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

Deleterious mitochondrial heteroplasmies exhibit increased longitudinal change in variant allele fraction

Kuiper, L. M., Shi, W., Verlouw, J. A., Hong, Y. S., Arp, P., Puiu, D., Broer, L., Xie, J., Newcomb, C., Rich, S. S., Taylor, K. D., Rotter, J. I., Bader, J. S., Guallar, E., van Meurs, J. B., & Arking, D. E. (n.d.).

Publication year

2025

Journal title

iScience

Volume

28

Issue

6

10.1016/j.isci.2025.112590

Abstract

Abstract

A common feature of human aging is the acquisition of somatic mutations, and mitochondria are particularly prone to mutation, leading to a state of mitochondrial DNA heteroplasmy. Cross-sectional studies have demonstrated that detection of heteroplasmy increases with participant age, a phenomenon that has been attributed to genetic drift. In this large-scale longitudinal study, we measured heteroplasmy in two prospective cohorts (combined n = 1404) at two time points (mean time between visits, 8.6 years), demonstrating that deleterious heteroplasmies were more likely to increase in variant allele fraction (VAF). We further demonstrated that increase in VAF was associated with increased risk of overall mortality. These results challenge the claim that somatic mtDNA mutations arise mainly due to genetic drift, instead suggesting a role for positive selection for a subset of predicted deleterious mutations at the cellular level, despite a negative impact of these mutations on overall mortality.

Detección de casos de EPOC en atención primaria en 4 países de Latinoamérica : Metodología del Estudio PUMA

Schiavi, E., Stirbulov, R., Hernández Vecino, R., Mercurio, S., Di Boscio, V., Zabert, G., Aguirre, C., Rey, A., Moreno, D., Montes De Oca, M., Casas, A., Guallar, E., Jardim, J., Varela, M. V., & Venegas, A. R. (n.d.).

Publication year

2014

Journal title

Archivos de Bronconeumologia

Volume

50

Issue

11

Page(s)

469-474

10.1016/j.arbr.2014.09.010

Abstract

Abstract

Introduction: The prevalence of COPD among patients treated in the healthcare system in Latin America is unknown. The PUMA study (Prevalencia y práctica habitUal -diagnóstico y tratamiento- en población de riesgo de EPOC en Médicos generalistas de 4 países de América Latina) screened at-risk patients attending primary care centers to evaluate the prevalence, diagnosis and treatment of COPD in this setting. The aim of this report is to describe the study methodology. Methods: Multicenter, observational, cross-sectional study conducted in Argentina, Colombia, Uruguay and Venezuela. Subjects were. ≥. 40 years, smokers, former smokers and/or exposed to fossil fuels attending primary care centers. Eligible patients underwent pre- and post- bronchodilator spirometry and completed standardized questionnaires on demographics, smoking, exposure to environmental/domestic pollution, symptoms/history and management of respiratory diseases, comorbidities, and use of healthcare resources. Results: A total of 57 centers in 4 countries participated; 1,907 patients were included, 1,743 completed the PUMA questionnaire and 1,540 patients underwent validated spirometry. Conclusions: We describe the methodology used in the PUMA study, the first systematic multicenter study in four Latin American countries aimed at detecting COPD cases confirmed by spirometry in primary care. Approximately 90% of patients who completed the PUMA questionnaire underwent valid spirometry tests. This gives room for reflection on the feasibility of opportunistic screening at the primary care level to detect patients in the early stages of COPD or with undiagnosed COPD, and improve the diagnosis and management of this disease.

Determinants of p, p'-Dichlorodiphenyldichloroethane (DDE) Concentration in Adipose Tissue in Women from Five European Cities

Sanz-gallardo, M. I., Guallar, E., Martín-moreno, J. M., Van 'T Veer, P., Kok, F. J., Longnecker, M. P., Strain, J. J., Martin, B. C., Kardinaal, A. F., Fernández-Crehuet, J., Thamm, M., & Kohlmeier, L. (n.d.).

Publication year

1999

Journal title

Archives of Environmental Health

Volume

54

Issue

4

Page(s)

277-283

10.1080/00039899909602486

Abstract

Abstract

To identify the determinants of p, p'-dichlorodiphenyldichloroethane (p, p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p, p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p, p'-DDE concentration was 1.66 μg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p, p'-DDE) were center of recruitment (p

Development of chronic kidney disease in patients with non-alcoholic fatty liver disease : A cohort study

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

Publication year

2017

Journal title

Journal of Hepatology

Volume

67

Issue

6

Page(s)

