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

Erratum : Stop wasting money on vitamin and mineral supplements (Annals of Internal Medicine (2013) 159 (850-851))

Guallar, E., Guallar, E., Stranges, S., Mulrow, C., Appel, L. J., & Miller, E. R. (n.d.).

Publication year

2014

Journal title

Annals of internal medicine

Volume

160

Issue

2

Page(s)

143

10.7326/L14-5001-8

Abstract

Abstract

~

Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes : A collaborative meta-analysis of individual participant data

for the CKD Prognosis Consortium, A., Matsushita, K., Coresh, J., Sang, Y., Chalmers, J., Fox, C., Guallar, E., Jafar, T., Jassal, S. K., Landman, G. W., Muntner, P., Roderick, P., Sairenchi, T., Schöttker, B., Shankar, A., Shlipak, M., Tonelli, M., Townend, J., van Zuilen, A., … Landray, M. J. (n.d.).

Publication year

2015

Journal title

The Lancet Diabetes and Endocrinology

Volume

3

Issue

7

Page(s)

514-525

10.1016/S2213-8587(15)00040-6

Abstract

Abstract

Background: The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-analytic approach. Methods: We meta-analysed individual-level data for 637 315 individuals without a history of cardiovascular disease from 24 cohorts (median follow-up 4·2-19·0 years) included in the Chronic Kidney Disease Prognosis Consortium. We assessed C statistic difference and reclassification improvement for cardiovascular mortality and fatal and non-fatal cases of coronary heart disease, stroke, and heart failure in a 5 year timeframe, contrasting prediction models for traditional risk factors with and without creatinine-based eGFR, albuminuria (either albumin-to-creatinine ratio [ACR] or semi-quantitative dipstick proteinuria), or both. Findings: The addition of eGFR and ACR significantly improved the discrimination of cardiovascular outcomes beyond traditional risk factors in general populations, but the improvement was greater with ACR than with eGFR, and more evident for cardiovascular mortality (C statistic difference 0·0139 [95% CI 0·0105-0·0174] for ACR and 0·0065 [0·0042-0·0088] for eGFR) and heart failure (0·0196 [0·0108-0·0284] and 0·0109 [0·0059-0·0159]) than for coronary disease (0·0048 [0·0029-0·0067] and 0·0036 [0·0019-0·0054]) and stroke (0·0105 [0·0058-0·0151] and 0·0036 [0·0004-0·0069]). Dipstick proteinuria showed smaller improvement than ACR. The discrimination improvement with eGFR or ACR was especially evident in individuals with diabetes or hypertension, but remained significant with ACR for cardiovascular mortality and heart failure in those without either of these disorders. In individuals with chronic kidney disease, the combination of eGFR and ACR for risk discrimination outperformed most single traditional predictors; the C statistic for cardiovascular mortality fell by 0·0227 (0·0158-0·0296) after omission of eGFR and ACR compared with less than 0·007 for any single modifiable traditional predictor. Interpretation: Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease. Our results lend some support to also incorporating eGFR and ACR into assessments of cardiovascular risk in the general population.

Estimating the Effects of Health Policy Initiatives : Where We Are and Where We Need to Go

Russell Localio, A., & Guallar, E. (n.d.).

Publication year

2024

Journal title

Annals of internal medicine

Volume

177

Issue

11

Page(s)

1586-1587

10.7326/M24-0896

Abstract

Abstract

~

Estimation of Inorganic Arsenic Exposure in Populations with Frequent Seafood Intake : Evidence from MESA and NHANES

Jones, M. R., Tellez-Plaza, M., Vaidya, D., Grau, M., Francesconi, K. A., Goessler, W., Guallar, E., Post, W. S., Kaufman, J. D., & Navas-Acien, A. (n.d.).

Publication year

2016

Journal title

American Journal of Epidemiology

Volume

184

Issue

8

Page(s)

