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

Coffee consumption and coronary artery calcium in young and middle-aged asymptomatic adults

Choi, Y., Chang, Y., Ryu, S., Cho, J., Rampal, S., Zhang, Y., Ahn, J., Lima, J. A., Shin, H., & Guallar, E. (n.d.).

Publication year

2015

Journal title

Heart

Volume

101

Issue

9

Page(s)

686-691

10.1136/heartjnl-2014-306663

Abstract

Abstract

Objective To investigate the association between regular coffee consumption and the prevalence of coronary artery calcium (CAC) in a large sample of young and middle-aged asymptomatic men and women. Methods This cross-sectional study included 25 138 men and women (mean age 41.3 years) without clinically evident cardiovascular disease who underwent a health screening examination that included a validated food frequency questionnaire and a multidetector CT to determine CAC scores. We used robust Tobit regression analyses to estimate the CAC score ratios associated with different levels of coffee consumption compared with no coffee consumption and adjusted for potential confounders. Results The prevalence of detectable CAC (CAC score >0) was 13.4% (n=3364), including 11.3% prevalence for CAC scores 1-100 (n=2832), and 2.1% prevalence for CAC scores >100 (n=532). The mean ±SD consumption of coffee was 1.8±1.5 cups/day. The multivariate-adjusted CAC score ratios (95% CIs) comparing coffee drinkers of

Coffee, alcohol, smoking, physical activity and QT interval duration : Results from the Third National Health and Nutrition examination Survey

Zhang, Y., Post, W. S., Dalal, D., Blasco-Colmenares, E., Tomaselli, G. F., & Guallar, E. (n.d.).

Publication year

2011

Journal title

PloS one

Volume

6

Issue

2

10.1371/journal.pone.0017584

Abstract

Abstract

Background: Abnormalities in the electrocardiographic QT interval duration have been associated with an increased risk of ventricular arrhythmias and sudden cardiac death. However, there is substantial uncertainty about the effect of modifiable factors such as coffee intake, cigarette smoking, alcohol consumption, and physical activity on QT interval duration. Methods: We studied 7795 men and women from the Third National Health and Nutrition Survey (NHANES III, 1988-1994). Baseline QT interval was measured from the standard 12-lead electrocardiogram. Coffee and tea intake, alcohol consumption, leisure-time physical activities over the past month, and lifetime smoking habits were determined using validated questionnaires during the home interview. Results: In the fully adjusted model, the average differences in QT interval comparing participants drinking ≥6 cups/day to those who did not drink any were -1.2 ms (95% CI -4.4 to 2.0) for coffee, and -2.0 ms (-11.2 to 7.3) for tea, respectively. The average differences in QT interval duration comparing current to never smokers was 1.2 ms (-0.6 to 2.9) while the average difference in QT interval duration comparing participants drinking ≥7 drinks/week to non-drinkers was 1.8 ms (-0.5 to 4.0). The age, race/ethnicity, and RR-interval adjusted differences in average QT interval duration comparing men with binge drinking episodes to non-drinkers or drinkers without binge drinking were 2.8 ms (0.4 to 5.3) and 4.0 ms (1.6 to 6.4), respectively. The corresponding differences in women were 1.1 (-2.9 to 5.2) and 1.7 ms (-2.3 to 5.7). Finally, the average differences in QT interval comparing the highest vs. the lowest categories of total physical activity was -0.8 ms (-3.0 to 1.4). Conclusion: Binge drinking was associated with longer QT interval in men but not in women. QT interval duration was not associated with other modifiable factors including coffee and tea intake, smoking, and physical activity.

Combined cardiac magnetic resonance imaging and C-reactive protein levels identify a cohort at low risk for defibrillator firings and death

Wu, K. C., Gerstenblith, G., Guallar, E., Marine, J. E., Dalal, D., Cheng, A., Marbán, E., Lima, J. A., Tomaselli, G. F., & Weiss, R. G. (n.d.).

Publication year

2012

Journal title

Circulation: Cardiovascular Imaging

Volume

5

Issue

2

Page(s)

178-186

10.1161/CIRCIMAGING.111.968024

Abstract

Abstract

Background-Annually, ≈80 000 Americans receive guideline-based primary prevention implantable cardioverterdefibrillators (ICDs), but appropriate firing rates are low. Current selection criteria for ICDs rely on left ventricular ejection fraction, which lacks sensitivity and specificity. Because scar-related myocardial tissue heterogeneity is a substrate for life-threatening arrhythmias, we hypothesized that cardiac magnetic resonance identification of myocardial heterogeneity improves risk stratification through (1) its association with adverse cardiac events independent of clinical factors and biomarker levels and (2) its ability to identify particularly high-and low-risk subgroups. Methods and Results-In 235 patients with chronic ischemic and nonischemic cardiomyopathy with a left ventricular ejection fraction of ≤35% undergoing clinically indicated primary prevention ICD implantation, gadolinium-enhanced cardiac magnetic resonance was prospectively performed to quantify the amount of heterogeneous myocardial tissue (gray zone [GZ]) and dense core scar. Serum high-sensitivity C-reactive protein (hsCRP) and other biomarkers were assayed. The primary end point was appropriate ICD shock for ventricular tachycardia/fibrillation or cardiac death, which occurred in 45 (19%) patients at a 3.6-year median follow-up. On univariable analysis, only diuretics, hsCRP, GZ, and core scar were associated with outcome. After multivariable adjustment, GZ and hsCRP remained independently associated with outcome (P