1274-1280

10.1016/j.jhep.2017.08.024

Abstract

Abstract

Background & Aims Non-alcoholic fatty liver disease (NAFLD) has been associated with chronic kidney disease (CKD), but cohort studies are limited. We investigated the longitudinal association of NAFLD and its severity with the development of CKD. Methods We performed a retrospective cohort study of 41,430 adult men and women (average age, 48.9 y) without CKD at baseline who underwent repeated health check-up examinations from January 1, 2003, through December 31, 2013. NAFLD status was assessed by ultrasonography, and NAFLD severity was assessed by the NAFLD fibrosis score (NFS). Results The outcome was an incident CKD, defined as an estimated glomerular filtration rate less than 60 ml/min/1.73 m2. During 200,790 person-years of follow-up (median follow-up of 4.15 years), we identified 691 incident CKD cases. The multivariable-adjusted hazard ratio for CKD comparing participants with and without NAFLD was 1.22 (95% confidence interval [CI] 1.04–1.43). The risk of CKD increased progressively with increased NAFLD severity. The multivariable-adjusted hazard ratios for CKD comparing participants with NFS

Diabetes mellitus and the incidence of hearing loss : A cohort study

Kim, M. B., Zhang, Y., Chang, Y., Ryu, S., Choi, Y., Kwon, M. J., Moon, I. J., Deal, J. A., Lin, F. R., Guallar, E., Chung, E. C., Hong, S. H., Ban, J. H., Shin, H., & Cho, J. (n.d.).

Publication year

2017

Journal title

International Journal of Epidemiology

Volume

46

Issue

2

Page(s)

717-726

10.1093/ije/dyw243

Abstract

Abstract

Background: To evaluate the association between diabetes mellitus (DM) and the development of incident hearing loss. Methods: Prospective cohort study was performed in 253 301 adults with normal hearing tests who participated in a regular health-screening exam between 2002 and 2014. The main exposure was the presence of DM at baseline, defined as a fasting serum glucose 126 mg/dL, a self-reported history of DM or current use of anti-diabetic medications. Pre-diabetes was defined as a fasting glucose 100–125 mg/dL and no history of DM or anti-diabetic medication use. Incident hearing loss was defined as a pure-tone average of thresholds at 0.5, 1.0 and 2.0 kHz > 25 dB in both right and left ears. Results: During 1 285 704 person-years of follow-up (median follow-up of four years), 2817 participants developed incident hearing loss. The rate of hearing loss in participants with normal glucose levels, pre-diabetes and DM were 1.8, 3.1 and 9.2 per 1000 person-years, respectively (P < 0.001). The multivariable-adjusted hazard ratios for incident hearing loss for participants with pre-diabetes and DM compared with those with normal glucose levels were 1.04 (95% confidence interval 0.95–1.14) and 1.36 (1.19–1.56), respectively. In spline regression analyses, the risk of incident hearing loss increased progressively with HbA1c levels above 5%. Conclusions: In this large cohort study of young and middle-aged men and women, DM was associated with the development of bilateral hearing loss. DM patients have a moderately increased risk of future hearing loss.

Diabetes mellitus is associated with an increased risk of gastric cancer : a cohort study

Yang, H. J., Kang, D., Chang, Y., Ahn, J., Ryu, S., Cho, J., Guallar, E., & Sohn, C. I. (n.d.).

Publication year

2020

Journal title

Gastric Cancer

Volume

23

Issue

3

Page(s)

382-390

10.1007/s10120-019-01033-8

Abstract

Abstract

Background: Diabetes mellitus (DM) has been considered a potential risk factor for gastric cancer, but the evidence is conflicting. We evaluated the association of DM with incident gastric cancer in a large cohort of men and women with endoscopic assessment at baseline and during follow-up. Methods: We performed a retrospective cohort study of 195,312 adult men and women who underwent upper endoscopy at baseline and during follow-up between 2003 and 2014. DM was defined as fasting serum glucose ≥ 126 mg/dL, self-reported history of DM or current use of antidiabetic medications. Gastric cancer was confirmed histologically. Results: The prevalence of DM at baseline was 3.0% (n = 5774). Over 865,511 person-years of follow-up, 198 participants developed gastric cancer. The fully adjusted hazard ratio (HR) for incident gastric cancer comparing participants with and without DM at baseline was 1.76 [95% confidence interval (CI) 1.04–2.97; P = 0.033). When we evaluated DM as a time-varying covariate, the fully adjusted HR was 1.66 (95% CI 1.04–2.68; P = 0.036). The association between DM and incident gastric cancer did not differ by the presence of intestinal metaplasia (P for interaction = 0.61). Conclusions: In this large cohort with endoscopic follow-up, DM was independently associated with increased gastric cancer incidence. The increased risk was independent of mucosal atrophy and intestinal metaplasia and was consistent in participants with newly developed DM during follow-up. Patients with DM may require more intensive endoscopic follow-up for gastric cancer screening.

Diabetes, fasting glucose, and the risk of glaucoma : A meta-analysis

Zhao, D., Cho, J., Kim, M. H., Friedman, D. S., & Guallar, E. (n.d.).