590-602

10.1093/aje/kww097

Abstract

Abstract

The sum of urinary inorganic arsenic (iAs) and methylated arsenic (monomethylarsonate and dimethylarsinate (DMA)) species is the main biomarker of iAs exposure. Assessing iAs exposure, however, is difficult in populations with moderate-to-high seafood intakes. In the present study, we used subsamples from the Multi-Ethnic Study of Atherosclerosis (2000-2002) (n = 310) and the 2003-2006 National Health and Nutrition Examination Survey (n = 1,175). We calibrated urinary concentrations of non-seafood-derived iAs, DMA, and methylarsonate, as well as the sum of inorganic and methylated arsenic species, in the Multi-Ethnic Study of Atherosclerosis and of DMA in the National Health and Nutrition Examination Survey by regressing their original concentrations by arsenobetaine and extracting model residuals. To confirm that calibrated biomarkers reflected iAs exposure but not seafood intake, we compared urinary arsenic concentrations by levels of seafood and rice intakes. Self-reported seafood intakes, estimated n-3 polyunsaturated fatty acid levels, and measured n-3 polyunsaturated fatty acid levels were positively associated with the original urinary arsenic biomarkers. Using the calibrated arsenic biomarkers, we found a marked attenuation of the associations with self-reported seafood intake and estimated or measured n-3 fatty acids, whereas associations with self-reported rice intake remained similar. Our residual-based method provides estimates of iAs exposure and metabolism for each participant that no longer reflect seafood intake and can facilitate research about low-to-moderate levels of iAs exposure in populations with high seafood intakes.

Ethnic Differences in the Prevalence of Metabolic Syndrome : Results from a Multi-Ethnic Population-Based Survey in Malaysia

Rampal, S., Mahadeva, S., Guallar, E., Bulgiba, A., Mohamed, R., Rahmat, R., Arif, M. T., & Rampal, L. (n.d.).

Publication year

2012

Journal title

PloS one

Volume

7

Issue

9

10.1371/journal.pone.0046365

Abstract

Abstract

Introduction: The prevalence of metabolic syndrome is increasing disproportionately among the different ethnicities in Asia compared to the rest of the world. This study aims to determine the differences in the prevalence of metabolic syndrome across ethnicities in Malaysia, a multi-ethnic country. Methods: In 2004, we conducted a national cross-sectional population-based study using a stratified two-stage cluster sampling design (N = 17,211). Metabolic syndrome was defined according to the International Diabetes Federation/National Heart, Lung and Blood Institute/American Heart Association (IDF/NHLBI/AHA-2009) criteria. Multivariate models were used to study the independent association between ethnicity and the prevalence of the metabolic syndrome. Results: The overall mean age was 36.9 years, and 50.0% participants were female. The ethnic distribution was 57.0% Malay, 28.5% Chinese, 8.9% Indian and 5.0% Indigenous Sarawakians. The overall prevalence of the metabolic syndrome was 27.5%, with a prevalence of central obesity, raised triglycerides, low high density lipoprotein cholesterol, raised blood pressure and raised fasting glucose of 36.9%, 29.3%, 37.2%, 38.0% and 29.1%, respectively. Among those

Ethnic, geographic and dietary differences in arsenic exposure in the multi-ethnic study of atherosclerosis (MESA)

Jones, M. R., Tellez-Plaza, M., Vaidya, D., Grau-Perez, M., Post, W. S., Kaufman, J. D., Guallar, E., Francesconi, K. A., Goessler, W., Nachman, K. E., Sanchez, T. R., & Navas-Acien, A. (n.d.).

Publication year

2019

Journal title

Journal of Exposure Science and Environmental Epidemiology

Volume

29

Issue

3

Page(s)

310-322

10.1038/s41370-018-0042-0

Abstract

Abstract

Differences in residential location as well as race/ethnicity and dietary habits may result in differences in inorganic arsenic (iAs) exposure. We investigated the association of exposure to iAs with race/ethnicity, geography, and dietary intake in a random sample of 310 White, Black, Hispanic, and Chinese adults in the Multi-Ethnic Study of Atherosclerosis from 6 US cities with inorganic and methylated arsenic (ΣAs) measured in urine. Dietary intake was assessed by food-frequency questionnaire. Chinese and Hispanic race/ethnicity was associated with 82% (95% CI: 46%, 126%) and 37% (95% CI: 10%, 70%) higher urine arsenic concentrations, respectively, compared to White participants. No differences were observed for Black participants compared to Whites. Urine arsenic concentrations were higher for participants in Los Angeles, Chicago, and New York compared to other sites. Participants that ate rice ≥2 times/week had 31% higher urine arsenic compared to those that rarely/never consumed rice. Participants that drank wine ≥2 times/week had 23% higher urine arsenic compared to rare/never wine drinkers. Intake of poultry or non-rice grains was not associated with urinary arsenic concentrations. At the low-moderate levels typical of the US population, exposure to iAs differed by race/ethnicity, geographic location, and frequency of rice and wine intake.