Comentarios a las guías de práctica clínica sobre manejo de las dislipemias de la Sociedad Europea de Cardiología y la Sociedad Europea de Aterosclerosis 2011. Un informe del Grupo de Trabajo del Comité de Guías de Práctica Clínica de la Sociedad Española de Cardiología

Anguita, M., Alegría, E., Barrios, V., Escobar, C., León, M., Luengo, E., Comín, J., Fernández-Ortiz, A., Heras, M., Pan, M., Worner, F., Barón, G., Bernal, E., Borrás, X., Civeira, F., Cordero, A., Guallar, E., Ib́ñez B., De Pablo, C., … Laclaustra, M. (n.d.).

Publication year

2011

Journal title

Revista Espanola de Cardiologia

Volume

64

Issue

12

Page(s)

1090-1095

10.1016/j.recesp.2011.10.004

Abstract

Abstract

~

Comparing the Value of Data Visualization Methods for Communicating Harms in Clinical Trials

Qureshi, R., Chen, X., Goerg, C., Mayo-Wilson, E., Dickinson, S., Golzarri-Arroyo, L., Hong, H., Phillips, R., Cornelius, V., DeMarco, M. M., Guallar, E., & Li, T. (n.d.).

Publication year

2022

Journal title

Epidemiologic Reviews

Volume

44

Issue

1

Page(s)

55-66

10.1093/epirev/mxac005

Abstract

Abstract

In clinical trials, harms (i.e., adverse events) are often reported by simply counting the number of people who experienced each event. Reporting only frequencies ignores other dimensions of the data that are important for stakeholders, including severity, seriousness, rate (recurrence), timing, and groups of related harms. Additionally, application of selection criteria to harms prevents most from being reported. Visualization of data could improve communication of multidimensional data. We replicated and compared the characteristics of 6 different approaches for visualizing harms: dot plot, stacked bar chart, volcano plot, heat map, treemap, and tendril plot. We considered binary events using individual participant data from a randomized trial of gabapentin for neuropathic pain. We assessed their value using a heuristic approach and a group of content experts. We produced all figures using R and share the open-source code on GitHub. Most original visualizations propose presenting individual harms (e.g., dizziness, somnolence) alone or alongside higher level (e.g., by body systems) summaries of harms, although they could be applied at either level. Visualizations can present different dimensions of all harms observed in trials. Except for the tendril plot, all other plots do not require individual participant data. The dot plot and volcano plot are favored as visualization approaches to present an overall summary of harms data. Our value assessment found the dot plot and volcano plot were favored by content experts. Using visualizations to report harms could improve communication. Trialists can use our provided code to easily implement these approaches.

Comparison Between Fimasartan Versus Other Angiotensin Receptor Blockers in Patients With Heart Failure After Acute Myocardial Infarction

Kim, J., Kang, D., Kim, S. E., Park, H., Park, T. K., Lee, J. M., Yang, J. H., Song, Y. B., Choi, J. H., Choi, S. H., Gwon, H. C., Guallar, E., Cho, J., & Hahn, J. Y. (n.d.).

Publication year

2023

Journal title

Journal of Korean Medical Science

Volume

38

Issue

25

10.3346/jkms.2023.38.e202

Abstract

Abstract

Backgrounds: Fimasartan is the most recently developed, potent, and long-acting angiotensin II receptor blocker (ARB). However, data are limited regarding treatment effects of fimasartan in patients with heart failure. Methods: Between 2010 and 2016, patients who underwent coronary revascularization for myocardial infarction (MI) with heart failure and prescription of ARB at hospital discharge were enrolled from the Korean nationwide medical insurance data. Clinical outcomes were compared between patients receiving fimasartan and those receiving other ARBs (candesartan, valsartan, losartan, telmisartan, olmesartan, and irbesartan). The primary outcome was a composite of all-cause death, recurrent MI, hospitalization for heart failure, and stroke. Results: Of 2,802 eligible patients, fimasartan was prescribed to 124 patients (4.4%). During a median follow-up of 2.2 years (interquartile range, 1.0–3.9), 613 events of the primary outcome occurred. There was no significant difference in the primary outcome between patients receiving fimasartan and those receiving other ARBs (adjusted hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.46–1.45). Compared with patients receiving other ARBs, those receiving fimasartan had comparable incidence of all-cause death (adjusted HR, 0.70; 95% CI, 0.30–1.63), recurrent MI (adjusted HR, 1.28; 95% CI, 0.49–3.34), hospitalization for heart failure (adjusted HR, 0.70; 95% CI, 0.27–1.84), and stroke (adjusted HR, 0.59; 95% CI, 0.18–1.96). Conclusion: In this nationwide cohort, fimasartan, compared with other ARBs, had comparable treatment effects for a composite of all-cause death, recurrent MI, hospitalization for heart failure, and stroke in patients with heart failure after MI.

