Narrative ReviewHuman serum albumin in cardiovascular diseases
Section snippets
Physiological properties of serum albumin
10 to 15 g of albumin is synthesized in the liver each day and released into the vascular space [9]. Its half-life averages 17 days. Exchanges between the intravascular and interstitial compartments are constant, with 40% of the total albumin pool remaining in the intravascular space. Albumin synthesis is stimulated by insulin, amino acids intake and low colloid osmotic pressure. Factors that decrease synthesis include high colloid osmotic pressure, malnutrition, inflammation, diabetes, liver
Prevalence and causes of hypoalbuminemia in cardiovascular diseases
There is no epidemiological data on the prevalence of hypoalbuminemia in patients with cardiovascular disease. However, its prevalence is reported as significant in many observational studies and varies from one to another. Prevalence of hypoalbuminemia ranges from 13% in stable coronary disease to 20–30% in acute coronary syndromes and myocardial infarction [[16], [17], [18], [19]], from 20 to 25% in chronic heart failure to 90% in frail elderly patients with acute heart failure [9], and from
Value of serum albumin as an independent predictor of incident cardiovascular diseases
While the relative contribution of hypoalbuminemia to atherosclerosis has long been debated, recent evidence indicates that occurrence of ischemic heart disease, heart failure, atrial fibrillation, stroke, and venous thromboembolism is inversely related to serum albumin levels, even after adjusting for risk factors, body mass index and inflammation (Table 1).
In the ARIC study, 14,506 individuals were followed. Low serum albumin concentration was significantly linked to the emergence of ischemic
Independent prognostic value of serum albumin in cardiovascular diseases
Hypoalbuminemia is a powerful prognosticator in patients with coronary artery disease, independent of its phenotype [36]. In a prospective study that followed 734 patients with stable coronary artery disease for 18 months, hypoalbuminemia independently predicted overall (p = 0.048) and cardiovascular (p = 0.037) mortality, even after adjusting for ejection fraction, body mass index, liver function and inflammation [16]. These results are consistent with those obtained in 2860 patients referred
Potential contribution of hypoalbuminemia to the development and progression of cardiovascular diseases
The prognostic relevance of serum albumin in cardiovascular disorders primarily refers to malnutrition and inflammation [8,9]. Nevertheless, its prognostic value independent of body mass index, inflammation, traditional risk factors and usual prognostic markers, raises question about its role in the emergence and progression of some cardiovascular diseases. The potential role of low serum albumin levels in coronary artery disease, heart failure, atrial fibrillation, stroke and venous
Clinical implications
Serum albumin concentration is a simple and inexpensive routine laboratory test, which provides relevant prognostic information in patients with some cardiovascular diseases. Targeted therapeutic measures will then be implemented in presence of low serum albumin levels. Optimal management of malnutrition has recently been reported favorable in patients with congestive heart failure under optimal conventional therapy [71,72]. In a multicenter, randomized, controlled clinical trial that included
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