Evaluation of frequency-doubling technology perimetry as a means of screening for glaucoma and other eye diseases using the national health and nutrition examination survey

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

Publication year

2016

Journal title

JAMA ophthalmology

Volume

134

Issue

1

Page(s)

57-62

10.1001/jamaophthalmol.2015.4459

Abstract

Abstract

IMPORTANCE Glaucoma is a significant cause of global blindness and there are, as yet, no effective means of screening. OBJECTIVE To assess the potential role of frequency-doubling technology (FDT) perimetry in screening for glaucoma using data collected as part of the National Health and Nutrition Examination Survey (NHANES). DESIGN, SETTING, AND PARTICIPANTS Reanalysis of cross-sectional data of 6797 participants in the 2005-2008 cycles of the NHANES, which evaluated a sample of the noninstitutionalized US population with at least light-perception vision. A subset of optic nerve photographs were regraded by 3 glaucoma specialists in December 2012. Each participant underwent visual field testing, including FDT perimetry screening, and had fundus photographs taken. MAIN OUTCOMES AND MEASURES Sensitivity and specificity of FDT perimetry to detect glaucoma, macular disease, or decreased visual acuity. RESULTS A total of 5746 NHANES participants had optic images originally graded.We regraded 1201 images of 1073 eyes of 548 participants with initial cup-disc ratio (CDR) of 0.6 or greater and 423 images of 360 eyes of 180 randomly selected participants with initial CDR less than 0.6. Diagnoses of glaucoma by disc photograph were 1.6%(3 of 180) in the CDR less than 0.6 group and 31.4%(172 of 548) in the CDR of 0.6 or greater group. The sensitivity of FDT was 33%(95%CI, 0%-87%) and specificity was 77%(95%CI, 71%-84%). For the group with at least 1 CDR of 0.6 or greater, sensitivity of FDT was 66%(95%CI, 59%-73%) and specificity was 70%(95%CI, 66%-75%). When analyzed to give FDT credit for identifying glaucoma, macular disease, or decreased visual acuity, the sensitivity of the test was 80% (95%CI, 77%-83%) and the specificity was 83%(95%CI, 82%-84%). Approximately 25%of the NHANES population was not able to successfully complete FDT testing, representing screening failures and decreasing specificity. CONCLUSIONS AND RELEVANCE Using the 2005-2008 waves of the NHANES as a model of population-based screening for eye disease, FDT perimetry lacks both sensitivity and specificity as a means of screening for glaucoma, the presence of retinal disease, or decreased acuity in a population-based setting. Given that no single test of glaucoma has yet been shown to be appropriate in a screening setting, to our knowledge, investigators should consider novelmethods of detecting glaucoma or combinations of tests that might work better in a screening setting.

Evaluation of mitochondrial DNA copy number estimation techniques

Longchamps, R. J., Castellani, C. A., Yang, S. Y., Newcomb, C. E., Sumpter, J. A., Lane, J., Grove, M. L., Guallar, E., Pankratz, N., Taylor, K. D., Rotter, J. I., Boerwinkle, E., & Arking, D. E. (n.d.).

Publication year

2020

Journal title

PloS one

Volume

15

Issue

1

10.1371/journal.pone.0228166

Abstract

Abstract

Mitochondrial DNA copy number (mtDNA-CN), a measure of the number of mitochondrial genomes per cell, is a minimally invasive proxy measure for mitochondrial function and has been associated with several aging-related diseases. Although quantitative real-time PCR (qPCR) is the current gold standard method for measuring mtDNA-CN, mtDNA-CN can also be measured from genotyping microarray probe intensities and DNA sequencing read counts. To conduct a comprehensive examination on the performance of these methods, we use known mtDNA-CN correlates (age, sex, white blood cell count, Duffy locus genotype, incident cardiovascular disease) to evaluate mtDNA-CN calculated from qPCR, two microarray platforms, as well as whole genome (WGS) and whole exome sequence (WES) data across 1,085 participants from the Atherosclerosis Risk in Communities (ARIC) study and 3,489 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). We observe mtDNA-CN derived from WGS data is significantly more associated with known correlates compared to all other methods (p < 0.001). Additionally, mtDNA-CN measured from WGS is on average more significantly associated with traits by 5.6 orders of magnitude and has effect size estimates 5.8 times more extreme than the current gold standard of qPCR. We further investigated the role of DNA extraction method on mtDNA-CN estimate reproducibility and found mtDNA-CN estimated from cell lysate is significantly less variable than traditional phenol-chloroform-isoamyl alcohol (p = 5.44x10-4) and silica-based column selection (p = 2.82x10-7). In conclusion, we recommend the field moves towards more accurate methods for mtDNA-CN, as well as re-analyze trait associations as more WGS data becomes available from larger initiatives such as TOPMed.

Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe - The EURIKA Study

Guallar, E., Banegas, J. R., Blasco-Colmenares, E., Jiménez, F. J., Dallongeville, J., Halcox, J. P., Borghi, C., Massá-González, E. L., Tafalla, M., Perk, J., De Backer, G., Steg, P. G., & Rodríguez-Artalejo, F. (n.d.).

Publication year

2011

Journal title

BMC public health

Volume

11

10.1186/1471-2458-11-704

Abstract

Abstract

Background: Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe. Methods. Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account. Results: The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27). Conclusions: Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

Exposure to ambient air pollution and calcification of the mitral annulus and aortic valve : The multi-ethnic study of atherosclerosis (MESA)

Tibuakuu, M., Jones, M. R., Navas-Acien, A., Zhao, D., Guallar, E., Gassett, A. J., Sheppard, L., Budoff, M. J., Kaufman, J. D., & Michos, E. D. (n.d.).

Publication year

2017

Journal title

Environmental Health: A Global Access Science Source

Volume

16

Issue

1

10.1186/s12940-017-0346-x

Abstract

Abstract

Background: Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression. Methods: We studied 6253 MESA participants aged 45-84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter

Factors associated with change in 25-hydroxyvitamin d levels over longitudinal follow-up in the aric study

McKibben, R. A., Zhao, D., Lutsey, P. L., Schneider, A. L., Guallar, E., Mosley, T. H., & Michos, E. D. (n.d.).

Publication year

2016

Journal title

Journal of Clinical Endocrinology and Metabolism

Volume

101

Issue

1

Page(s)

33-43

10.1210/jc.2015-1711

Abstract

Abstract

Context: A single measurement of 25-hydroxyVitamin D (25 [OH] D) may not accurately reflect long-term Vitamin D status. Little is known about change in 25(OH)D levels over time, particularly among blacks. Objective: The objective of the study was to determine the longitudinal changes in 25(OH)D levels among Atherosclerosis Risk in Communities (ARIC) study participants. Design: This was a longitudinal study. Setting: The study was conducted in the general community. Participants: A total of 9890 white and 3222 black participants at visit 2 (1990â€"1992), 888 whites and 876 blacks at visit 3 (1993â€"1994), and 472 blacks at the brain visit (2004â€"2006) participated in the study. Main Outcome Measure: The 25(OH)D levels were measured, and regression models were used to assess the associations between clinical factors and longitudinal changes in 25(OH)D. Results: VitaminDdeficiency (

Fasting glucose level and the risk of incident atherosclerotic cardiovascular diseases

Park, C., Guallar, E., Linton, J. A., Lee, D. C., Jang, Y., Son, D. K., Han, E. J., Baek, S. J., Yun, Y. D., Jee, S. H., & Samet, J. M. (n.d.).

Publication year

2013

Journal title

Diabetes Care

Volume

36

Issue

7

Page(s)

1988-1993

10.2337/dc12-1577

Abstract

Abstract

Objective-Although diabetes increases the risk of cardiovascular disease (CVD) and mortality, the dose-response relationship between fasting glucose levels below those diagnostic of diabetes with cardiovascular events has not been well characterized. Research design and methods-A prospective cohort study of more than one million Koreans was conducted with a mean follow-up of 16 years. A total of 1,197,384 Korean adults with no specific medical conditions diagnosed were classified by baseline fasting serum glucose level. Associations of fasting glucose level with CVD incidence and mortality, stroke incidence and mortality, and all-cause mortality were analyzed using multivariate proportional hazards regression. ResultsThe relationships between fasting glucose levels and CVD risks generally followed J-shape curves, with lowest risk in the glucose range of 85-99 mg/dL. As fasting glucose levels increased to .100 mg/dL, risks for CVD, ischemic heart disease, myocardial infarction, and thrombotic stroke progressively increased, but risk for hemorrhagic stroke did not. Fasting glucose levels ,70 mg/dL were associated with increased risk of all stroke (hazard ratio 1.06, 95% CI 1.01-1.11) in men and (hazard ratio 1.11, 1.05-1.17) in women. Conclusions-Both low glucose level and impaired fasting glucose should be considered as predictors of risk for stroke and coronary heart disease. The fasting glucose level associated with the lowest cardiovascular risk may be in a narrow range.

Fasting versus nonfasting and low- density lipoprotein cholesterol accuracy

Sathiyakumar, V., Park, J., Golozar, A., Lazo, M., Quispe, R., Guallar, E., Blumenthal, R. S., Jones, S. R., & Martin, S. S. (n.d.).