Publication year

2015

Journal title

Ophthalmology

Volume

122

Issue

1

Page(s)

72-78

10.1016/j.ophtha.2014.07.051

Abstract

Abstract

Topic: We performed a systematic review to summarize the association of diabetes and blood glucose levels with glaucoma, intraocular pressure (IOP), and ocular hypertension in the general population. Clinical Relevance: Diabetes has been proposed as a risk factor for glaucoma, but epidemiologic studies have been inconsistent, and the association is still controversial. Furthermore, no systematic reviews evaluated other metabolic abnormalities, such as the metabolic syndrome, with the risk of glaucoma. Methods: We identified the studies by searching the PubMed and EMBASE databases. We used inversevariance weighted random-effects models to summarize relative risks across studies. Results: We identified 47 studies including 2 981 342 individuals from 16 countries. The quality of evidence generally was higher in the cohort compared with case-control or cross-sectional studies. The pooled relative risk for glaucoma comparing patients with diabetes with those without diabetes was 1.48 (95% confidence interval [CI], 1.29-1.71), with significant heterogeneity across studies (I2 = 82.3%; P < 0.001). The risk of glaucoma increased by 5% (95% CI, 1%-9%) for each year since diabetes diagnosis. The pooled average difference in IOP comparing patients with diabetes with those without diabetes was 0.18 mmHg (95% CI, 0.09-0.27; I2 = 73.2%), whereas the pooled average increase in IOP associated with an increase in 10 mg/dl in fasting glucose was 0.09 mmHg (95% CI, 0.05-0.12; I2 = 34.8%). Conclusions: Diabetes, diabetes duration, and fasting glucose levels were associated with a significantly increased risk of glaucoma, and diabetes and fasting glucose levels were associated with slightly higher IOP.

Diabetes, glucose metabolism, and glaucoma : The 2005-2008 National Health and Nutrition Examination Survey

Zhao, D., Cho, J., Kim, M. H., Friedman, D., & Guallar, E. (n.d.).

Publication year

2014

Journal title

PloS one

Volume

9

Issue

11

10.1371/journal.pone.0112460

Abstract

Abstract

Results:Diabetes was strongly associated with prevalent glaucoma.In fully adjusted models, the odds ratiofor glaucoma comparing participants with diabetes with participants in the reference group with neither pre-diabetes nor diabetes was 2.12 (95% CI: 1.23, 3.67). The corresponding odd ratio comparing participants with pre-diabetes to those in the reference group was 1.01 (95% CI: 0.57, 1.82). Patients with 5 or more years of diabetes duration hadan OR for glaucoma of 3.90 (95% CI: 1.63, 9.32) compared with patients with

Diabetes, triglyceride levels, and other risk factors for glaucoma in the national health and nutrition examination survey 2005-2008

Ko, F., Boland, M. V., Gupta, P., Gadkaree, S. K., Vitale, S., Guallar, E., Zhao, D., & Friedman, D. S. (n.d.).

Publication year

2016

Journal title

Investigative Ophthalmology and Visual Science

Volume

57

Issue

4

Page(s)

2152-2157

10.1167/iovs.15-18373

Abstract

Abstract

PURPOSE. To determine risk factors for glaucoma in a population-based study in the United States. METHODS. Participants age 40 and older from the National Health and Nutrition Examination Survey underwent questionnaires, physical examination, laboratory tests, and vision tests including fundus imaging. Glaucoma was determined based on expert grading of fundus photographs. Regression modeling of glaucoma risk factors was performed. RESULTS. Participants with glaucoma (172) were older (mean age 68.1 [95% confidence interval (CI) 65.6-70.7] vs. 56.4 years [95% CI 55.6-57.2, P < 0.001]), likely to have less than high school education (25.1% vs. 18.1%, P = 0.05), to have diabetes (23.1% vs. 10.8%, P < 0.001), to have central obesity (72.5% vs. 60.7%, P = 0.01), to have systolic hypertension (30.3% vs. 20.1%, P = 0.01), to have diastolic hypotension (30.3% vs. 13.9%, P < 0.001), and to be nonsmokers (91.0% vs. 79.3%, P =0.002). Sex, poverty, access to health care, fasting glucose, insulin dependence, body mass index, cholesterol levels, diastolic hypertension, systolic hypotension, obstructive sleep apnea, and marijuana were not associated with glaucoma. Multivariable modeling showed associations between glaucoma and older age (odds ratio [OR] 1.09 per year, 95% CI 1.04-1.14), black race (OR 4.40, 95% CI 1.71-11.30), and poverty (OR 3.39, 95% CI 1.73-6.66). Diabetes was no longer associated with glaucoma after adjustment for triglyceride levels. Sex, education, insurance status, body mass index, blood pressure, obstructive sleep apnea, and smoking were not associated with glaucoma. CONCLUSIONS. People who are older, of black race, and with lower income levels have a higher prevalence of glaucoma. A novel association between diabetes, triglyceride levels, and glaucoma is also identified.

Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver : A meta-analysis

Hernaez, R., Lazo, M., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., & Clark, J. M. (n.d.).

