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

Low thigh muscle mass is associated with coronary artery stenosis among HIV-infected and HIV-uninfected men : The Multicenter AIDS Cohort Study (MACS)

Tibuakuu, M., Zhao, D., Saxena, A., Brown, T. T., Jacobson, L. P., Palella, F. J., Witt, M. D., Koletar, S. L., Margolick, J. B., Guallar, E., Korada, S. K., Budoff, M. J., Post, W. S., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

Journal of Cardiovascular Computed Tomography

Volume

12

Issue

2

Page(s)

131-138

10.1016/j.jcct.2018.01.007

Abstract

Abstract

Background: HIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown. Methods: We performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010–2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis ≥50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (

Mapping progress in reducing cardiovascular risk with kidney disease : Sudden cardiac death

Shafi, T., & Guallar, E. (n.d.).

Publication year

2018

Journal title

Clinical Journal of the American Society of Nephrology

Volume

13

Issue

9

Page(s)

1429-1431

10.2215/CJN.02760218

Abstract

Abstract

~

Non-alcoholic fatty liver disease and the development of reflux esophagitis : A cohort study

Min, Y. W., Kim, Y., Gwak, G. Y., Gu, S., Kang, D., Cho, S. J., Guallar, E., Cho, J., & Sinn, D. H. (n.d.).

Publication year

2018

Journal title

Journal of Gastroenterology and Hepatology (Australia)

Volume

33

Issue

5

Page(s)

1053-1058

10.1111/jgh.14042

Abstract

Abstract

Background and Aim: Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of the metabolic syndrome, is associated with gastroesophageal reflux disease in cross-sectional studies, but a prospective association has not been evaluated. The current study aimed to determine whether NAFLD increases the risk of incident reflux esophagitis in a large cohort study. Methods: We conducted a cohort study of 34 063 men and women without reflux esophagitis or other upper gastrointestinal disease at baseline who underwent health checkup examinations between January 2003 and December 2013. Fatty liver was diagnosed by ultrasound based on standard criteria. Reflux esophagitis was defined by the presence of at least grade A mucosal break on esophagogastroduodenoscopy. Results: The prevalence of NAFLD at baseline was 33.2%. During 153 520.2 person-years of follow-up, the cumulative incidences of reflux esophagitis for participants without and with NAFLD were 9.6% and 13.8%, respectively (P < 0.001). The age-adjusted and sex-adjusted hazard ratio for the risk of reflux esophagitis development in participants with NAFLD compared with those without NAFLD was 1.15 (95% confidence interval 1.07–1.23; P < 0.001). However, this association disappeared after adjusting for body mass index and other metabolic factors (hazard ratio 1.01, 95% confidence interval 0.94–1.09; P = 0.79). Similarly, in multivariable-adjusted models, there was no significant association between NAFLD severity and the risk of developing reflux esophagitis. Conclusions: Non-alcoholic fatty liver disease is not independently associated with the risk of the development of reflux esophagitis, but rather, reflux esophagitis is primarily the consequence of increased body mass index commonly associated with NAFLD.

Nonalcoholic fatty liver disease accelerates kidney function decline in patients with chronic kidney disease : A cohort study

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

Publication year

2018

Journal title

Scientific reports

Volume

8

Issue

1

10.1038/s41598-018-23014-0

Abstract

Abstract

This study aimed to investigate the association of nonalcoholic fatty liver disease (NAFLD) and its severity with the decline in kidney function in patients with chronic kidney disease (CKD). We conducted a cohort study of 1,525 CKD patients who underwent repeated health check-up examinations from January 2003 through December 2013. NAFLD was diagnosed by ultrasonography and its severity was assessed by the NAFLD fibrosis score. At baseline, the prevalence of NAFLD was 40.9%, and the mean estimated glomerular filtration rate (EGFR) was 59.1 ml/min/1.73 m2. The average follow-up was 6.5 years. The age- and sex-adjusted decline in EGFR was greater in patients with NAFLD (-0.79% per year, 95% CI -1.31%, -0.27%) compared to those without it (0.30%, 95% CI -0.14%, 0.76%; p = 0.002). In multivariable adjusted models, the average difference in annual percent change in decline in EGFR comparing patients with NAFLD to those without NAFLD was -1.06% (-1.73%, -0.38%; p = 0.002). The decline in EGFR associated with NAFLD was greater in patients with higher NAFLD fibrosis score, in those with proteinuria or with low EGFR at baseline (

Physical activity and impaired left ventricular relaxation in middle aged adults

Ryu, S., Chang, Y., Kang, J., Yun, K. E., Jung, H. S., Kim, C. W., Cho, J., Lima, J. A., Sung, K. C., Shin, H., & Guallar, E. (n.d.).