Confounding of the relation between homocysteine and peripheral arterial disease by lead, cadmium, and renal function

Guallar, E., Silbergeld, E. K., Navas-Acien, A., Malhotra, S., Astor, B. C., Sharrett, A. R., & Schwartz, B. S. (n.d.).

Publication year

2006

Journal title

American Journal of Epidemiology

Volume

163

Issue

8

Page(s)

700-708

10.1093/aje/kwj090

Abstract

Abstract

Homocysteine levels are associated with peripheral arterial disease (PAD) in observational studies. Lead and cadmium are risk factors for PAD that affect thiol metabolism, and they may partly explain the association of homocysteine with PAD. To evaluate the roles of lead and cadmium exposure in confounding the association between homocysteine and PAD, the authors performed a cross-sectional study among 4,447 persons aged ≥40 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAD was defined as an ankle-brachial blood pressure index less than 0.90 in at least one leg. After adjustment for sociodemographic variables, the odds ratio for PAD in the highest quintile of homocysteine compared with the lowest was 1.92 (ptrend = 0.004). Adjusting for blood lead and cadmium levels reduced this odds ratio to 1.37 (ptrend = 0.13), and further adjusting for estimated glomerular filtration rate and smoking reduced it to 0.89 (p trend = 0.87). Adjustment for other risk factors did not affect this association. In the general population, the association of homocysteine level with PAD can be completely explained by confounding due to smoking, increased blood lead and cadmium levels, and impaired renal function. The association of lead and cadmium with PAD risk deserves further investigation.

Consumo de pescado y mortalidad coronaria en la población general : meta-análisis de estudios de cohorte

Guallar, E., Guallar Castillón, E., Javier Jiménez Jiménez, F., Tafalla García, M., & Martín-Moreno, J. M. (n.d.).

Publication year

1993

Journal title

Gaceta Sanitaria

Volume

7

Issue

38

Page(s)

228-236

10.1016/S0213-9111(93)71155-3

Abstract

Abstract

Con objeto de estimar el efecto del consumo de pescado sobre la mortalidad por cardiopatía isquémica en la población general, se ha realizado un meta-análisis de los estudios epidemiológicos publicados sobre el tema que incluían individuos inicialmente as intomáticos. De los siete estudios publicados hasta la fecha, todos ellos de cohorte, sólo cinco presentaban los resultados con el detalle suficiente como para poder ser utilizados en un meta-análisis formal. En éstos, participaron un total de 27.656 personas, con un seguimiento medio que varió de 7,5 a 25 años, y un número total de muertes por cardiopatía isquémica de 1.731. El estimador combinado del riesgo relativo para un consumo de 30 g/día de pescado frente al no consumo fue de 0,96 (IC al 95%: 0,93–1,00; P=0,058). Dada la presencia de heterogeneidad significativa entre los estudios, no explicada por factores a priori, se procedió a combinar los estudios utilizando un modelo de efectos aleatorios, obteniendo un estimador combinado de riesgo relativo de 0,92 (IC al 95%: 0,84–1,01; P=0,090). Estos resultados, considerados junto con los del único ensayo clínico realizado de consumo de pescado en pacientes que se habían recuperado de un infarto de miocardio, en el que el consumo de 200 a 400 g/semana de pescado graso redujo la mortalidad subsiguiente en un 29% (riesgo relativo del consumo frente al no consumo de 0,71; IC al 95%; 0,54–0,93), sugieren un moderado efecto protector del consumo de pescado en relación a la cardiopatía isquémica.

Controversy over clinical guidelines : Listen to the evidence, not the noise

Guallar, E., & Laine, C. (n.d.).

Publication year

2014

Journal title

Annals of internal medicine

Volume

160

Issue

5

Page(s)

361-362

10.7326/m14-0112

Abstract

Abstract

~

Coronary artery calcium is associated with cortical thinning in cognitively normal individuals

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

Publication year

2016

Journal title

Scientific reports

Volume

6

10.1038/srep34722

Abstract

Abstract

To evaluate the association between coronary artery calcium (CAC) and cortical thickness in a large sample of cognitively normal individuals, with special emphasis in determining if the association thickness has regional brain specificity and if it is mediated by white matter hyperintensities (WMH). A total of 512 participants were included in this study. CAC scores were assessed by multi-detector computed tomography. Cortical thickness was measured using a surface-based method. Linear mixed models were used to assess the association between CAC scores and cortical thickness. In fully adjusted models, increased CAC scores were associated with cortical thinning across several brain regions, which generally overlapped with the distribution of default mode network. The association between CAC scores and cortical thickness was significantly stronger in participants with moderate or severe WMH compared to those with none or mild WMH, even though CAC scores were not associated with WMH. In cognitively normal adults, CAC was associated with cortical thinning in areas related to cognitive function. This association was evident after adjusting for multiple coronary artery disease risk factors and for WMH, suggesting that CAC may be more closely related to Alzheimer's Disease-type disease rather than to cerebral small vessel disease.