Publication year

2011

Journal title

Hepatology

Volume

54

Issue

3

Page(s)

1082-1090

10.1002/hep.24452

Abstract

Abstract

Ultrasonography is a widely accessible imaging technique for the detection of fatty liver, but the reported accuracy and reliability have been inconsistent across studies. We aimed to perform a systematic review and meta-analysis of the diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver. We used MEDLINE and Embase from October 1967 to March 2010. Studies that provided cross-tabulations of ultrasonography versus histology or standard imaging techniques, or that provided reliability data for ultrasonography, were included. Study variables were independently abstracted by three reviewers and double checked by one reviewer. Forty-nine (4720 participants) studies were included for the meta-analysis of diagnostic accuracy. The overall sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of ultrasound for the detection of moderate-severe fatty liver, compared to histology (gold standard), were 84.8% (95% confidence interval: 79.5-88.9), 93.6% (87.2-97.0), 13.3 (6.4-27.6), and 0.16 (0.12-0.22), respectively. The area under the summary receiving operating characteristics curve was 0.93 (0.91-0.95). Reliability of ultrasound for the detection of fatty liver showed kappa statistics ranging from 0.54 to 0.92 for intrarater reliability and from 0.44 to 1.00 for interrater reliability. Sensitivity and specificity of ultrasound was similar to that of other imaging techniques (i.e., computed tomography or magnetic resonance imaging). Statistical heterogeneity was present even after stratification for multiple clinically relevant characteristics. Conclusion: Ultrasonography allows for reliable and accurate detection of moderate-severe fatty liver, compared to histology. Because of its low cost, safety, and accessibility, ultrasound is likely the imaging technique of choice for screening for fatty liver in clinical and population settings.

Dietary iron and blood pressure

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

Publication year

2008

Journal title

BMJ

Volume

337

Issue

7663

Page(s)

183-184

10.1136/bmj.a547

Abstract

Abstract

~

Differential methylation of the arsenic (III) methyltransferase promoter according to arsenic exposure

Gribble, M. O., Tang, W. Y., Shang, Y., Pollak, J., Umans, J. G., Francesconi, K. A., Goessler, W., Silbergeld, E. K., Guallar, E., Cole, S. A., Fallin, M. D., & Navas-Acien, A. (n.d.).

Publication year

2014

Journal title

Archives of Toxicology

Volume

88

Issue

2

Page(s)

275-282

10.1007/s00204-013-1146-x

Abstract

Abstract

Inorganic arsenic is methylated in the body by arsenic (III) methyltransferase (AS3MT). Arsenic methylation is thought to play a role in arsenic-related epigenetic phenomena, including aberrant DNA and histone methylation. However, it is unclear whether the promoter of the AS3MT gene, which codes for AS3MT, is differentially methylated as a function of arsenic exposure. In this study, we evaluated AS3MT promoter methylation according to exposure, assessed by urinary arsenic excretion in a stratified random sample of 48 participants from the Strong Heart Study who had urine arsenic measured at baseline and DNA available from 1989 to 1991 and 1998-1999. For this study, all data are from the 1989-1991 visit. We measured AS3MT promoter methylation at its 48 CpG loci by bisulphite sequencing. We compared mean % methylation at each CpG locus by arsenic exposure group using linear regression adjusted for study centre, age and sex. A hypomethylated region in the AS3MT promoter was associated with higher arsenic exposure. In vitro, arsenic induced AS3MT promoter hypomethylation, and it increased AS3MT expression in human peripheral blood mononuclear cells. These findings may suggest that arsenic exposure influences the epigenetic regulation of a major arsenic metabolism gene.

Differential prognosis of vasospastic angina according to presentation with sudden cardiac arrest or not : Analysis of the Korean Health Insurance Review and Assessment Service

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

Publication year

2018

Journal title

International Journal of Cardiology

Volume

273

Page(s)

39-43

10.1016/j.ijcard.2018.09.082

Abstract

Abstract

Background: The long-term prognosis of vasospastic angina (VSA) patients presenting with aborted sudden cardiac death (ASCD) is still unknown. We sought to compare the long-term clinical outcomes between VSA patients presenting with and without ASCD by retrospective analysis of a nationwide population-based database. Methods: A total of 6972 patients in the Health Insurance Review and Assessment database who were hospitalized in the intensive care unit with VSA between July 1, 2007 and May 31, 2015 were enrolled. Primary outcome was the composite of cardiac arrest and acute myocardial infarction after discharge. Results: Five hundred ninety-eight (8.6%) VSA patients presented with ASCD. On inverse probability of treatment weighting, ASCD patients had a significantly increased risk of the composite of cardiac arrest and acute myocardial infarction (adjusted hazard ratio, 2.52; 95% confidence interval, 1.72–3.67; p < 0.001) during the median follow-up duration of 4 years. The association of ASCD presentation with a worse outcome in terms of primary outcome was consistent across various subgroups, including comorbidity type and use of vasodilators (all p-values for interaction: non-significant). ASCD patients treated with an implantable cardioverter defibrillator (ICD) had a lower incidence of the composite of cardiac arrest and acute myocardial infarction during follow-up than those without an ICD (p = 0.009). Conclusions: VSA patients that present with ASCD are at increased risk of cardiac arrest or myocardial infarction during long-term follow-up despite adequate vasodilator therapy. An ICD is a potential therapeutic option for secondary prevention.