Publication year

2018

Journal title

Scientific reports

Volume

8

Issue

1

10.1038/s41598-018-31018-z

Abstract

Abstract

The aim of this study was to examine the relationship between physical activity level and impaired left ventricular (LV) relaxation in a large sample of apparently healthy men and women. We conducted a cross-sectional study in 57,449 adults who underwent echocardiography as part of a comprehensive health examination between March 2011 and December 2014. Physical activity level was assessed using the Korean version of the International Physical Activity Questionnaire Short Form. The presence of impaired LV relaxation was determined based on echocardiographic findings. Physical activity levels were inversely associated with the prevalence of impaired LV relaxation. The multivariable-adjusted odds ratios (95% confidence interval) for impaired LV relaxation comparing minimally active and health-enhancing physically active groups to the inactive group were 0.84 (0.77–0.91) and 0.64 (0.58–0.72), respectively (P for trend < 0.001). These associations were modified by sex (p for interaction

Progressive myocardial injury is associated with mortality in the acute respiratory distress syndrome

Metkus, T. S., Guallar, E., Sokoll, L., Morrow, D. A., Tomaselli, G., Brower, R., Kim, B. S., Schulman, S., & Korley, F. K. (n.d.).

Publication year

2018

Journal title

Journal of Critical Care

Volume

48

Page(s)

26-31

10.1016/j.jcrc.2018.08.009

Abstract

Abstract

Purpose: Myocardial injury connotes worse prognosis in the Acute Respiratory Distress Syndrome (ARDS), however the prognostic connotation of changes in cardiac troponin (cTn) levels in ARDS patients is not known. Methods: We performed a study of 908 ARDS patients enrolled in two previously completed ARDS Network trials. We obtained plasma samples via the NIH BIOLINCC repository and measured cTn using the ARCHITECT STAT high sensitivity troponin-I assay (Abbott Laboratories) at trial day 0 and 3. We constructed Cox proportional hazard models to determine the association between 60-day mortality and quintiles of percentage change in high-sensitivity troponin (ΔhsTnI). Results: The median percent change in hsTnI (%ΔhsTnI) from day 0 to day 3 was −58.2% (IQR -79.0 to 0%). After multivariable adjustment, participants with a 32.1% or greater increase in hsTnI between day 0 and day 3 (highest quintile) had a 2.27 fold increased risk for mortality (95% CI 1.29 – 3.99, p = 0.002) as well as fewer ventilator-free and ICU-free days compared to the lowest quintile. Conclusion: Progressive myocardial injury in ARDS patients is associated with worse outcome, independent of severity of critical illness. Investigation of the mechanisms underlying this relationship is warranted to guide possible strategies to mitigate myocardial injury in ARDS.

Racial differences in comorbidity profile among patients with chronic obstructive pulmonary disease

Lee, H., Shin, S. H., Gu, S., Zhao, D., Kang, D., Joi, Y. R., Suh, G. Y., Pastor-Barriuso, R., Guallar, E., Cho, J., & Park, H. Y. (n.d.).

Publication year

2018

Journal title

BMC Medicine

Volume

16

Issue

1

10.1186/s12916-018-1159-7

Abstract

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by multiple comorbidities, which are associated with an increased risk of exacerbation, a poor health-related quality of life, and high mortality. However, differences in comorbidity profile by race and ethnicity in COPD patients have not been fully elucidated. Methods: Participants aged 40 to 79 years with spirometry-defined COPD from the U.S. National Health and Nutrition Examination Survey (NHANES) (2007-2012) and from the Korea NHANES (2007-2015) were analyzed to compare the prevalence of comorbidities by race and ethnicity group. Comorbidities were defined using questionnaire data, physical exams, and laboratory tests. Results: Non-Hispanic Whites had the highest prevalence of dyslipidemia (65.5%), myocardial infarction (6.2%), osteoarthritis (40.1%), and osteoporosis (13.6%), while non-Hispanic Blacks had the highest prevalence of asthma (24.0%), hypertension (70.2%), stroke (7.3%), diabetes mellitus (DM) (23.3%), anemia (16.4%), and rheumatoid arthritis (11.9%). Compared to non-Hispanic Whites, non-Hispanic Blacks had a significantly higher prevalence of hypertension, stroke, DM, anemia, and rheumatoid arthritis after adjusting for age, sex, body mass index, and smoking status, while Hispanics had a significantly higher prevalence of DM and anemia, and Koreans had significantly lower prevalences of all comorbidities except stroke, DM, and anemia. Conclusions: COPD-related comorbidities varied significantly by race and ethnicity, and different strategies may be required for the optimal management of COPD and its comorbidities in different race and ethnicity groups.