Correspondence

Wu, K. C., Gerstenblith, G., Marine, J. E., Dalal, D., Cheng, A., Lima, J. A., Tomaselli, G. F., Weiss, R. G., Guallar, E., & Marban, E. (n.d.).

Publication year

2012

Journal title

Circulation: Cardiovascular Imaging

Volume

5

Issue

4

Page(s)

e53

10.1161/CIRCIMAGING.112.977215

Abstract

Abstract

~

Corrigendum to Association Between Retinopathy of Prematurity in Very-Low-Birth-Weight Infants and Neurodevelopmental Impairment. Am J Ophthalmol 2022;244;205–215 (American Journal of Ophthalmology (2022) 244 (205–215), (S0002939422003129), (10.1016/j.ajo.2022.08.010))

Han, G., Lim, D. H., Kang, D., Cho, J., Guallar, E., Chang, Y. S., Chung, T. Y., Kim, S. J., & Park, W. S. (n.d.).

Publication year

2023

Journal title

American Journal of Ophthalmology

Volume

248

Page(s)

179

10.1016/j.ajo.2023.01.010

Abstract

Abstract

The authors regret that in the December 2022 issue, the Funding/Support section of the article above should have included the following funding information: This research was supported by a fund (2022-ER0603-00#) by Research of the Korea National Institute of Health.

Cost-benefit analysis of Haemophilus influenzae type b vaccination in children in Spain

Jiménez, F. J., Guallar-Castillón, P., Terrés, C. R., & Guallar, E. (n.d.).

Publication year

1999

Journal title

PharmacoEconomics

Volume

15

Issue

1

Page(s)

75-83

10.2165/00019053-199915010-00005

Abstract

Abstract

Objective: Invasive disease caused by Haemophilus influenzae type b (Hib), including meningitis, pneumonia, sepsis and epiglottitis, is associated with high mortality and serious neurological sequelae in children under 5 years of age. The availability of an efficacious vaccine suggests the need to perform an economic evaluation of its use. The objective of this study was to evaluate the costs and benefits of introducing a universal vaccination programme for children under 1 year of age in Spain. Design & Setting: A cost-benefit analysis (CBA) was conducted over a 5-year period from the societal perspective in the Spanish healthcare setting. Both direct and indirect costs were included in the analysis [using 1996 Spanish pesetas (Pta); Pta 126.5 = $US1 in April 1996]. Patients and participants: The target population used for cost and benefit estimation was the 384 883 Spaniards aged 1 year or less in the last Spanish Population and Housing Census of 1991. Main outcome measures and results: The introduction of the universal Hib vaccination programme would imply vaccinating 346 395 children under 1 year of age, with a global expense of Pta2 444 855 910. For an average incidence of 15 cases of invasive disease per 100 000 children per year nationwide, the programme would prevent 219 cases of invasive disease and 8 deaths over a 5-year period, with a benefit of Pta2 182 868 907, a net benefit (i.e. benefit minus cost) of -Pta261 987 003, a benefit/cost ratio of 0.89 and a benefit per case prevented of -Pta1 196 288. Benefit/cost ratios above 1 would be obtained in the regions of highest incidence of invasive disease. Conclusion: The decision to implement a universal vaccination programme should not be based only on economic factors, but our results suggest that the economic returns of the programme for children under 1 year of age in Spain would be at least of a similar magnitude as its expenses.

Cost-effectiveness analysis of pneumococcal vaccination in the elderly Spanish population

Guallar, E., Jimenez, F. J., Guallar, P., Rubio, C., Villasante, P., & Guallar, E. (n.d.).

Publication year

1996

Journal title

British Journal of Medical Economics

Volume

10

Issue

3

Page(s)

193-202

Abstract

Abstract

The high morbidity and mortality associated with pneumococcal pneumonia in subjects over 60 years old, the emergence of bacterial strains resistant to standard antimicrobial therapy and the availability of an anti-pneumococcal vaccine suggest the need to perform an economic study to evaluate the suitability of vaccination as a preventive strategy in those aged 60 years and over in Spain. The introduction of the Vaccination programme would cost US$ 97,593,663. Over the subsequent five years - with a basal rate of three pneumococcal pneumonias per 1000 person-years and a 66% vaccine efficacy - the programme would result in a net benefit of US$ 127,142,481, a benefit/cost ratio of 2.30 and a benefit per case prevented of US$ 2,656. Benefit/cost ratios above 1 would be obtained for incidences above 1.5 cases per 1000 person-years. Introduction of a universal vaccination programme in those over 60 years of age in Spain would be cost-effective over a wide range of incidence rates of pneumococcal pneumonia.