Direct, progressive association of cardiovascular risk factors with incident proteinuria : Results from the Korea Medical Insurance Corporation (KMIC) study

Jee, S. H., Boulware, L. E., Guallar, E., Suh, I., Appel, L. J., & Miller, E. R. (n.d.).

Publication year

2005

Journal title

Archives of Internal Medicine

Volume

165

Issue

19

Page(s)

2299-2304

10.1001/archinte.165.19.2299

Abstract

Abstract

Background: Proteinuria is a major risk factor for the progression of kidney disease and the development of cardiovascular disease. Little is known, however, about risk factors for incident proteinuria. Methods: We conducted a 10-year prospective cohort study of 104 523 Korean men and 52 854 women, aged 35 to 59 years, who attended Korea Medical Insurance Corporation health examinations and who did not have proteinuria at baseline. Incident proteinuria was assessed at biennial examinations during the next 10 years. We performed Cox proportional hazards analyses. Results: During 10 years of follow-up, proteinuria developed in 3951 men (3.8%) and 1527 women (2.9%). The adjusted relative risk (RR) of proteinuria associated with diabetes was 3.27 (95% confidence interval [CI], 2.98-3.58) in men and 2.60 (95% CI, 1.98-3.43) in women; with body mass index (calculated as weight in kilograms divided by the square of height in meters), it was 1.43 (95% CI, 1.35-1.50) in men and 1.45 (95% CI, 1.35-1.55) in women per 5-U increment. Compared with subjects with serum cholesterol levels of less than 200 mg/dL (

Discontinuation of β-blocker therapy in stabilised patients after acute myocardial infarction (SMART-DECISION) : rationale and design of the randomised controlled trial

SMART-DECISION investigators, A., Choi, K. H., Kim, J., Kang, D., Doh, J. H., Kim, J., Park, Y. H., Ahn, S. G., Kim, W., Park, J. P., Kim, S. M., Cho, B. R., Nam, C. W., Cho, J. H., Joo, S. J., Suh, J., Jeong, J. O., Jang, W., Yoon, C. H., … Joh, H. S. (n.d.).

Publication year

2024

Journal title

BMJ open

Volume

14

Issue

8

10.1136/bmjopen-2024-086971

Abstract

Abstract

Introduction There is a lack of evidence to support the effectiveness of prolonged β-blocker therapy after stabilisation of patients with acute myocardial infarction (AMI) without heart failure (HF) or left ventricular systolic dysfunction. Methods and analysis The SMart Angioplasty Research Team: DEcision on Medical Therapy in Patients with Coronary Artery DIsease or Structural Heart Disease Undergoing InterventiON (SMART-DECISION) trial is a multicentre, prospective, open-label, randomised, non-inferiority trial designed to determine whether discontinuing β-blocker therapy after ≥1 year of maintenance in stabilised patients after AMI is non-inferior to continuing it. Patients eligible for participation are those without HF or left ventricular systolic dysfunction (ejection fraction >40%) who have been continuing β-blocker therapy for ≥1 year after AMI. A total of 2540 patients will be randomised 1: 1 to continuation of β-blocker therapy or not. Randomisation will be stratified according to the type of AMI (ie, ST-segment-elevation MI or non-ST-segment-elevation MI), type of β-blocker (carvedilol, bisoprolol, nebivolol or other) and participating centre. The primary study endpoint is a composite of all-cause death, MI and hospitalisation for HF over a median follow-up period of 3.5 years (minimum, 2.5 years; maximum, 4.5 years). Adverse effects related to β-blocker therapy, the occurrence of atrial fibrillation, medical costs and Patient-reported Outcomes Measurement Information system-29 questionnaire responses will also be collected as secondary endpoints. Ethics and dissemination Ethics approval for this study was granted by the Institutional Review Board of Samsung Medical Center (no. 2020-10-176). Informed consent is obtained from every participant before randomisation. The results of this study will be submitted for publication in international peer-reviewed journals and the key findings will be presented at international scientific conferences.

Discordance between 10-year cardiovascular risk estimates using the ACC/AHA 2013 estimator and coronary artery calcium in individuals from 5 racial/ethnic groups : Comparing MASALA and MESA

Al Rifai, M., Cainzos-Achirica, M., Kanaya, A. M., Kandula, N. R., Dardardi, Z., Joshi, P. H., Patel, J., Budoff, M., Yeboah, J., Guallar, E., Blumenthal, R. S., & Blaha, M. J. (n.d.).