Relation of Sex Hormone Levels with Prevalent and 10-Year Change in Aortic Distensibility Assessed by MRI : The Multi-Ethnic Study of Atherosclerosis

Subramanya, V., Ambale-Venkatesh, B., Ohyama, Y., Zhao, D., Nwabuo, C. C., Post, W. S., Guallar, E., Ouyang, P., Shah, S. J., Allison, M. A., Ndumele, C. E., Vaidya, D., Bluemke, D. A., Lima, J. A., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

American Journal of Hypertension

Volume

31

Issue

7

Page(s)

774-783

10.1093/ajh/hpy024

Abstract

Abstract

Background: Women experience a steeper decline in aortic elasticity related to aging compared to men. We examined whether sex hormone levels were associated with ascending aortic distensibility (AAD) in the Multi-Ethnic Study of Atherosclerosis. Methods: We studied 1,345 postmenopausal women and 1,532 men aged 45-84 years, who had serum sex hormone levels, AAD measured by phase-contrast cardiac magnetic resonance imaging, and ejection fraction>50% at baseline. Among these participants, 457 women and 548 men returned for follow-up magnetic resonance imaging 10-years later. Stratified by sex, and using mixed effects linear regression methods, we examined associations of sex hormones (as tertiles) with baseline and annual change in log-transformed AAD (mm Hg-110-3), adjusting for demographics, body size, lifestyle factors, mean arterial pressure, heart rate, hypertensive medication use (and in women, for hormone therapy use and years since menopause). Results: The mean (SD) age was 65 (9) for women and 62 (10) years for men. AAD was lower in women than men (P < 0.001). In adjusted cross-sectional analysis, the highest tertile of free testosterone (compared to lowest) in women was significantly associated with lower AAD [-0.10 (-0.19, -0.01)] and the highest tertile of estradiol in men was associated with greater AAD [0.12 (0.04, 0.20)]. There were no associations of sex hormones with change in AAD over 10 years, albeit in a smaller sample size. Conclusions: Lower free testosterone in women and higher estradiol in men were associated with greater aortic distensibility at baseline, but not longitudinally. Sex hormone levels may account for differences in AAD between women and men.

Reply : Free Androgen Index as a Biomarker of Increased Cardiovascular Risk in Postmenopausal Women

Zhao, D., Guallar, E., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

Journal of the American College of Cardiology

Volume

72

Issue

16

Page(s)

1987

10.1016/j.jacc.2018.08.1042

Abstract

Abstract

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Resting heart rate and the incidence and progression of valvular calcium : The Multi-Ethnic Study of Atherosclerosis (MESA)

Amoakwa, K., Fashanu, O. E., Tibuakuu, M., Zhao, D., Guallar, E., Whelton, S. P., O'Neal, W. T., Post, W. S., Budoff, M. J., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

Atherosclerosis

Volume

273

Page(s)

45-52

10.1016/j.atherosclerosis.2018.04.004

Abstract

Abstract

Background and aims: Left-sided valvular calcification is associated with cardiovascular disease (CVD) morbidity and mortality. Resting heart rate (RHR) may influence valvular calcium progression through shear stress. Whether RHR, an established CVD risk factor, is associated with valvular calcium progression is unknown. We assessed whether RHR predicts incidence and progression of mitral annular calcium (MAC) and aortic valve calcium (AVC) in a community-based cohort free of CVD at baseline. Methods: RHR was obtained from baseline electrocardiograms of 5498 MESA participants. MAC and AVC were quantified using Agatston scoring from cardiac computed tomography scans obtained at baseline and at a second examination during follow-up. We examined associations of RHR with incident MAC/AVC and annual change in MAC/AVC scores, after adjusting for demographics, CVD risk factors, physical activity, and atrioventricular nodal blocker use. Results: At baseline, participants had mean age of 62 ± 10 years and mean RHR of 63 ± 10 bpm; 12.3% and 8.9% had prevalent AVC and MAC, respectively. Over a median of 2.3 years, 4.1% and 4.5% developed incident AVC and MAC, respectively. Each 10 bpm higher RHR was significantly associated with incident MAC [Risk Ratio 1.17 (95% CI 1.03–1.34)], but not incident AVC. However, RHR was associated with AVC progression [β = 1.62 (0.45–2.80) Agatston units/year for every 10 bpm increment], but not MAC progression. Conclusions: Higher RHR was associated with MAC incidence and AVC progression, independent of traditional CVD risk factors. Future studies are needed to determine whether modification of RHR through lifestyle or pharmacologic interventions can reduce valvular calcium incidence or progression.

Risk factors control for primary prevention of cardiovascular disease in men : Evidence from the Aragon Workers Health Study (AWHS)

Aguilar-Palacio, I., Malo, S., Feja, C., Lallana, M., León-Latre, M., Casasnovas, J. A., Rabanaque, M., & Guallar, E. (n.d.).