Cost-Effectiveness of Fractional FlowReserve-Guided Treatment for Acute Myocardial Infarction and Multivessel Disease A Prespecified Analysis of the FRAME-AMI Randomized Clinical Trial

The FRAME-AMI Investigators, A., Hong, D., Lee, S. H., Lee, J., Lee, H., Shin, D., Kim, H. K., Park, K. H., Choo, E. H., Kim, C. J., Kim, M. C., Hong, Y. J., Jeong, M. H., Ahn, S. G., Doh, J. H., Lee, S. Y., Park, S. D., Lee, H. J., Kang, M. G., … Lee, J. M. (n.d.).

Publication year

2024

Journal title

JAMA network open

Volume

7

Issue

1

Page(s)

E2352427

10.1001/jamanetworkopen.2023.52427

Abstract

Abstract

IMPORTANCE Complete revascularization by non-infarct-related artery (IRA) percutaneous coronary intervention (PCI) in patients with acutemyocardial infarction is standard practice to improve patient prognosis. However, it is unclear whether a fractional flow reserve (FFR)-guided or angiography-guided treatment strategy for non-IRA PCI would be more cost-effective. OBJECTIVE To evaluate the cost-effectiveness of FFR-guided compared with angiography-guided PCI in patients with acutemyocardial infarction and multivessel disease. DESIGN, SETTING, AND PARTICIPANTS In this prespecified cost-effectiveness analysis of the FRAME-AMI randomized clinical trial, patients were randomly allocated to either FFR-guided or angiography-guided PCI for non-IRA lesions between August 19, 2016, and December 24, 2020. Patients were aged 19 years or older, had ST-segment elevationmyocardial infarction (STEMI) or non-STEMI and underwent successful primary or urgent PCI, and had at least 1 non-IRA lesion (diameter stenosis > 50% in a major epicardial coronary artery or major side branch with a vessel diameter of ≥2.0 mm). Data analysis was performed on August 27, 2023. INTERVENTION Fractional flow reserve-guided vs angiography-guided PCI for non-IRA lesions. MAIN OUTCOMES AND MEASURES The model simulated death, myocardial infarction, and repeat revascularization. Future medical costs and benefits were discounted by 4.5%per year. The main outcomes were quality-adjusted life-years (QALYs), direct medical costs, incremental costeffectiveness ratio (ICER), and incremental net monetary benefit (INB) of FFR-guided PCI compared with angiography-guided PCI. State-transition Markov models were applied to the Korean, US, and European health care systems using medical cost (presented in US dollars), utilities data, and transition probabilities from meta-analysis of previous trials. RESULTS The FRAME-AMI trial randomized 562 patients, with a mean (SD) age of 63.3 (11.4) years. Most patients were men (474 [84.3%]). Fractional flow reserve-guided PCI increased QALYs by 0.06 compared with angiography-guided PCI. The total cumulative cost per patient was estimated as $1208 less for FFR-guided compared with angiography-guided PCI. The ICER was -$19 484 and the INB was $3378, indicating that FFR-guided PCI was more cost-effective for patients with acute myocardial infarction and multivessel disease. Probabilistic sensitivity analysis showed consistent results and the likelihood iteration of cost-effectiveness in FFR-guided PCI was 97%. When transition probabilities from the pairwise meta-analysis of the FLOWER-MI and FRAME-AMI trials were used, FFR-guided PCI was more cost-effective than angiography-guided PCI in the Korean, US, and European health care systems, with an INB of $3910, $8557, and $2210, respectively. In probabilistic sensitivity analysis, the likelihood iteration of cost-effectiveness with FFR-guided PCIwas 85%, 82%, and 31% for the Korean, US, and European health care systems, respectively. CONCLUSIONS AND RELEVANCE This cost-effectiveness analysis suggests that FFR-guided PCI for non-IRA lesions saved medical costs and increased quality of life better than angiography-guided PCI for patients with acute myocardial infarction and multivessel disease. Fractional flow reserve- guided PCI should be considered in determining the treatment strategy for non-IRA stenoses in these patients.

Cost-Effectiveness of Intravascular Imaging-Guided Complex PCI : Prespecified Analysis of RENOVATE-COMPLEX-PCI Trial

Hong, D., Lee, J., Lee, H., Cho, J., Guallar, E., Choi, K. H., Lee, S. H., Shin, D., Lee, J. Y., Lee, S. J., Lee, S. Y., Kim, S. M., Yun, K. H., Cho, J. Y., Kim, C. J., Ahn, H. S., Nam, C. W., Yoon, H. J., Park, Y. H., … Lee, J. M. (n.d.).