Publication year

2018

Journal title

Atherosclerosis

Volume

279

Page(s)

122-129

10.1016/j.atherosclerosis.2018.09.015

Abstract

Abstract

Background and aims: South Asian (SA) individuals are thought to represent a group that is at high-risk for atherosclerotic cardiovascular disease (ASCVD). However, the performance of the Pooled Cohort Equations (PCE) remains uncertain in SAs living in the US. We aimed to study the interplay between predicted 10-year ASCVD risk and coronary artery calcium (CAC) in SAs compared to other racial/ethnic groups. Methods: We studied 536 SAs from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, and 2073 Non-Hispanic Whites (NHWs), 1514 African Americans (AAs), 1254 Hispanics, and 671 Chinese Americans (CAs) from the Multi-Ethnic Study of Atherosclerosis (MESA) who were not currently on statins. We used logistic regression models to assess the association between race/ethnicity and CAC within each ASCVD risk stratum. Results: SAs at low and at intermediate estimated ASCVD risk were more likely to have CAC = 0 compared to NHWs, while SAs at high risk had a similar CAC burden to NHWs. For example, intermediate-risk SAs had a 73% higher odds of CAC = 0 compared to NHWs (95% 1.00–2.99), while high-risk SAs were equally likely to have CAC = 0 (OR 0.95, 95% CI 0.65–1.38) and CAC >100 (OR 0.86, 95% CI 0.61–1.22). Conclusions: Our results suggest that the extent of ASCVD risk overestimation using the PCEs may be even greater among SAs considered at low and intermediate risk than among NHWs. Studies with incident ASCVD events are required to validate and/or recalibrate current ASCVD risk prediction tools in this group.

Discordance in perceived needs between patients and physicians in oncology practice : A nationwide survey in Korea

Shin, D. W., Kim, S. Y., Cho, J., Sanson-Fisher, R. W., Guallar, E., Chai, G. Y., Kim, H. S., Park, B. R., Park, E. C., & Park, J. H. (n.d.).

Publication year

2011

Journal title

Journal of Clinical Oncology

Volume

29

Issue

33

Page(s)

4424-4429

10.1200/JCO.2011.35.9281

Abstract

Abstract

Purpose: Identification of supportive care needs in patients with cancer is essential for planning appropriate interventions. We aimed to determine patient-physician concordance in perceived supportive care needs in cancer care and to explore the predictors and potential consequences of patient-physician concordance. Patients and Methods: A national, multicenter, cross-sectional survey of patient-physician dyads was performed, and 97 oncologists (participation rate, 86.5%) and 495 patients (participation rate, 87.4%) were included. A short form of the Comprehensive Needs Assessment Tool for Cancer Patients was independently administered to patients and their oncologists. Concordance and agreement rates between physicians and patients were calculated. Mixed logistic regression was used to identify predictors of concordance and to explore the association of concordance with patient satisfaction and trust in physicians. Results: Physicians systematically underestimated patient needs and patient-physician concordance was generally poor, with weighted κ statistics ranging from 0.04 to 0.15 for individual items and Spearman's ρ coefficients ranging from 0.11 to 0.21 for questionnaire domains. Length of experience as oncologist was the only significant predictor of concordance (adjusted odds ratio for overall concordance [aOR] = 2.09; 95% CI, 1.02 to 4.31). Concordance was not significantly associated with overall patient satisfaction (aOR = 1.24; 95% CI, 0.74 to 2.07) or trust in physician (aOR = 1.17; 95% CI, 0.76 to 1.81). Conclusion: Our findings revealed significant underestimation of patient needs and poor concordance between patients and physicians in assessing perceived needs of supportive care. The clinical implications of this discordance warrant further investigation.

Do genes modify the association of selenium and lipid levels?

Galan-Chilet, I., Guallar, E., Martin-Escudero, J. C., De Marco, G., Dominguez-Lucas, A., Gonzalez-Manzano, I., Lopez-Izquierdo, R., Redon, J., Chaves, F. J., & Tellez-Plaza, M. (n.d.).

Publication year

2015

Journal title

Antioxidants and Redox Signaling

Volume

22

Issue

15

Page(s)

1352-1362

10.1089/ars.2015.6248

Abstract

Abstract

The interaction of selenium, a component of antioxidant selenoproteins, with genetic variation in lipid-related pathways has not been evaluated earlier as a potential determinant of blood lipid levels. We aimed at evaluating the effects of gene-environment interactions between plasma levels of selenium and polymorphisms in lipid metabolic pathways on plasma lipid levels in a study population from Spain (N=1,315). We observed statistically significant associations between plasma selenium and lipid levels (differences in total, low-density lipoprotein [LDL]-cholesterol, and triglycerides comparing the 80th with the 20th percentiles of plasma selenium levels were, respectively, 12.0 (95% confidence interval 6.3, 17.8), 8.9 (3.7, 14.2), and 9.0 (2.9, 15.2) mg/dl). We also found statistically significant interactions at the Bonferroni-corrected significance level (p=0.0008) between selenium and rs2290201 in FABP4 for total and LDL cholesterol levels and rs1800774 in CETP for elevated LDL cholesterol. Other polymorphisms showed statistically significant differential associations of plasma selenium levels and lipids biomarkers at the nominal p-value of 0.05. Reported statistical interactions with genes involved in lipid transport and transfer provide biological support to the positive associations of selenium with lipids shown in cross-sectional studies and lead to the hypothesis that selenium and lipid levels share common biological pathways that need to be elucidated in mechanistic studies. Antioxid. Redox Signal. 22, 1352-1362.

Do genes modify the association of selenium and lipid levels?