Publication year

2018

Journal title

PloS one

Volume

13

Issue

2

10.1371/journal.pone.0193541

Abstract

Abstract

Benefits of cardiovascular disease (CVD) risk factors control are well known, but goals achievement remains low. The objective of this study is to evaluate the prevalence of CVD risk factors among men ina worker’s cohort with no previous CVD, to study control variations across time and the factors associated with poor control. To this end, we conducted a cohort reexamination (2010–2014) within the context of the Aragon Workers Health Study (AWHS). Data from working characteristics, analytical values and pharmacological prescription were included in the analysis. Prevalences of risk factor diagnosis and control were calculated, as well as factors associated with poor control. The prevalence of CVD risk factors was high. In 2014dyslipidaemia was the most prevalent (85.2%) followed by Hypertension (HT) (42.0%). People under treatment increased for the period analysed (p

Serum 25-Hydroxyvitamin D Concentrations Are Associated with Computed Tomography Markers of Subclinical Interstitial Lung Disease among Community-Dwelling Adults in the Multi-Ethnic Study of Atherosclerosis (MESA)

Kim, S. M., Zhao, D., Podolanczuk, A. J., Lutsey, P. L., Guallar, E., Kawut, S. M., Barr, R. G., de Boer, I. H., Kestenbaum, B. R., Lederer, D. J., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

Journal of Nutrition

Volume

148

Issue

7

Page(s)

1126-1134

10.1093/jn/nxy066

Abstract

Abstract

Background: Activated vitamin D has anti-inflammatory properties. 25-Hydroxyvitamin D [25(OH)D] deficiency might contribute to subclinical interstitial lung disease (ILD). Objective: We examined associations between serum 25(OH)D concentrations and subclinical ILD among middle-aged to older adults who were free of cardiovascular disease at baseline. Methods: We studied 6302 Multi-Ethnic Study of Atherosclerosis (MESA) participants who had baseline serum 25(OH)D concentrations and computed tomography (CT) imaging spanning ≤ 10 y. Baseline cardiac CT scans (2000–2002) included partial lung fields. Some participants had follow-up cardiac CT scans at exams 2–5 and a full-lung CT scan at exam 5 (2010–2012), with a mean ± SD of 2.1 ± 1.0 scans. Subclinical ILD was defined quantitatively as high-attenuation areas (HAAs) between –600 and –250 Hounsfield units. We assessed associations of 25(OH)D with adjusted HAA volumes and HAA progression. We also examined associations between baseline 25(OH)D and the presence of interstitial lung abnormalities (ILAs) assessed qualitatively (yes or no) from full-lung CT scans at exam 5. Models were adjusted for sociodemographic characteristics, lifestyle factors (including smoking), and lung volumes. Results: The cohort's mean ± SD characteristics were 62.2 ± 10 y for age, 25.8 ± 10.9 ng/mL for 25(OH)D concentrations, and 28.3 ± 5.4 for body mass index (kg/m2); 53% were women, with 39% white, 27% black, 22% Hispanic, and 12% Chinese race/ethnicities. Thirty-three percent had replete (≥30 ng/mL), 35% intermediate (20 to

Serum uric acid levels are associated with cardiovascular risk score : A post hoc analysis of the EURIKA study

Borghi, C., Rodriguez-Artalejo, F., De Backer, G., Dallongeville, J., Medina, J., Nuevo, J., Guallar, E., Perk, J., Banegas, J. R., Tubach, F., Roy, C., & Halcox, J. P. (n.d.).

Publication year

2018

Journal title

International Journal of Cardiology

Volume

253

Page(s)

167-173

10.1016/j.ijcard.2017.10.045

Abstract

Abstract

Background Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk. Methods This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients had at least one CV risk factor but no clinical CV disease. Ten-year risk of CV death was estimated using SCORE-HDL and SCORE algorithms, categorized as low (< 1%), intermediate (1% to < 5%), high (≥ 5% to < 10%) or very high (≥ 10%). Results Mean serum sUA levels increased significantly with increasing CV death risk category in the overall population and in subgroups stratified by diuretics use or renal function (all P < 0.0001). Multivariate ordinal logistic regression analyses, adjusted for factors significantly associated with CV death risk in univariate analyses (study country, body mass index, number of CV risk factors and comorbidities, use of lipid lowering therapies, antihypertensives and antidiabetics), showed a significant association between sUA levels and SCORE-HDL category in the overall population (OR: 1.39 [95% CI: 1.34–1.44]) and all subgroups (using diuretics: 1.32 [1.24–1.40]; not using diuretics: 1.46 [1.39–1.53]; estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2: 1.30 [1.22–1.38]; eGFR ≥ 60 ml/min/1.73 m2: 1.44 [1.38–1.51]; all P < 0.0001). Similar results were obtained when using SCORE. Conclusions Higher sUA levels are associated with progressively higher 10-year CV death risk score in patients with at least one CV risk factor but no CV disease.