Publication year

2024

Journal title

Circulation: Cardiovascular Quality and Outcomes

Volume

17

Issue

3

Page(s)

E010230

10.1161/CIRCOUTCOMES.123.010230

Abstract

Abstract

BACKGROUND: Although clinical benefits of intravascular imaging-guided percutaneous coronary intervention (PCI) in patients with complex coronary artery lesions have been observed in previous trials, the cost-effectiveness of this strategy is uncertain. METHODS: RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance vs Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) was conducted in Korea between May 2018 and May 2021. This prespecified cost-effectiveness substudy was conducted using Markov model that simulated 3 states: (1) post-PCI, (2) spontaneous myocardial infarction, and (3) death. A simulated cohort was derived from the intention-to-treat population, and input parameters were extracted from either the trial data or previous publications. Cost-effectiveness was evaluated using time horizon of 3 years (within trial) and lifetime. The primary outcome was incremental cost-effectiveness ratio (ICER), an indicator of incremental cost on additional quality-adjusted life years (QALYs) gained, in intravascular imaging-guided PCI compared with angiography-guided PCI. The current analysis was performed using the Korean health care sector perspective with reporting the results in US dollar (1200 Korean Won, =1 dollar, $). Willingness to pay threshold was $35 000 per QALY gained. RESULTS: A total of 1639 patients were included in the trial. During 3-year follow-up, medical costs ($8661 versus $7236; incremental cost, $1426) and QALY (2.34 versus 2.31; incremental QALY, 0.025) were both higher in intravascular imaging-guided PCI than angiography-guided PCI, resulting incremental cost-effectiveness ratio of $57 040 per QALY gained within trial data. Conversely, lifetime simulation showed total cumulative medical cost was reversed between the 2 groups ($40 455 versus $49 519; incremental cost, -$9063) with consistently higher QALY (8.24 versus 7.89; incremental QALY, 0.910) in intravascular imaging-guided PCI than angiography-guided PCI, resulting in a dominant incremental cost-effectiveness ratio. Consistently, 70% of probabilistic iterations showed cost-effectiveness of intravascular imaging-guided PCI in probabilistic sensitivity analysis. CONCLUSIONS: The current cost-effectiveness analysis suggests that imaging-guided PCI is more cost-effective than angiography-guided PCI by reducing medical cost and increasing quality-of-life in complex coronary artery lesions in long-term follow-up. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.

Cruciferous vegetable consumption and lung cancer risk : A systematic review

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

Publication year

2009

Journal title

Cancer Epidemiology Biomarkers and Prevention

Volume

18

Issue

1

Page(s)

184-195

10.1158/1055-9965.EPI-08-0710

Abstract

Abstract

Background: Cruciferous vegetables, rich in isothiocyanates, may protect against lung cancer. Glutathione S-transferases are important in metabolizing isothiocyanates; hence, variants in GST genes may modify the association between cruciferous vegetable intake and lung cancer. We carried out a systematic review to characterize the association between cruciferous vegetable intake and lung cancer risk, with an emphasis on the potential interaction between cruciferous vegetables and GSTM1 and GSTT1 gene variants. Methods: A search of the epidemiologic literature through December 2007 was conducted using 15 bibliographic databases without language restrictions. Thirty studies on the association between lung cancer and either total cruciferous vegetable consumption (6 cohort and 12 case-control studies) or specific cruciferous vegetables (1 cohort and 11 case-control studies) were included. Results: The risk for lung cancer among those in the highest category of total cruciferous vegetable intake was 22% lower in case-control studies [random-effects pooled odds ratio, 0.78; 95% confidence interval (95% CI), 0.70-0.88] and 17% lower in cohort studies (pooled relative risk, 0.83; 95% CI, 0.62-1.08) compared with those in the lowest category of intake. The strongest inverse association of total cruciferous vegetable intake with lung cancer risk was seen among individuals with GSTM1 and GSTT1 double null genotypes (odds ratio, 0.41; 95% CI, 0.26-0.65; P for interaction = 0.01). Conclusions: Epidemiologic evidence suggests that cruciferous vegetable intake may be weakly and inversely associated with lung cancer risk. Because of a gene-diet interaction, the strongest inverse association was among those with homozygous deletion for GSTM1 and GSTT1.

Cyclic guanosine monophosphate and 10-year change in left ventricular mass : the Multi-Ethnic Study of Atherosclerosis (MESA)

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

Publication year

2021

Journal title

Biomarkers

Volume

26

Issue

4

Page(s)