Galan-Chilet, I., Guallar, E., Martin-Escudero, J. C., De Marco, G., Dominguez-Lucas, A., Gonzalez-Manzano, I., Lopez-Izquierdo, R., Redon, J., Chaves, F. J., & Tellez-Plaza, M. (n.d.).

Publication year

2015

Journal title

Antioxidants and Redox Signaling

Volume

22

Issue

15

Page(s)

1352-1362

10.1089/ars.2015.6248

Abstract

Abstract

The interaction of selenium, a component of antioxidant selenoproteins, with genetic variation in lipid-related pathways has not been evaluated earlier as a potential determinant of blood lipid levels. We aimed at evaluating the effects of gene-environment interactions between plasma levels of selenium and polymorphisms in lipid metabolic pathways on plasma lipid levels in a study population from Spain (N=1,315). We observed statistically significant associations between plasma selenium and lipid levels (differences in total, low-density lipoprotein [LDL]-cholesterol, and triglycerides comparing the 80th with the 20th percentiles of plasma selenium levels were, respectively, 12.0 (95% confidence interval 6.3, 17.8), 8.9 (3.7, 14.2), and 9.0 (2.9, 15.2) mg/dl). We also found statistically significant interactions at the Bonferroni-corrected significance level (p=0.0008) between selenium and rs2290201 in FABP4 for total and LDL cholesterol levels and rs1800774 in CETP for elevated LDL cholesterol. Other polymorphisms showed statistically significant differential associations of plasma selenium levels and lipids biomarkers at the nominal p-value of 0.05. Reported statistical interactions with genes involved in lipid transport and transfer provide biological support to the positive associations of selenium with lipids shown in cross-sectional studies and lead to the hypothesis that selenium and lipid levels share common biological pathways that need to be elucidated in mechanistic studies. Antioxid. Redox Signal. 22, 1352-1362.

Does peer review predict the performance of research projects in health sciences?

Clavería, L. E., Guallar, E., Camí, J., Conde, J., Pastor, R., Ricoy, J. R., Rodríguez-Farré, E., Ruiz-Palomo, F., & Muñoz, E. (n.d.).

Publication year

2000

Journal title

Scientometrics

Volume

47

Issue

1

Page(s)

11-23

10.1023/A:1005609624130

Abstract

Abstract

Peer review is a basic component of the scientific process, but its performance has seldom been evaluated systematically. To determine whether pre-approval characteristics of research projects predicted the performance of projects, we conducted a retrospective cohort study of all 2744 single-centre research projects financed by the Spanish Health Research Fund since 1938 and completed before 1996. Peer review scores of grant applications were significant predictors of performance of funded projects, and the likelihood of production was also higher for projects with a basic research component, longer duration, higher budget or a financed research fellow. Funding agencies should monitor their selection process and assess the performance of funded projects to design future strategies in supporting health sciences research.

Drug and alcohol use in Spain : Consumption habits, attitudes and opinions

Guallar, E., Royo-Bordonada, M. A., Cid-Ruzafa, J., Martin-Moreno, J. M., & Guallar, E. (n.d.).

Publication year

1997

Journal title

Public Health

Volume

111

Issue

5

Page(s)

277-284

10.1016/S0033-3506(97)00054-1

Abstract

Abstract

To estimate the lifetime prevalence of drug and alcohol use and its sociodemographic determinants and to investigate opinions towards drug use in Spain, we examined a representative nation-wide sample of 2495 adult Spaniards, males and females, aged 18 y or older, selected by a multistaged random strategy during 1989. Information was obtained by at-home interviews using a structured closed questionnaire. Participants were asked for their lifetime prevalence of use of cannabis, sedatives and sleeping pills, alcohol, amphetamines, inhalants, cocaine and heroin, as well as for their sociodemographic characteristics and their opinions towards drug use. Alcohol had the highest lifetime prevalence of consumption (55.7%), followed by cannabis (12.3%), sedatives and sleeping pills (12.0%), amphetamines (4.3%), cocaine (3.0%), inhalants (0.8%) and heroin (0.6%). Being male, young, separated or divorced, and unemployed were the main determinants of alcohol and drug use. A higher use of illicit drugs was also observed in the higher socioeconomic groups. Regular use of any drug was considered a risky health habit by more than 80% of the sample. We conclude that the consumption of drugs and alcohol is a rather extended habit in Spain. Drug users tend to share some common sociodemographic characteristics (being male, young, separated or divorced, and unemployed) which may help target intervention programs.

Dynamic analysis of cardiac rhythms for discriminating atrial fibrillation from lethal ventricular arrhythmias

De Mazumder, D., Lake, D. E., Cheng, A., Moss, T. J., Guallar, E., Weiss, R. G., Jones, S. R., Tomaselli, G. F., & Moorman, J. R. (n.d.).