Sex hormone levels and change in left ventricular structure among men and post-menopausal women : The Multi-Ethnic Study of Atherosclerosis (MESA)

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

Publication year

2018

Journal title

Maturitas

Volume

108

Page(s)

37-44

10.1016/j.maturitas.2017.11.006

Abstract

Abstract

Objective Sex hormone (SH) levels may contribute to sex differences in the risk of heart failure with preserved ejection fraction (HFpEF). We examined the associations of SH levels with left ventricular mass (LVM) and mass (M):volume (V) ratio, which are risk markers for HFpEF. Study design We studied 1941 post-menopausal women and 2221 men, aged 45–84 years, participating in the Multi-Ethnic Study of Atherosclerosis (MESA). Serum SH levels, cardiac magnetic resonance imaging (MRI) and ejection fraction (EF) ≥50% had been recorded at baseline (2000–2002). Of these participants, 2810 underwent repeat MRI at Exam 5 (2010–2012). Stratified by sex, linear mixed-effect models were used to test associations between SH and sex hormone binding globulin (SHBG) level [per 1 SD greater log-transformed (SH)] with baseline and change in LV structure. Models were adjusted for age, race/ethnicity, center, height, weight, education, physical activity and smoking, and, in women, for hormone therapy and years since menopause. Main outcome measures LVM and M:V ratio. Results After a median of 9.1 years, higher free testosterone levels were independently associated with a modest increase in LVM (g/yr) in women [0.05 (95% CI 0.01, 0.10)] and men [0.16 (0.03, 0.28)], while higher SHBG levels were associated with less LVM change (g/yr) in women [−0.07 (−0.13, −0.01)] and men [−0.15 (−0.27, −0.02)]. In men, higher dehydroepiandrosterone and estradiol levels were associated with increased LVM. Among women, free testosterone levels were positively and SHBG levels inversely associated with change in M:V ratio. Conclusion A more androgenic profile (higher free testosterone and lower SHBG levels) is associated with a greater increase in LVM in men and women and greater increase in M:V ratio in women over the course of 9 years.

Sleep duration and subclinical atherosclerosis : The Aragon Workers' Health Study

Blasco-Colmenares, E., Moreno-Franco, B., Latre, M. L., Mur-Vispe, E., Pocovi, M., Jarauta, E., Civeira, F., Laclaustra, M., Casasnovas, J. A., & Guallar, E. (n.d.).

Publication year

2018

Journal title

Atherosclerosis

Volume

274

Page(s)

35-40

10.1016/j.atherosclerosis.2018.05.003

Abstract

Abstract

Background and aims: Few studies have evaluated the association of sleep duration with subclinical atherosclerosis, and with heterogeneous findings. We evaluated the association of sleep duration with the presence of coronary, carotid, and femoral subclinical atherosclerosis in healthy middle-age men with low prevalence of clinical comorbidities. Methods: We performed a cross-sectional analysis of 1968 men, 40–60 years of age, participating in the Aragon Workers' Health Study (AWHS). Duration of sleep during a typical work week was assessed by questionnaire. Coronary artery calcium scores (CACS) was assessed by computed tomography and the presence of carotid plaque and femoral plaque by ultrasound. Results: In fully adjusted models, the odds ratios (95% CI) for CACS >0 comparing sleep durations of ≤5, 6, and ≥8 h with 7 h were 1.34 (0.98–1.85), 1.35 (1.08–1.69) and 1.21 (0.90–1.62), respectively (p = 0.04). A similar U-shaped association was observed for CACS ≥100 and for CACS. The corresponding odds ratios for the presence of at least one carotid plaque were ≤5, 6, and ≥8 h with 7 h were 1.23 (0.88–1.72), 1.09 (0.86–1.38), and 0.86 (0.63–1.17), respectively (p = 0.31), and for the presence of at least one femoral plaque were 1.25 (0.87–1.80), 1.19 (0.93–1.51) and 1.17 (0.86–1.61), respectively (p = 0.39). Conclusions: Middle-aged men reporting 7 h of sleep duration had the lowest prevalence of subclinical coronary atherosclerosis as assessed by CACs. Our results support that men with very short or very long sleep durations are at increased risk of atherosclerosis.

Subclinical Hypothyroidism and Incident Depression in Young and Middle-Age Adults

Kim, J. S., Zhang, Y., Chang, Y., Ryu, S., Guallar, E., Shin, Y. C., Shin, H., Lim, S. W., & Cho, J. (n.d.).

