Schillinger Martin, Exner Markus, Mlekusch Wolfgang, Amighi Jasmin, Sabeti Schila, Schlager Oliver, Wagner Oswald, Minar Erich
Department of Angiology, Vienna General Hospital, Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Thromb Haemost. 2004 Mar;91(3):610-8. doi: 10.1160/TH03-08-0504.
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.
低血清白蛋白是健康受试者以及患有亚临床动脉粥样硬化患者发生心血管不良事件的有力预测指标。我们调查了515例晚期动脉粥样硬化和严重外周动脉疾病患者的血清白蛋白、传统心血管危险因素、炎症标志物与心血管结局之间的关联。在基线时获取心血管风险概况、血清白蛋白、血清淀粉样蛋白A（SAA）和纤维蛋白原，并对患者进行中位21个月（四分位间距12至25个月）的随访，观察主要不良心脏事件（MACE：心肌梗死、经皮冠状动脉介入治疗、冠状动脉搭桥术和死亡）的发生情况。我们在109例患者（21%）中观察到135例MACE。6个月、12个月和24个月时的累积无事件生存率分别为95%、91%和80%。低白蛋白独立于SAA和纤维蛋白原预测MACE。根据白蛋白四分位数增加，MACE、任何死亡以及死亡和心肌梗死复合事件发生的校正风险比分别为2.40、1.14和1.09（p<0.001），2.94、1.34和1.11（p=0.003），以及3.63、1.86和1.29（p<0.001），与最高四分位数相比。将白蛋白与传统心血管危险因素（吸烟、高脂血症、高血压和糖尿病）结合考虑，我们发现低白蛋白仅在低风险概况（少于3个危险因素）的患者中预测MACE（p<0.001），而在有三个或更多危险因素的患者中，低白蛋白与MACE无关（p=0.66）。我们得出结论，低血清白蛋白与晚期动脉粥样硬化患者的心血管结局相关，增加了其他炎症标志物的预后信息，并且可能对传统危险因素较少的患者的风险预测特别有用。