Publication year

2018

Journal title

Circulation

Volume

137

Issue

1

Page(s)

10-19

10.1161/CIRCULATIONAHA.117.030677

Abstract

Abstract

BACKGROUND: Recent recommendations favoring nonfasting lipid assessment may affect low-density lipoprotein cholesterol (LDL-C) estimation. The novel method of LDL-C estimation (LDL-C N ) uses a flexible approach to derive patientspecific ratios of triglycerides to very low-density lipoprotein cholesterol. This adaptability may confer an accuracy advantage in nonfasting patients over the fixed approach of the classic Friedewald method (LDL-C F ). METHODS: We used a US cross-sectional sample of 1 545 634 patients (959 153 fasting ≥10-12 hours; 586 481 nonfasting) from the second harvest of the Very Large Database of Lipids study to assess for the first time the impact of fasting status on novel LDL-C accuracy. Rapid ultracentrifugation was used to directly measure LDL-C content (LDL-C D ). Accuracy was defined as the percentage of LDLC D falling within an estimated LDL-C (LDL-C N or LDL-C F ) category by clinical cut points. For low estimated LDL-C (

Feeling the Heat : Cardiovascular Consequences of Heat Exposure Under Controlled Experimental Conditions

Guallar, E., Bravo, P. E., & Ferrari, V. A. (n.d.).

Publication year

2024

Journal title

Annals of internal medicine

Volume

177

Issue

7

Page(s)

976-977

10.7326/M24-0882

Abstract

Abstract

~

Femoral and carotid subclinical atherosclerosis association with risk factors and coronary calcium : The AWHS study

Laclaustra, M., Casasnovas, J. A., Fernández-Ortiz, A., Fuster, V., León-Latre, M., Jiménez-Borreguero, L. J., Pocovi, M., Hurtado-Roca, Y., Ordovas, J. M., Jarauta, E., Guallar, E., Ibañez, B., & Civeira, F. (n.d.).

Publication year

2016

Journal title

Journal of the American College of Cardiology

Volume

67

Issue

11

Page(s)

1263-1274

10.1016/j.jacc.2015.12.056

Abstract

Abstract

Background Early subclinical atherosclerosis has been mainly researched in carotid arteries. The potential value of femoral arteries for improving the predictive capacity of traditional risk factors is an understudied area. Objectives This study sought to evaluate the association of subclinical carotid and femoral plaques with risk factors and coronary artery calcium score (CACS) in middle-aged men. Methods Participants (n = 1,423) of the AWHS (Aragon Workers' Health Study), a study designed to assess cardiovascular risk and subclinical atherosclerosis in a cohort of middle-aged men (40 to 59 years of age), underwent carotid and femoral ultrasound plus noncontrast coronary computed tomography. Subclinical atherosclerosis was defined as the presence of any plaque in carotid or femoral arteries and/or CACS ≥1. Logistic regression models were used to estimate the prevalence of atherosclerosis adjusted for risk factors and age, to evaluate the association of atherosclerosis with risk factors, and to calculate areas under the receiver-operating characteristic curves for the presence of positive CACS. Results Subclinical atherosclerosis was found in 72% of participants. Plaques were most common in femoral arteries (54%), followed by coronary calcification (38%) and carotid plaques (34%). Association of atherosclerosis with risk factors was stronger in femoral arteries than carotid or coronary arteries. The area under the receiver-operating characteristic curve for prediction of positive CACS increased from 0.665 when considering only risk factors (dyslipidemia, current smoking, hypertension, diabetes, and age) to 0.719 when adding femoral and carotid plaques (p < 0.001). In this model, the femoral odds ratio (2.58) exceeded the carotid odds ratio (1.80) for prediction of positive CACS. Conclusions Subclinical atherosclerosis was highly prevalent in this middle-aged male cohort. Association with risk factors and positive CACS was stronger in femoral than carotid arteries. Screening for femoral plaques may be an appealing strategy for improving cardiovascular risk scales and predicting coronary disease.

Finding the pathway : Mediation analyses in randomized controlled trials

Localio, A. R., Meibohm, A. R., & Guallar, E. (n.d.).

