDL-c therapeutic goal. However, LDL-c levels could be reduced by using more intensive LLT such as combined therapy with maximum statin dose and ezetimibe.

Clinical decision tool for CRT-P vs. CRT-D implantation : Findings from PROSE-ICD

Nauffal, V., Zhang, Y., Tanawuttiwat, T., Blasco-Colmenares, E., Rickard, J., Marine, J. E., Butcher, B., Norgard, S., Dickfeld, T. M., Ellenbogen, K. A., Guallar, E., Tomaselli, G. F., & Cheng, A. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

4

10.1371/journal.pone.0175205

Abstract

Abstract

Background: Cardiac resynchronization therapy (CRT) devices reduce mortality through pacing-induced cardiac resynchronization and implantable cardioverter defibrillator (ICD) therapy for ventricular arrhythmias (VAs). Whether certain factors can predict if patients will benefit more from implantation of CRT pacemakers (CRT-P) or CRT defibrillators (CRT-D) remains unclear. Methods and results: We followed 305 primary prevention CRT-D recipients for the two primary outcomes of HF hospitalization and ICD therapy for VAs. Serum biomarkers, electrocardiographic and clinical variables were collected prior to implant. Multivariable analysis using Cox-proportional hazards model was used to fit the final models. Among 282 patients with follow-up outcome data, 75 (26.6%) were hospitalized for HF and 31 (11%) received appropriate ICD therapy. Independent predictors of HF hospitalization were atrial fibrillation (HR = 1.8 (1.1,2.9)), NYHA class III/IV (HR = 2.2 (1.3,3.6)), ejection fraction 4.03pg/ml (HR = 1.7 (1.1,2.9)) and hemoglobin (20mg/dL (HR = 3.0 (1.3,7.1)), HS-CRP >9.42mg/L (HR = 2.3 (1.1,4.7)), no beta blocker therapy (HR = 3.2 (1.4,7.1)) and hematocrit ≥38% (HR = 2.7 (1.03,7.0)). Patients with 0-1 risk factors for appropriate therapy (IR 1 per 100 person-years) and ≥3 risk factors for HF hospitalization (IR 23 per 100-person-years) were more likely to die prior to receiving an appropriate ICD therapy. Conclusions: Clinical and biomarker data can risk stratify CRT patients for HF progression and VAs. These findings may help characterize subgroups of patients that may benefit more from the use of CRT-P vs. CRT-D systems.

Clinical features and outcomes of invasive breast cancer : Age-specific analysis of a modern hospital-based registry

Kim, J. Y., Kang, D., Nam, S. J., Kim, S. W., Lee, J. E., Yu, J. H., Lee, S. K., Im, Y. H., Ahn, J. S., Guallar, E., Cho, J., & Park, Y. H. (n.d.).

Publication year

2019

Journal title

Journal of global oncology

Volume

2019

Issue

5

Page(s)

1-9

10.1200/JGO.19.00034

Abstract

Abstract

PURPOSE We evaluated the clinical features and outcomes of invasive breast cancer (BC) among different age groups by analyzing a modern BC registry including subtypes and treatment information. METHODS This was a retrospective cohort study of 6,405 women aged 18 years or older with pathologically confirmed stage I, II, or III BC who underwent curative surgery followed by adjuvant therapy at a university-based hospital in Seoul, South Korea, between January 2003 and December 2011. The study end point was all-cause mortality. We used Cox proportional hazards models and hazard ratios (HRs) with 95% CIs calculated after adjusting for age, body mass index, stage, subtype, and treatment, including type of surgery and use of chemotherapy, radiation therapy, hormone therapy, and targeted therapy. RESULTS During 36,360 person-years of follow-up (median follow-up: 5.45 years; interquartile range, 4.3-7.1), 256 deaths were reported (mortality rate, 7.0/1,000 person-years). The adjusted HR for all-cause mortality was higher in patients older than 40 years (HR, 2.03; 95% CI, 1.44 to 2.87) and older than 60 years (HR, 2.35; 95% CI, 1.63 to 3.39) than in patients aged 40 to 49 years. Across age groups, advanced stage at diagnosis, luminal type as well as triple-negative BC, and not receiving adjuvant treatment were associated with increased risk of mortality. CONCLUSION A strong J-shaped relationship was observed between age and mortality, indicating worse clinical outcomes in young and old patients. This study suggested a possible benefit of personalized BC screening examination and precise and active treatment strategies to reduce BC-related mortality.

Clinical N Staging Subclassification for Stage III-N2 NSCLC Patients Undergoing Trimodality Therapy : A Good Beginning Is Half the Battle

Lee, J., Hong, Y. S., Lee, J., Lee, G., Kang, D., Park, J., Jeon, Y. J., Park, S. Y., Cho, J. H., Choi, Y. S., Kim, J., Shim, Y. M., Guallar, E., Cho, J., & Kim, H. K. (n.d.).