309-317

10.1080/1354750X.2021.1893811

Abstract

Abstract

Purpose: Cyclic guanosine monophosphate (cGMP) is a second messenger for natriuretic peptide (NP) and nitric oxide pathways; its enhancement a target for heart failure and cardiovascular disease (CVD). We evaluated whether plasma cGMP was associated with change in left ventricular mass (LVM) among individuals free of CVD and if this differed by sex. Methods and Results: In 611 men and 612 women aged 45–84 years with plasma cGMP measured at baseline and cardiac MRI performed at baseline and 10 years later, we tested associations of cGMP [log-transformed, per 1 SD increment] with LVM, adjusting for CVD risk factors and N-terminal pro-B-type-NP (NT-proBNP). Participants had mean (SD) age of 63.1(8.5) years and cGMP 4.8(2.6) pmol/mL. Cross-sectionally, higher cGMP was associated with lesser LVM, non-lin- early. In contrast, longitudinally, higher cGMP was associated with increase in LVM [1.70g (0.61, 2.78)] over 10 years. Higher cGMP was associated with greater LVM change in men [2.68g (1.57, 3.79)] but not women [0.24g ((−0.92, 1.39); p-interaction < 0.001]. Conclusion: In conclusion, in a community-based cohort, higher cGMP levels were associated with increase in LVM over 10 years independent of CVD risk factors and NT-proBNP in men, perhaps reflecting compensatory changes. Further studies are needed to understand mechanistic roles of cGMP in LV remodelling and associated sex differences.

Cyclic Guanosine Monophosphate and Risk of Incident Heart Failure and Other Cardiovascular Events : the ARIC Study

Zhao, 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

2020

Journal title

Journal of the American Heart Association

Volume

9

Issue

2

10.1161/JAHA.119.013966

Abstract

Abstract

Background: 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.

D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction : A cardiac magnetic resonance imaging study

Choi, S., Jang, W. J., Song, Y. B., Lima, J. A., Guallar, E., Choe, Y. H., Hwang, J. K., Kim, E. K., Yang, J. H., Hahn, J. Y., Choi, S. H., Lee, S. C., Lee, S. H., & Gwon, H. C. (n.d.).

Publication year

2016

Journal title

PloS one

Volume

11

Issue

8

10.1371/journal.pone.0160955

Abstract

Abstract

Objectives: Elevated D-dimer levels on admission predict prognosis in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), but the association of D-dimer levels with structural markers of myocardial injury in these patients is unknown. Methods: We performed cardiac magnetic resonance (CMR) imaging in 208 patients treated with primary PCI for STEMI. CMR was performed a median of 3 days after the index procedure. Of the 208 patients studied, 75 patients had D-dimer levels above the normal range on admission (>0.5 μg/mL; high D-dimer group) while 133 had normal levels (≤0.5 μg/mL; low Ddimer group). The primary outcome was myocardial infarct size assessed by CMR. Secondary outcomes included area at risk (AAR), microvascular obstruction (MVO) area, and myocardial salvage index (MSI). Results: In CMR analysis, myocardial infarct size was larger in the high D-dimer group than in the low D-dimer group (22.3% [16.2-30.5] versus 18.8% [10.7-26.7]; p = 0.02). Compared to the low D-dimer group, the high D-dimer group also had a larger AAR (38.1% [31.7-46.9] versus 35.8% [24.2-45.3]; p = 0.04) and a smaller MSI (37.7 [28.2-46.9] versus 47.1 [33.2-57.0]; p = 0.01). In multivariate analysis, high D-dimer levels were significantly associated with larger myocardial infarct (OR 2.59; 95% CI 1.37-4.87; p

Damage Control in the Wake of Political Action That Threatens the Integrity of Medical Research

Laine, C., Chang, S., Chopra, V., Cotton, D., Guallar, E., Wee, C., & Williams, S. (n.d.).

Publication year

2025

Journal title

Annals of internal medicine

Volume

178

Issue

5

Page(s)

745-746

10.7326/ANNALS-25-00985

Abstract

Abstract

~

DDT (dicophane) and postmenopausal breast cancer in Europe : Case-control study

Van 'T Veer, P., Lobbezoo, I. E., Martín-Moreno, J. M., Guallar, E., Gómez-Aracena, J., Kardinaal, A. F., Kohlmeier, L., Martin, B. C., Strain, J. J., Thamm, M., Van Zoonen, P., Baumann, B. A., Huttunen, J. K., & Kok, F. J. (n.d.).

Publication year

1997

Journal title

British Medical Journal

Volume

315

Issue

7100

Page(s)

81-85

10.1136/bmj.315.7100.81

Abstract

Abstract

Objective: To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane DDT), and breast cancer. Design: Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires. Setting: Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain. Subjects: 265 postmenopausal women with breast cancer and 341 controls matched for age and centre. Main outcome measure: Adipose DDE concentration. Results: Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentration. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates. Conclusions: The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.

Declining exposures to lead and cadmium contribute to explaining the reduction of cardiovascular mortality in the US population, 1988-2004

Ruiz-Hernandez, A., Navas-Acien, A., Pastor-Barriuso, R., Crainiceanu, C. M., Redon, J., Guallar, E., & Tellez-Plaza, M. (n.d.).