Publication year

2020

Journal title

Annals of internal medicine

Volume

172

Issue

8

Page(s)

553-557

10.7326/M20-0887

Abstract

Abstract

~

Frailty and subclinical coronary atherosclerosis : The Multicenter AIDS Cohort Study (MACS)

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

Publication year

2017

Journal title

Atherosclerosis

Volume

266

Page(s)

240-247

10.1016/j.atherosclerosis.2017.08.026

Abstract

Abstract

Background and aims Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. Methods We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having ≥3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. Results Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of HIV-uninfected and HIV-infected men, respectively. After adjustment for demographics, frailty was significantly associated with prevalence of any CAC (CAC>0), any plaque (TPS>0), and mixed plaque (MPS>0) in HIV-uninfected but not in HIV-infected men (p-interactionHIV0 [Prevalence Ratio 1.27 (95%CI 1.02, 1.59)] and TPS>0 [1.19 (1.06, 1.35)]. No association was found for NCPS. Conclusions Frailty was independently associated with subclinical coronary atherosclerosis among HIV-uninfected men, but not among HIV-infected men. Further work is needed to ascertain mechanisms underlying these differences and whether interventions that improve frailty (i.e. strength training) can improve cardiovascular outcomes.

Frequency of arrhythmia symptoms and acceptability of implantable cardiac monitors in Hemodialysis patients

El Hage, N., Jaar, B. G., Cheng, A., Knight, C., Blasco-Colmenares, E., Gimenez, L., Guallar, E., & Shafi, T. (n.d.).

Publication year

2017

Journal title

BMC Nephrology

Volume

18

Issue

1

10.1186/s12882-017-0740-1

Abstract

Abstract

Background: Arrhythmia-related complications and sudden death are common in dialysis patients. However, routine cardiac monitoring has so far not been feasible. Miniaturization of implantable cardiac monitors offers a new paradigm for detection and management of arrhythmias in dialysis patients. The goal of our study was to determine the frequency of arrhythmia-related symptoms in hemodialysis patients and to assess their willingness to undergo implantation of a cardiac monitor. Methods: We conducted a survey of in-center hemodialysis patients at a hemodialysis clinic in Baltimore, Maryland. We assessed the frequency of arrhythmia-related symptoms and willingness to undergo placement of an implantable cardiac monitor (LINQ, Medtronic Inc.). Results: Forty six patients completed the survey. The mean age of the survey respondents was 59 years and 65% were male. Symptoms were common with 74% (n = 34) of participants reporting at least one arrhythmia-related symptom and many [22% (n = 10)] had all 3 symptoms. Among the patients with symptoms, 57% (n = 26) reported "heart skipping beats, flopping in chest or beating very hard," 61% (n = 28) reported "heart racing (palpitations)," and 37% (n = 17) reported feeling that they "passed out or almost passed out." The majority of the patients felt that the timing of the symptoms was unrelated to dialysis treatments. The acceptability of the monitoring device implantation was high, with 59% (n = 20) of patients with symptoms and 50% (n = 6) of patients without symptoms willing to consider it. The main reason for not considering the device was not wanting to have an implanted device. Conclusion: The prevalence of arrhythmia-related symptoms is high in hemodialysis patients and the majority would consider an implantable cardiac monitor if recommended by their physicians. Routine implantation of cardiac monitoring devices to manage arrhythmias in dialysis patients may be feasible and will provide further insights on the leading causes of morbidity and mortality in dialysis patients.

Frequency of the PNPLA3 rs738409 polymorphism and other genetic loci for liver disease in a Guatemalan adult population

Lazo, M., Xie, J., Alvarez, C. S., Parisi, D., Yang, S., Rivera-Andrade, A., Kroker-Lobos, M. F., Groopman, J. D., Guallar, E., Ramirez-Zea, M., Arking, D. E., & McGlynn, K. A. (n.d.).

Publication year

2022

Journal title

Liver International

Volume

42

Issue

6

Page(s)

1470-1474

10.1111/liv.15268

Abstract

Abstract

~

Functional status and mortality prediction in community-acquired pneumonia

Jeon, K., Yoo, H., Jeong, B. H., Park, H. Y., Koh, W. J., Suh, G. Y., & Guallar, E. (n.d.).

Publication year

2017

Journal title

Respirology

Volume

22

Issue

7

Page(s)

1400-1406

10.1111/resp.13072

Abstract

Abstract

Background and objective: Poor functional status (FS) has been suggested as a poor prognostic factor in both pneumonia and severe pneumonia in elderly patients. However, it is still unclear whether FS is associated with outcomes and improves survival prediction in community-acquired pneumonia (CAP) in the general population. Methods: Data on hospitalized patients with CAP and FS, assessed by the Eastern Cooperative Oncology Group (ECOG) scale were prospectively collected between January 2008 and December 2012. The independent association of FS with 30-day mortality in CAP patients was evaluated using multivariable logistic regression. Improvement in mortality prediction when FS was added to the CRB-65 (confusion, respiratory rate, blood pressure and age 65) score was evaluated for discrimination, reclassification and calibration. Results: The 30-day mortality of study participants (n = 1526) was 10%. Mortality significantly increased with higher ECOG score (P for trend

GlycA, a novel inflammatory marker, is associated with subclinical coronary disease

Tibuakuu, M., Fashanu, O. E., Zhao, D., Otvos, J. D., Brown, T. T., Haberlen, S. A., Guallar, E., Budoff, M. J., Palella, F. J., Martinson, J. J., Akinkuolie, A. O., Mora, S., Post, W. S., & Michos, E. D. (n.d.).