Publication year

2013

Journal title

Circulation: Arrhythmia and Electrophysiology

Volume

6

Issue

3

Page(s)

555-561

10.1161/CIRCEP.113.000034

Abstract

Abstract

Background-Implantable cardioverter-defibrillators (ICDs), the first line of therapy for preventing sudden cardiac death in high-risk patients, deliver appropriate shocks for termination of ventricular tachycardia (VT)/ventricular fibrillation. A common shortcoming of ICDs is imperfect rhythm discrimination, resulting in the delivery of inappropriate shocks for atrial fibrillation (AF). An underexplored area for rhythm discrimination is the difference in dynamic properties between AF and VT/ventricular fibrillation. We hypothesized that the higher entropy of rapid cardiac rhythms preceding ICD shocks distinguishes AF from VT/ventricular fibrillation. Methods and Results-In a multicenter, prospective, observational study of patients with primary prevention ICDs, 119 patients received shocks from ICDs with stored, retrievable intracardiac electrograms. Blinded adjudication revealed shocks were delivered for VT/ventricular fibrillation (62%), AF (23%), and supraventricular tachycardia (15%). Entropy estimation of only 9 ventricular intervals before ICD shocks accurately distinguished AF (receiver operating characteristic curve area, 0.98; 95% confidence intervals, 0.93-1.0) and outperformed contemporary ICD rhythm discrimination algorithms. Conclusions-This new strategy for AF discrimination based on entropy estimation expands on simpler concepts of variability, performs well at fast heart rates, and has potential for broad clinical application.

Early-onset vasomotor symptoms and development of depressive symptoms among premenopausal women

Choi, H. R., Chang, Y., Park, J., Cho, Y., Kim, C., Kwon, M. J., Kang, J., Kwon, R., Lim, G. y., Ahn, J., Kim, K. H., Kim, H., Hong, Y. S., Park, J., Zhao, D., Cho, J., Guallar, E., Park, H. Y., & Ryu, S. (n.d.).

Publication year

2024

Journal title

Journal of Affective Disorders

Volume

354

Page(s)

376-384

10.1016/j.jad.2024.03.083

Abstract

Abstract

Background: We investigated the association between vasomotor symptoms (VMSs) and the onset of depressive symptoms among premenopausal women. Methods: This cross-sectional study included 4376 premenopausal women aged 42–52 years, and the cohort study included 2832 women without clinically relevant depressive symptoms at baseline. VMSs included the symptoms of hot flashes and night sweats. Depressive symptoms were evaluated using the Center for Epidemiological Studies Depression Scale; a score of ≥16 was considered to define clinically relevant depressive symptoms. Results: Premenopausal Women with VMSs at baseline exhibited a higher prevalence of depressive symptoms compared with women without VMSs at baseline (multivariable-adjusted prevalence ratio 1.76, 95 % confidence interval [CI] 1.47–2.11). Among the 2832 women followed up (median, 6.1 years), 406 developed clinically relevant depressive symptoms. Women with versus without VMSs had a significantly higher risk of developing clinically relevant depressive symptoms (multivariable-adjusted hazard ratio, 1.72; 95 % CI 1.39–2.14). VMS severity exhibited a dose-response relationship with depressive symptoms (P for trend

Ecuestas alimentarias en los niños españoles de edad escolar : Análisis del período 1984-1994

Gorgojo Jiménez, L., Guallar, E., Martín-Moreno, J. M., Löpez-Nomdedeu, C., Vázquez, C., Martí-Henneberg, C., & Serrano-Ríos, M. (n.d.).

Publication year

1999

Journal title

Medicina Clinica

Volume

112

Issue

10

Page(s)

368-374

Abstract

Abstract

OBJECTIVE: To review available data on the usual dietary intake of school-age Spanish children, by analyzing the nutritional surveys carried out during the period 1984-1994. METHODS: Systematic and comprehensive search of surveys with dietary data in Spanish children aged 6 to 16 years collected during the period 1984-1994 and published after January 1997. The search of bibliographic databases (MEDLINE, IME, ISBN and Teseo), was completed with an extensive search of the gray literature and of unpublished studies through contact with public and private institutions which may fund such studies. The quality of the original surveys was assessed, and the data of the studies fulfilling pre-established quality requirements were summarized and tabulated. RESULTS: We located 65 nutritional surveys in children and adolescents performed between 1984 and 1994, which generated 91 documents. Most surveys (76.9%) were local, while 18.5% of them studied provinces or regions and 3.1% studied more than one region. Only 4 studies (6.2%) met the quality requirements, but the methods or the presentation of the results of these surveys were too heterogeneous. In spite of that, the available data tends to show a certain lack of balance of macronutrient intakes in relation to the usual dietary recomendations. CONCLUSIONS: Available data on nutritional intake of Spanish school-age children during 1984-1994 were too heterogeneous to be comparable, even if the analysis was restricted to high-quality surveys. Furthermore, there are no repeated surveys monitoring changes in intake in representative samples of children performed during the study period. This should be taken into account in future research endeavours which should contemplate a well defined sampling framework and the appropriate methodology to assure the proper interpretation of the eventual results.

Editorial : higher levels of certain serum bile acids in non-alcoholic fatty liver disease–new insights from Guatemala.Authors’ reply

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)

361-362

10.1111/apt.17061

Abstract

Abstract

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