Summary
Low serum albumin is a powerful predictor of cardiovascular adverse events in healthy
subjects and patients with subclinical atherosclerosis. We investigated the association
between serum albumin, traditional cardiovascular risk factors, markers of inflammation
and cardiovascular outcome in 515 patients with advanced atherosclerosis and severe
peripheral artery disease. Cardiovascular risk profile, serum albumin, serum amyloid
A (SAA) and fibrinogen were obtained at baseline, and patients were followed for median
21 months (interquartile range 12 to 25) for the occurrence of major adverse cardiac
events (MACE: myocardial infarction, percutaneous coronary interventions, coronary
artery bypass graft, and death). We observed 135 MACE in 109 patients (21%). Cumulative
event-free survival rates at 6, 12, and 24 months were 95%, 91%, and 80%, respectively.
Low albumin predicted MACE independently of SAA and fibrinogen. Adjusted hazard ratios
for the occurrence of MACE, any death, and the composite of death and MI according
to increasing quartiles of albumin were 2.40, 1.14 and 1.09 (p<0.001), 2.94, 1.34
and 1.11 (p=0.003) and 3.63, 1.86 and 1.29 (p<0.001), respectively, as compared to
the highest quartile. Considering albumin in conjunction with traditional cardiovascular
risk factors (smoking, hyperlipidemia, hypertension and diabetes), we found that low
albumin predicted MACE only in patients with a low risk profile (less than 3 risk
factors) (p<0.001), whereas low albumin was not associated with MACE in patients with
three or more risk factors (p=0.66). We conclude that low serum albumin is associated
with cardiovascular outcome of patients with advanced atherosclerosis adding to the
prognostic information of other inflammatory markers, and may be particularly useful
for risk prediction in patients with few traditional risk factors.
Keywords
Arteriosclerosis - complications - inflammation - albumin
