Lu Ting-Wei, Chien Shih-Chieh, Leu Hsin-Bang, Yin Wei-Hsian, Tseng Wei-Kung, Wu Yen-Wen, Lin Tsung-Hsien, Chang Kuan-Cheng, Wang Ji-Hung, Wu Chau-Chung, Yeh Hung-I, Chen Jaw-Wen
Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC.
Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2024 Dec 1;87(12):1054-1059. doi: 10.1097/JCMA.0000000000001158. Epub 2024 Aug 23.
Diabetes and insulin resistance alter the physiological state of serum albumin (SA), which is a prognostic marker for stable coronary artery disease (CAD). However, whether the SA concentration is associated with long-term cardiovascular (CV) outcomes in diabetic patients with stable CAD remains unclear.
In total, 1148 patients were retrospectively identified from a nationwide multicenter cohort study on patients with stable CAD. They were categorized into four groups according to their diabetes mellitus (DM) status and SA concentration (cutoff: 4 g/dL).
The patients' mean age was 62.5 years, and 83.5% were male. Of the total patients, 405 were included in group 1 (SA ≥4/non-DM), 322 in group 2 (SA <4/non-DM), 201 in group 3 (SA ≥4/DM), and 220 in group 4 (SA <4/DM). Group 4 had the oldest age and a higher prevalence of prior myocardial infarction and stroke. During the median 4.5-year follow-up (interquartile range: 1.5-6.7 years), the highest and lowest survival rates in terms of all-cause and CV mortality were found in groups 1 and 4, respectively. However, no prognostic differences were noted in nonfatal stroke and myocardial infarction among the groups. The data were consistent after covariate adjustment. Using group 1 as the reference, hazard ratio (HRs) (95% CIs) for all-cause mortality in groups 2, 3, and 4 were 3.64 (1.22-10.83), 3.26 (0.95-11.33), and 5.74 (1.92-16.95), respectively, and those for CV mortality were 2.8 (0.57-13.67), 2.62 (0.40-17.28), and 6.15 (1.32-28.58), respectively.
In diabetic patients with stable CAD, a low SA concentration (<4 g/dL) was associated with increased long-term mortality regardless of all-cause or CV reasons but not nonfatal CV events.
糖尿病和胰岛素抵抗会改变血清白蛋白（SA）的生理状态，血清白蛋白是稳定型冠状动脉疾病（CAD）的一个预后标志物。然而，在患有稳定型CAD的糖尿病患者中，SA浓度是否与长期心血管（CV）结局相关仍不清楚。
从一项针对稳定型CAD患者的全国多中心队列研究中，回顾性纳入了1148例患者。根据他们的糖尿病（DM）状态和SA浓度（临界值：4 g/dL）将他们分为四组。
患者的平均年龄为62.5岁，83.5%为男性。在所有患者中，405例被纳入第1组（SA≥4/非糖尿病），322例被纳入第2组（SA<4/非糖尿病），201例被纳入第3组（SA≥4/糖尿病），220例被纳入第4组（SA<4/糖尿病）。第4组年龄最大，既往心肌梗死和中风的患病率较高。在中位4.5年的随访期间（四分位间距：1.5 - 6.7年），全因死亡率和CV死亡率方面，生存率最高和最低的分别是第1组和第4组。然而，各组间非致命性中风和心肌梗死的预后差异未被发现。协变量调整后数据一致。以第1组为参照，第2、3和4组全因死亡率的风险比（HRs）（95%可信区间）分别为3.64（1.22 - 10.83）、3.26（0.95 - 11.33）和5.74（1.92 - 16.95），CV死亡率的风险比分别为2.8（0.57 - 13.67）、2.6（0.40 - 17.28）和6.15（1.32 - 28.58）。
在患有稳定型CAD的糖尿病患者中，低SA浓度（<4 g/dL）与全因或CV原因导致的长期死亡率增加相关，但与非致命性CV事件无关。