Publication year

2018

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

103

Issue

5

Page(s)

1827-1833

10.1210/jc.2017-01247

Abstract

Abstract

Background: The role of subclinical hypothyroidism in the development of depression remains controversial. We examined the prospective association between subclinical hypothyroidism and incident depressive symptoms. Methods: We conducted a prospective cohort study of 220,545 middle-age adults without depression who had undergone at least two comprehensive health examinations between 1 January 2011 and 31 December 2014. Thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured using an electrochemiluminescent immunoassay. The study outcome was incident depressive symptoms, defined as a Center for Epidemiologic Studies- Depression score .16. Results: During a median follow-up period of 2 years, incident depressive symptoms occurred in 7323 participants. The multivariable-adjusted hazard ratio for incident depressive symptoms comparing subclinical hypothyroid and euthyroid participants was 0.97 (95% confidence interval, 0.87 to 1.09). Similarly, among euthyroid participants (n = 87,822), no apparent association was found between thyroid hormone levels and an increased risk of incident depressive symptoms. Conclusions: No apparent association was found between subclinical hypothyroidism and incident depressive symptoms in a large prospective cohort of middle-age men and women.

Synergistic opportunities in the interplay between cancer screening and cardiovascular disease risk assessment : Together we are stronger

Handy, C. E., Quispe, R., Pinto, X., Blaha, M. J., Blumenthal, R. S., Michos, E. D., Lima, J. A., Guallar, E., Ryu, S., Cho, J., Kaye, J. A., Comin-Colet, J., Corbella, X., & Cainzos-Achirica, M. (n.d.).

Publication year

2018

Journal title

Circulation

Volume

138

Issue

7

Page(s)

727-734

10.1161/CIRCULATIONAHA.118.035516

Abstract

Abstract

Cardiovascular disease (CVD) and cancer continue to be the 2 leading causes of death in developed countries despite significant improvements in the prevention, screening, and treatment of both diseases. They remain significant public health problems, growing in importance globally. Despite this threat, the fields of cardiology and oncology have been relatively disconnected. With many shared modifiable risk factors, cancer and CVD often coexist in the same individuals; those diagnosed with lung cancer, breast cancer, and colon cancer are at higher risk of CVD, and those with CVD are at higher risk of developing many types of common cancers. Screening paradigms have been established in parallel, but there are opportunities for combined risk assessments for cancer and CVD risk. Joining forces for combined cardiovascular and hemato-oncological preventive and research efforts will likely have synergistic, worldwide public health benefits.

Systematic review for the 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines

American College of Cardiology, A., American College of Cardiology/American Heart Association, A., Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. R., Polonsky, T., Thompson-Paul, A. M., Vupputuri, S., Levine, G. N., O'Gara, P. T., Halperin, J. L., Past, I., Al-Khatib, S. M., Beckman, J. A., Birtcher, K. K., … Hundley, J. (n.d.).

Publication year

2018

Journal title

Hypertension

Volume

71

Issue

6

Page(s)

E116-E135

10.1161/HYP.0000000000000067

Abstract

Abstract

Objective-To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods-Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results-Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. P., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (n.d.).

Publication year

2018

Journal title

Circulation

Volume

138

Issue

17

Page(s)

e595-e616

10.1161/CIR.0000000000000601

Abstract

Abstract

Objective To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults : A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Reboussin, D. M., Allen, N. B., Griswold, M. E., Guallar, E., Hong, Y., Lackland, D. T., Miller, E. (., Polonsky, T., Thompson-Paul, A. M., & Vupputuri, S. (n.d.).

Publication year

2018

Journal title

Journal of the American College of Cardiology

Volume

71

Issue

19

Page(s)

2176-2198

10.1016/j.jacc.2017.11.004

Abstract

Abstract

Objective: To review the literature systematically and perform meta-analyses to address these questions: 1) Is there evidence that self-measured blood pressure (BP) without other augmentation is superior to office-based measurement of BP for achieving better BP control or for preventing adverse clinical outcomes that are related to elevated BP? 2) What is the optimal target for BP lowering during antihypertensive therapy in adults? 3) In adults with hypertension, how do various antihypertensive drug classes differ in their benefits and harms compared with each other as first-line therapy? Methods: Electronic literature searches were performed by Doctor Evidence, a global medical evidence software and services company, across PubMed and EMBASE from 1966 to 2015 using key words and relevant subject headings for randomized controlled trials that met eligibility criteria defined for each question. We performed analyses using traditional frequentist statistical and Bayesian approaches, including random-effects Bayesian network meta-analyses. Results: Our results suggest that: 1) There is a modest but significant improvement in systolic BP in randomized controlled trials of self-measured BP versus usual care at 6 but not 12 months, and for selected patients and their providers self-measured BP may be a helpful adjunct to routine office care. 2) systolic BP lowering to a target of

Usefulness of Lipoprotein-Associated Phospholipase A 2 Activity and C-Reactive Protein in Identifying High-Risk Smokers for Atherosclerotic Cardiovascular Disease (from the Atherosclerosis Risk in Communities Study)

Tibuakuu, M., Kianoush, S., DeFilippis, A. P., McEvoy, J. W., Zhao, D., Guallar, E., Ballantyne, C. M., Hoogeveen, R. C., Blaha, M. J., & Michos, E. D. (n.d.).

