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The higher the serum albumin, the better? Findings from the PRACTICE study

Ying-Ying Zheng1, Ting-Ting Wu1, Xian-Geng Hou1

  • 1Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.

European Journal of Internal Medicine
|August 2, 2023
PubMed

Insights

Higher albumin levels in coronary artery disease (CAD) patients showed a U-shaped risk curve for major adverse cardiovascular events (MACE). Albumin levels around 45 g/L were associated with the lowest risk, while levels ≥50 g/L increased MACE risk.

Area of Science:

  • Cardiology
  • Clinical Biochemistry
  • Epidemiology

Background:

  • Hypoalbuminemia is a known risk factor for coronary artery disease (CAD).
  • The impact of elevated or normal-high albumin levels on CAD outcomes remains under-investigated.

Purpose of the Study:

  • To investigate the association between various serum albumin levels and adverse outcomes in patients with established CAD.
  • To determine the optimal albumin level for predicting MACE and MACCE in CAD patients.

Main Methods:

  • A prospective cohort study of 14,994 CAD patients from the PRACTICE study.
  • Patients were categorized into five groups based on serum albumin levels (<35, 35-40, 40-45, 45-50, and ≥50 g/L).
  • Outcomes including all-cause death (ACD), cardiac death (CD), major adverse cardiovascular events (MACE), and major adverse cardiac and cerebrovascular events (MACCE) were analyzed over a 60-month follow-up.

Main Results:

  • A U-shaped relationship was observed between albumin levels and MACE/MACCE, with the lowest risk at approximately 45 g/L.
  • Albumin levels ≥50 g/L were significantly associated with increased risk of MACE (adjusted HR=1.617) and MACCE (adjusted HR=1.439).
  • Only decreased albumin levels (<35 g/L) were associated with increased risk of ACD and CD.

Conclusions:

  • A U-shaped curve describes the relationship between serum albumin levels and MACE/MACCE in CAD patients.
  • An albumin level of 45 g/L appears to be associated with the lowest risk of adverse cardiovascular events.
  • Elevated albumin levels (≥50 g/L) may indicate an increased risk for MACE and MACCE in this population.
Abstract

Keywords:
AlbuminCoronary artery diseaseMain cardiovascular adverse eventsMain cardiovascular and cerebrovascular adverse eventsMortality

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