Tong Jiayi, Wang Tao, Wei Qin, Hao Qing, Yu Fuchao, Xu Xuan, Zhen Penghao
Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, 210009 Nanjing, Jiangsu, China.
Department of Cardiology, The First Affiliated Hospital of Soochow University, 215006 Suzhou, Jiangsu, China.
Rev Cardiovasc Med. 2025 Aug 29;26(8):38034. doi: 10.31083/RCM38034. eCollection 2025 Aug.
Despite advances in treatment and the potential role of serum albumin as a prognostic biomarker, the mortality rate of individuals with coronary heart disease (CHD) continues to increase. Thus, this study aimed to assess the relationship between serum albumin levels and the risk of all-cause mortality and cardiovascular death in individuals with CHD.
This large-scale retrospective cohort study included 1556 participants diagnosed with CHD from the National Health and Nutrition Examination Survey spanning 1999 to 2015. We conducted multivariate Cox regression, subgroup and sensitivity analyses, and restricted cubic spline (RCS) plots to examine the link between serum albumin levels and all-cause mortality and cardiovascular death.
After gradually adjusting the confounding variables, serum albumin consistently demonstrated a strong link to increased overall and cardiovascular-related mortality risk when employed as a continuous variable (hazard ratio [HR]: 0.938, 95% confidence interval [CI]: 0.912-0.964; < 0.001; HR: 0.921, 95% CI: 0.884-0.960; < 0.001; respectively); meanwhile, serum albumin as a three-category variable, with Tertile 1 (T1, ≤40 g/L), Tertile 2 (T2, 40-43 g/L), and Tertile 3 (T3, >43 g/L), was only closely related to the risk of all-cause death (T2 vs. T1, HR: 0.771, 95% CI: 0.633-0.939; = 0.010; T3 vs. T1, HR: 0.761, 95% CI: 0.612-0.947; = 0.014; respectively). Subgroup analysis showed that serum albumin was linked to all-cause mortality across most groups (≤60 or >60 years, male or female, and without hypertension, diabetes, or chronic kidney disease); however, its correlation with cardiovascular death was observed only in the subgroup without hypertension ( < 0.05). The sensitivity analysis indicated that excluding participants with an estimated glomerular filtration rate <30 mL/min/1.73 m did not alter the association between serum albumin and the risk of all-cause and cardiovascular mortality. Moreover, the RCS analysis further supported a consistent negative linear trend between serum albumin levels and mortality risks ( for nonlinearity >0.05).
The serum albumin levels in individuals with CHD were inversely and linearly related to all-cause mortality and cardiovascular death risk.
尽管在治疗方面取得了进展，且血清白蛋白具有作为预后生物标志物的潜在作用，但冠心病（CHD）患者的死亡率仍在持续上升。因此，本研究旨在评估血清白蛋白水平与CHD患者全因死亡风险和心血管死亡风险之间的关系。
这项大规模回顾性队列研究纳入了1999年至2015年国家健康与营养检查调查中诊断为CHD的1556名参与者。我们进行了多变量Cox回归、亚组和敏感性分析，以及限制性立方样条（RCS）图分析，以检验血清白蛋白水平与全因死亡和心血管死亡之间的联系。
在逐步调整混杂变量后，当将血清白蛋白作为连续变量时，其始终显示出与总体和心血管相关死亡风险增加存在密切联系（风险比[HR]：0.938，95%置信区间[CI]：0.912 - 0.964；P < 0.001；HR：0.921，95% CI：0.884 - 0.960；P < 0.001；）；同时，血清白蛋白作为一个三类变量，即第一三分位数（T1，≤40 g/L）、第二三分位数（T2，40 - 43 g/L）和第三三分位数（T3，>43 g/L），仅与全因死亡风险密切相关（T2与T1相比，HR：0.771，95% CI：0.633 - 0.939；P = 0.010；T3与T1相比，HR：0.761，95% CI：0.612 - 0.947；P = 0.014；）。亚组分析表明，血清白蛋白与大多数组（≤60岁或>60岁、男性或女性、无高血压、糖尿病或慢性肾脏病）的全因死亡相关；然而，仅在无高血压的亚组中观察到其与心血管死亡的相关性（P < 0.05）。敏感性分析表明，排除估计肾小球滤过率<30 mL/min/1.73 m²的参与者并未改变血清白蛋白与全因和心血管死亡风险之间的关联。此外，RCS分析进一步支持了血清白蛋白水平与死亡风险之间存在一致的负线性趋势（非线性检验P>0.05）。
CHD患者的血清白蛋白水平与全因死亡风险和心血管死亡风险呈负向线性相关。