Publication year

2025

Journal title

Annals of Thoracic Surgery

10.1016/j.athoracsur.2025.02.026

Abstract

Abstract

Background: Lung cancer patients with stage III-N2 disease may benefit from the subclassification of nodal involvement before decision-making. We aimed to evaluate whether the clinical N descriptor subclassification predicts prognosis in patients undergoing trimodality therapy for stage III-N2 non-small cell lung cancer. Methods: Using our institutional registry between 2003 and 2019, we analyzed 899 consecutive patients with stage III-N2 non-small cell lung cancer undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery. We subclassified clinical N2 into cN2a and cN2b on the basis of imaging and histopathologic results. Recurrence-free survival and overall survival were compared by N2 subclassification and separately by histologic type, using competing risks models and Cox proportional hazards models. Results: By the proposed N subclassification, 503 (56.0%) and 396 (44.0%) patients were assigned to cN2a and cN2b, respectively. During a median follow-up of 53.1 months, 492 patients had recurrence and 477 died. The hazard ratios for recurrence comparing cN2b with cN2a after adjustment for age, sex, comorbidities, clinical T category, and histologic type were 1.22 (95% CI, 1.03-1.46). The adjusted hazard ratios for mortality comparing cN2b to cN2a were 1.43 (1.19-1.71). When stratified by histologic type, cN2b had a higher risk of mortality compared with cN2a in both adenocarcinoma and squamous cell carcinoma. Conclusions: In our study evaluating the International Association for the Study of Lung Cancer's approach to subclassify the clinical N descriptor for stage III-N2 non-small cell lung cancer patients, cN2b had a higher risk of recurrence and mortality compared with cN2a, suggesting that clinical N subclassification may be a valuable predictor for stage III-N2 patients.

Closing in on the truth about recombinant human bone morphogenetic protein-2 : Evidence synthesis, data sharing, peer review, and reproducible research

Laine, C., Guallar, E., Mulrow, C., Taichman, D. B., Cornell, J. E., Cotton, D., Griswold, M. E., Russell Localio, A., Meibohm, A. R., Stack, C. B., Williams, S. V., & Goodman, S. N. (n.d.).

Publication year

2013

Journal title

Annals of internal medicine

Volume

158

Issue

12

Page(s)

916-918

10.7326/0003-4819-158-12-201306180-00012

Abstract

Abstract

~

Coexistence of Colorectal Adenomas and Coronary Calcification in Asymptomatic Men and Women

Yun, K. E., Chang, Y., Rampal, S., Zhang, Y., Cho, J., Jung, H. S., Kim, C. W., Jeong, C., Cainzos-Achirica, M., Zhao, D., Pastor-Barriuso, R., Shin, H., Guallar, E., & Ryu, S. (n.d.).

Publication year

2018

Journal title

Journal of Clinical Gastroenterology

Volume

52

Issue

6

Page(s)

508-514

10.1097/MCG.0000000000000824

Abstract

Abstract

Goals: Because of shared risk factors between clinically manifest cardiovascular disease and colorectal cancer, we hypothesized the coexistence of subclinical atherosclerosis measured by coronary artery calcium (CAC) and colorectal adenoma (CRA) and that these 2 processes would also share common risk factors. Background: No study has directly compared the risk factors associated with subclinical coronary atherosclerosis and CRA. Study: This was a cross-sectional study using multinomial logistic regression analysis of 4859 adults who participated in a health screening examination (2010 to 2011; analysis 2014 to 2015). CAC scores were categorized as 0, 1 to 100, or >100. Colonoscopy results were categorized as absent, low-risk, or high-risk CRA. Results: The prevalence of CAC>0, CAC 1 to 100 and >100 was 13.0%, 11.0%, and 2.0%, respectively. The prevalence of any CRA, low-risk CRA, and high-risk CRA was 15.1%, 13.0%, and 2.1%, respectively. The adjusted odds ratios (95% confidence interval) for CAC>0 comparing participants with low-risk and high-risk CRA with those without any CRA were 1.35 (1.06-1.71) and 2.09 (1.29-3.39), respectively. Similarly, the adjusted odds ratios (95% confidence interval) for any CRA comparing participants with CAC 1 to 100 and CAC>100 with those with no CAC were 1.26 (1.00-1.6) and 2.07 (1.31-3.26), respectively. Age, smoking, diabetes, and family history of CRC were significantly associated with both conditions. Conclusions: We observed a graded association between CAC and CRA in apparently healthy individuals. The coexistence of both conditions further emphasizes the need for more evidence of comprehensive approaches to screening and the need to consider the impact of the high risk of coexisting disease in individuals with CAC or CRA, instead of piecemeal approaches restricted to the detection of each disease independently.

Coffee and tea consumption in the early adult lifespan and left ventricular function in middle age : the CARDIA study

Nwabuo, 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

2020

Journal title

ESC heart failure

Volume

7

Issue

4

Page(s)

1510-1519

10.1002/ehf2.12684

Abstract

Abstract

Aims: 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.