Service de Cardiologie, Centre hospitalier Edmond Garcin, Avenue des Soeurs Gastine, 13400 Aubagne, France.
Ann Cardiol Angeiol (Paris). 2020 Oct;69(4):192-200. doi: 10.1016/j.ancard.2020.07.012. Epub 2020 Aug 11.
Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.
心血管疾病是全球范围内的主要致死原因。从概念上讲，内皮功能障碍、炎症状态和氧化应激是大多数心血管疾病（尤其是冠状动脉疾病和心力衰竭）发病和发展的前沿。血清白蛋白具有许多生理特性，特别是具有抗氧化、抗炎、抗凝和抗血小板聚集作用。它在毛细血管膜的液体交换中也起着至关重要的作用。低白蛋白血症是一般人群以及许多疾病状态中的强有力预后标志物。在心血管疾病的更具体情况下，低血清白蛋白与各种有害情况的发展独立相关，例如冠状动脉疾病、心力衰竭、心房颤动、中风和静脉血栓栓塞。无论通常的预后标志物如何，低血清白蛋白在心血管疾病患者中也已成为强有力的预后参数。值得注意的是，即使在调整了营养不良和炎症等因果混杂因素后，其强大的预后价值仍然存在。这种预后价值可能主要与营养不良-炎症综合征和合并症的严重程度有关。然而，几项最近的荟萃分析强烈支持低白蛋白血症可能是一种未被识别的、潜在可改变的风险因素的假说，它主要通过加剧氧化应激、炎症和血小板聚集，以及通过促进外周充血和肺水肿，导致心血管疾病的发生和进展。目前尚不清楚预防和纠正低血清白蛋白血症是否对心血管疾病患者或有心血管疾病风险的患者有益，在这种情况下，迫切需要进一步的研究。