Publication year

2018

Journal title

American Journal of Cardiology

Volume

121

Issue

9

Page(s)

1056-1064

10.1016/j.amjcard.2018.01.020

Abstract

Abstract

Despite the causal role of cigarette smoking in atherosclerotic cardiovascular disease (ASCVD), the underlying mechanisms are not fully understood. We evaluated the joint relation between smoking and inflammatory markers with ASCVD risk. We tested cross-sectional associations of self-reported smoking status (never, former, current) and intensity (packs/day) with lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) activity and high-sensitivity C-reactive protein (hsCRP) in 10,506 Atherosclerosis Risk in Communities participants at Visit 4 (1996 to 1998). Using Cox hazard models adjusted for demographic and traditional ASCVD risk factors, we examined the associations of smoking status and intensity with incident adjudicated ASCVD events (n = 1,745 cases) over an average of 17 years, stratified by Lp-PLA 2 and hsCRP categories. Greater packs/day smoked was linearly associated with higher levels of both Lp-PLA 2 and hsCRP among current smokers. Compared with never smokers, the hazard ratio for incident ASCVD in current smokers was 2.04 (95% CI 1.76 to 2.35). Among current smokers, the risk for ASCVD per 1 pack/day greater was 1.39 (1.10 to 1.76). Both Lp-PLA 2 activity ≥253 nmol/min/ml and hsCRP >3 mg/L identified current smokers at the highest risk for incident ASCVD, with similar hazard ratios. hsCRP risk-stratified current smokers better based on intensity. Among current smokers, hsCRP improved ASCVD prediction beyond traditional risk factors better than Lp-PLA 2 (C-statistic 0.675 for hsCRP vs 0.668 for Lp-PLA2, p = 0.001). In this large cohort with long follow-up, we found a dose-response relation between smoking intensity with Lp-PLA 2 activity, hsCRP, and ASCVD events. Although both Lp-PLA 2 activity and hsCRP categories identified high risk among current smokers, hsCRP may better stratify risk of future ASCVD.

Vitamin D deficiency is associated with inferior survival of patients with extranodal natural killer/T-cell lymphoma

Kim, S. J., Shu, C., Ryu, K. J., Kang, D., Cho, J., Ko, Y. H., Lee, S. Y., Guallar, E., Zhao, W., & Kim, W. S. (n.d.).

Publication year

2018

Journal title

Cancer Science

Volume

109

Issue

12

Page(s)

3971-3980

10.1111/cas.13844

Abstract

Abstract

Vitamin D deficiency is a common health issue; however, the effect of vitamin D deficiency on the survival of T-cell lymphoma is still not clear. We evaluated the impact of serum vitamin D level of patients with peripheral T-cell lymphoma (PTCL) and extranodal natural killer/T-cell lymphoma (ENKTL) on survival outcome. Pretreatment levels of 25-hydroxyvitamin D [25(OH)D] and inflammatory cytokines were measured in serum samples that were archived at diagnosis, and we evaluated their association with survival in newly diagnosed patients with PTCL (n = 137) and ENKTL (n = 114) at a university-based hospital in Korea. An independent cohort from Rui Jin Hospital (Shanghai, China) was used for validation. The median 25(OH)D serum level was 12.0 ng/mL (1.3-60.0 ng/mL), and 40% had less than 10 ng/mL, which was defined as vitamin D deficiency. Median serum 25(OH)D levels were similar between PTCL (11.5 ng/mL) and ENKTL (12.9 ng/mL); however, vitamin D deficiency was associated with inferior survival in ENKTL but not with PTCL. The independent validation cohort (n = 115) also showed a significant association of vitamin D deficiency with poor survival in ENKTL. The 25(OH)D level had an inverse relation with inflammatory cytokines; this association had a negative effect only on survival of ENKTL, and not on PTCL. In conclusion, vitamin D deficiency was associated with inferior survival outcome of patients with ENKTL.