Publication year

2017

Journal title

International Journal of Epidemiology

Volume

46

Issue

6

Page(s)

1903-1912

10.1093/ije/dyx176

Abstract

Abstract

Background: Lead and cadmium exposures have markedly declined in the USA following the implementation of large-scale public health policies and could have contributed to the unexplained decline in cardiovascular mortality in US adults. We evaluated the potential contribution of lead and cadmium exposure reductions to explain decreasing cardiovascular mortality trends occurring in the USA from 1988-94 to 1999-2004. Methods: Prospective study in 15 421 adults ≥40 years old who had participated in the National Health and Nutrition Examination Survey 1988-94 or 1999-2004. We estimated the amount of change in cardiovascular mortality over time that can be independently attributed to the intermediate pathway of changes in blood lead and urine cadmium concentrations. Results: There was a 42.0% decrease in blood lead and a 31.0% decrease in urine cadmium concentrations. The cardiovascular mortality rate ratio [95% confidence intervals (CIs)] associated with a doubling of metal levels was 1.19 (1.07, 1.31) for blood lead and 1.20 (1.09, 1.32) for urine cadmium. The absolute reduction in cardiovascular deaths comparing 1999-2004 to 1988-94 was 230.7 deaths/100 000 person-years, in models adjusted for traditional cardiovascular risk factors. Among these avoided deaths, 52.0 (95% CI 8.4, 96.7) and 19.4 (4.3, 36.4) deaths/100 000 person-years were attributable to changes in lead and cadmium, respectively. Conclusions: Environmental declines in lead and cadmium exposures were associated with reductions in cardiovascular mortality in US adults. Given the fact that lead and cadmium remain associated with cardiovascular disease at relatively low levels of exposure, prevention strategies that further minimize exposure to lead and cadmium may be needed.

Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer

Shin, D. W., Cho, J., Kim, S. Y., Guallar, E., Hwang, S. S., Cho, B., Oh, J. H., Jung, K. W., Seo, H. G., & Park, J. H. (n.d.).

Publication year

2013

Journal title

Annals of Surgical Oncology

Volume

20

Issue

8

Page(s)

2468-2476

10.1245/s10434-013-2957-y

Abstract

Abstract

Background: Surgery for cancer is often delayed due to variety of patient-, provider-, and health system-related factors. However, impact of delayed surgery is not clear, and may vary among cancer types. We aimed to determine the impact of the delay from cancer diagnosis to potentially curative surgery on survival. Methods: Cohort study based on representative sample of patients (n = 7,529) with colorectal, breast, lung and thyroid cancer with local or regional disease who underwent potentially curative surgery as their first therapeutic modality within 1 year of cancer diagnosis. They were diagnosed in 2006 and followed for mortality until April 2011, a median follow-up of 4.7 years. Results: For colorectal and breast cancers, the adjusted hazard ratios (95 % confidence intervals) for all-cause mortality comparing a surgical delay beyond 12 weeks to performing surgery within weeks 1-4 after diagnosis were 2.65 (1.50-4.70) and 1.91 (1.06-3.49), respectively. No clear pattern of increased risk was observed with delays between 4 and 12 weeks, or for any delay in lung and thyroid cancers. Concordance between the area of the patient's residence and the hospital performing surgery, and the patient's income status were associated with delayed surgery. Conclusions: Delays to curative surgery beyond 12 weeks were associated with increased mortality in colorectal and breast cancers, suggesting that health provision services should be organized to avoid unnecessary treatment delays. Health care systems should also aim to reduce socioeconomic and geographic disparities and to guarantee equitable access to high quality cancer care.

Deleterious heteroplasmic mitochondrial mutations are associated with an increased risk of overall and cancer-specific mortality

Hong, Y. S., Battle, S. L., Shi, W., Puiu, D., Pillalamarri, V., Xie, J., Pankratz, N., Lake, N. J., Lek, M., Rotter, J. I., Rich, S. S., Kooperberg, C., Reiner, A. P., Auer, P. L., Heard-Costa, N., Liu, C., Lai, M., Murabito, J. M., Levy, D., … Arking, D. E. (n.d.).

Publication year

2023

Journal title

Nature communications

Volume

14

Issue

1

10.1038/s41467-023-41785-7

Abstract

Abstract

Mitochondria carry their own circular genome and disruption of the mitochondrial genome is associated with various aging-related diseases. Unlike the nuclear genome, mitochondrial DNA (mtDNA) can be present at 1000 s to 10,000 s copies in somatic cells and variants may exist in a state of heteroplasmy, where only a fraction of the DNA molecules harbors a particular variant. We quantify mtDNA heteroplasmy in 194,871 participants in the UK Biobank and find that heteroplasmy is associated with a 1.5-fold increased risk of all-cause mortality. Additionally, we functionally characterize mtDNA single nucleotide variants (SNVs) using a constraint-based score, mitochondrial local constraint score sum (MSS) and find it associated with all-cause mortality, and with the prevalence and incidence of cancer and cancer-related mortality, particularly leukemia. These results indicate that mitochondria may have a functional role in certain cancers, and mitochondrial heteroplasmic SNVs may serve as a prognostic marker for cancer, especially for leukemia.