Publication year

2019

Journal title

AIDS

Volume

33

Issue

3

Page(s)

547-557

10.1097/QAD.0000000000002079

Abstract

Abstract

GlycA, a novel NMR biomarker of inflammation, has been associated with incident cardiovascular disease (CVD) in the general population, but its association with CVD among HIV-infected individuals is unknown. We examined the associations between GlycA and subclinical coronary plaque among HIV-infected and HIV-uninfected men participating in Multicenter AIDS Cohort Study (MACS).Design:Cross-sectional analysis of 935 men with plasma measurement of GlycA and noncontrast cardiac computed tomography (CT) and/or coronary CT angiography.Methods:We used multivariable Poisson and linear regression to assess associations of GlycA with prevalent coronary atherosclerosis and plaque extent, respectively.Results:Mean±SD age was 54±7 years; 31% were black; 63% HIV-infected. GlycA levels were higher in HIV-infected compared with HIV-uninfected men (397±68 vs. 380±60μmol/l, P=0.0001) and higher for men with detectable viral load vs. undetectable (413±79 vs. 393±65μmol/l, P=0.004). After adjusting for HIV serostatus, demographic and CVD risk factors, every 1SD increment in GlycA level was associated with a higher prevalence of coronary artery calcium (CAC >0) [prevalence ratio 1.09 (95% CI 1.03-1.15)] and coronary stenosis at least 50% [1.20 (1.02-1.41)]. These associations were not significantly altered after adjusting for traditional inflammatory biomarkers or differ by HIV serostatus. Among men with plaque, GlycA was positively associated with the extent of CAC and total plaque.Conclusion:HIV infection was associated with higher GlycA levels. In both HIV-infected and HIV-uninfected individuals, GlycA was significantly associated with several measures of subclinical coronary atherosclerosis, independent of other CVD risk factors and inflammatory biomarkers. These findings suggest the potential role of GlycA in CVD risk stratification among HIV patients.

Glycated hemoglobin, fasting insulin and the metabolic syndrome in males. Cross-sectional analyses of the aragon workers health study baseline

Saravia, G., Civeira, F., Hurtado-Roca, Y., Andres, E., Leon, M., Pocovi, M., Ordovas, J., Guallar, E., Fernandez-Ortiz, A., Casasnovas, J. A., & Laclaustra, M. (n.d.).

Publication year

2015

Journal title

PloS one

Volume

10

Issue

8

10.1371/journal.pone.0132244

Abstract

Abstract

Background and Aims Glycated hemoglobin (HbA1c) is currently used to diagnose diabetes mellitus, while insulin has been relegated to research. Both, however, may help understanding the metabolic syndrome and profiling patients. We examined the association of HbA1c and fasting insulin with clustering of metabolic syndrome criteria and insulin resistance as two essential characteristics of the metabolic syndrome. Methods We used baseline data from 3200 non-diabetic male participants in the Aragon Workers' Health Study.We conducted analysis to estimate age-adjusted odds ratios (ORs) across tertiles of HbA1c and insulin. Fasting glucose and Homeostatic model assessment - Insulin Resistance were used as reference. Here we report the uppermost-to-lowest tertile ORs (95%CI). Results Mean age (SD) was 48.5 (8.8) years and 23% of participants had metabolic syndrome. The ORs for metabolic syndrome criteria tended to be higher across HbA1c than across glucose, except for high blood pressure. Insulin was associated with the criteria more strongly than HbA1c and similarly to Homeostatic model assessment - Insulin Resistance (HOMAIR). For metabolic syndrome, the OR of HbA1c was 2.68, of insulin, 11.36, of glucose, 7.03, and of HOMA-IR, 14.40. For the clustering of 2 or more non-glycemic criteria, the OR of HbA1c was 2.10, of insulin, 8.94, of glucose, 1.73, and of HOMA-IR, 7.83. All ORs were statistically significant. The areas under the receiver operating characteristics curves for metabolic syndrome were 0.670 (across HbA1c values) and 0.770 (across insulin values), and, for insulin resistance, 0.647 (HbA1c) and 0.995 (insulin). Among non-metabolic syndrome patients, a small insulin elevation identified risk factor clustering. Conclusions HbA1c and specially insulin levels were associated with metabolic syndrome criteria, their clustering, and insulin resistance. Insulin could provide early information in subjects prone to develop metabolic syndrome.