A gene-environment interaction analysis of plasma selenium with prevalent and incident diabetes : The Hortega study

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

Publication year

2017

Journal title

Redox Biology

Volume

12

Page(s)

798-805

10.1016/j.redox.2017.04.022

Abstract

Abstract

Background Selenium and single-nucleotide-polymorphisms in selenoprotein genes have been associated to diabetes. However, the interaction of selenium with genetic variation in diabetes and oxidative stress-related genes has not been evaluated as a potential determinant of diabetes risk. Methods We evaluated the cross-sectional and prospective associations of plasma selenium concentrations with type 2 diabetes, and the interaction of selenium concentrations with genetic variation in candidate polymorphisms, in a representative sample of 1452 men and women aged 18–85 years from Spain. Results The geometric mean of plasma selenium levels in the study sample was 84.2 µg/L. 120 participants had diabetes at baseline. Among diabetes-free participants who were not lost during the follow-up (N=1234), 75 developed diabetes over time. The multivariable adjusted odds ratios (95% confidence interval) for diabetes prevalence comparing the second and third to the first tertiles of plasma selenium levels were 1.80 (1.03, 3.14) and 1.97 (1.14, 3.41), respectively. The corresponding hazard ratios (95% CI) for diabetes incidence were 1.76 (0.96, 3.22) and 1.80 (0.98, 3.31), respectively. In addition, we observed significant interactions between selenium and polymorphisms in PPARGC1A, and in genes encoding mitochondrial proteins, such as BCS1L and SDHA, and suggestive interactions of selenium with other genes related to selenoproteins and redox metabolism. Conclusions Plasma selenium was positively associated with prevalent and incident diabetes. While the statistical interactions of selenium with polymorphisms involved in regulation of redox and insulin signaling pathways provide biological plausibility to the positive associations of selenium with diabetes, further research is needed to elucidate the causal pathways underlying these associations.

Aflatoxin and viral hepatitis exposures in Guatemala : Molecular biomarkers reveal a unique profile of risk factors in a region of high liver cancer incidence

Smith, J. W., Kroker-Lobos, M. F., Lazo, M., Rivera-Andrade, A., Egner, P. A., Wedemeyer, H., Torres, O., Freedman, N. D., McGlynn, K. A., Guallar, E., Groopman, J. D., & Ramirez-Zea, M. (n.d.).

Publication year

2017

Journal title

PloS one

Volume

12

Issue

12

10.1371/journal.pone.0189255

Abstract

Abstract

Liver cancer is an emerging global health issue, with rising incidence in both the United States and the economically developing world. Although Guatemala experiences the highest rates of this disease in the Western hemisphere and a unique 1:1 distribution in men and women, few studies have focused on this population. Thus, we determined the prevalence and correlates of aflatoxin B1 (AFB1) exposure and hepatitis virus infection in Guatemalan adults. Healthy men and women aged 40 years (n = 461), residing in five departments of Guatemala, were enrolled in a cross-sectional study from May—October of 2016. Serum AFB1-albumin adducts were quantified using isotope dilution mass spectrometry. Multivariate linear regression was used to assess relationships between AFB1-albumin adduct levels and demographic factors. Biomarkers of hepatitis B virus and hepatitis C virus infection were assessed by immunoassay and analyzed by Fisher’s exact test. AFB1-albumin adducts were detected in 100% of participants, with a median of 8.4 pg/mg albumin (range, 0.2–814.8). Exposure was significantly higher (p

Airflow limitation severity and post-operative pulmonary complications following extra-pulmonary surgery in COPD patients

Shin, B., Lee, H., Kang, D., Jeong, B. H., Kang, H. K., Chon, H. R., Koh, W. J., Chung, M. P., Guallar, E., Cho, J., & Park, H. Y. (n.d.).

Publication year

2017

Journal title

Respirology

Volume

22

Issue

5

Page(s)

935-941

10.1111/resp.12988

Abstract

Abstract

Background and objective: The association between airflow limitation severity and post-operative pulmonary complications (PPCs) among COPD patients undergoing extra-pulmonary surgery is unknown. We evaluated the association between forced expiratory volume in 1 s (FEV1) and PPC in COPD patients undergoing extra-pulmonary surgery. Methods: Using prospective cohort of PPC evaluation for extra-pulmonary surgery, we identified 694 COPD patients who conducted PPC evaluation before extra-pulmonary surgery between March 2014 and January 2015 at a tertiary hospital, Seoul, Korea. Results: The overall incidence of PPC was 24.4%. The incidence of PPC in quintiles 1–5 of FEV1 (% predicted) was 31.4, 25.8, 23.7, 21.6 and 19.7%, respectively (P for trend: 0.019). In fully adjusted multivariable models, the relative risks (RRs, 95% CI) for PPC comparing participants in quintiles 1–4 of FEV1 (% predicted) with those in quintile 5 were 1.69 (1.03–2.79), 1.41 (0.83–2.37), 1.26 (0.75–2.11) and 1.30 (0.76–2.22), respectively (P for trend: 0.046). The association of severe airflow limitation with respiratory failure and post-operative exacerbations was stronger in participants who did not use bronchodilators compared with those who did. Conclusion: We found a progressive and significant relationship between severity of airflow limitation and the incidence of PPC in COPD patients undergoing extra-pulmonary surgery. Furthermore, perioperative bronchodilator use was associated with a reduced risk of respiratory failure and post-operative exacerbations in patients with severe airflow limitation.