Guía para la evaluación de proyectos de investigación en ciencias de la salud

Guallar, E., Conde, J., De La Cal, M. A., & Martín-Moreno, J. M. (n.d.).

Publication year

1997

Journal title

Medicina Clinica

Volume

108

Issue

12

Page(s)

460-471

Abstract

Abstract

~

Guideline-concordant antipsychotic use and mortality in schizophrenia

Cullen, B. A., Mcginty, E. E., Zhang, Y., Dosreis, S. C., Steinwachs, D. M., Guallar, E., & Daumit, G. L. (n.d.).

Publication year

2013

Journal title

Schizophrenia bulletin

Volume

39

Issue

5

Page(s)

1159-1168

10.1093/schbul/sbs097

Abstract

Abstract

Objective: To determine if care concordant with 2009 Schizophrenia Patient Outcomes Research Team (PORT) pharmacological recommendations for schizophrenia is associated with decreased mortality. Methods: We conducted a retrospective cohort study of adult Maryland Medicaid beneficiaries with schizophrenia and any antipsychotic use from 1994 to 2004 (N = 2132). We used Medicaid pharmacy data to measure annual and average antipsychotic continuity, to calculate chlorpromazine (CPZ) dosing equivalents, and to examine anti-Parkinson medication use. Cox proportional hazards regression models were used to examine the relationship between antipsychotic continuity, antipsychotic dosing, and anti-Parkinson medication use and mortality. Results: Annual antipsychotic continuity was associated with decreased mortality. Among patients with annual continuity greater than or equal to 90%, the hazard ratio [HR] for mortality was 0.75 (95% confidence interval [CI] 0.57-0.99) compared with patients with annual medication possession ratios (MPRs) of less than 10%. The HRs for mortality associated with continuous annual and average antipsychotic continuity were 0.75 (95% CI 0.58-0.98) and 0.84 (95% CI 0.58-1.21), respectively. Among users of first-generation antipsychotics, doses greater than or equal to 1500 CPZ dosing equivalents were associated with increased risk of mortality (HR 1.88, 95% CI 1.10-3.21), and use of anti-Parkinson medication was associated with decreased risk of mortality (HR 0.72, 95% CI 0.55-0.95). Mental health visits were also associated with decreased mortality (HR 0.96, 95% CI 0.93-0.98). Conclusions: Adherence to PORT pharmacological guidelines is associated with reduced mortality among patients with schizophrenia. Adoption of outcomes monitoring systems and innovative service delivery programs to improve adherence to the PORT guidelines should be considered.

Harms in Systematic Reviews Paper 2 : Methods used to assess harms are neglected in systematic reviews of gabapentin

Qureshi, R., Mayo-Wilson, E., Rittiphairoj, T., McAdams-DeMarco, M., Guallar, E., & Li, T. (n.d.).

Publication year

2022

Journal title

Journal of Clinical Epidemiology

Volume

143

Page(s)

212-223

10.1016/j.jclinepi.2021.10.024

Abstract

Abstract

Objective: We compared methods used with current recommendations for synthesizing harms in systematic reviews and meta-analyses (SRMAs) of gabapentin. Study Design & Setting: We followed recommended systematic review practices. We selected reliable SRMAs of gabapentin (i.e., met a pre-defined list of methodological criteria) that assessed at least one harm. We extracted and compared methods in four areas: pre-specification, searching, analysis, and reporting. Whereas our focus in this paper is on the methods used, Part 2 examines the results for harms across reviews. Results: We screened 4320 records and identified 157 SRMAs of gabapentin, 70 of which were reliable. Most reliable reviews (51/70; 73%) reported following a general guideline for SRMA conduct or reporting, but none reported following recommendations specifically for synthesizing harms. Across all domains assessed, review methods were designed to address questions of benefit and rarely included the additional methods that are recommended for evaluating harms. Conclusion: Approaches to assessing harms in SRMAs we examined are tokenistic and unlikely to produce valid summaries of harms to guide decisions. A paradigm shift is needed. At a minimal, reviewers should describe any limitations to their assessment of harms and provide clearer descriptions of methods for synthesizing harms.