Serum albumin level as a predictor of incident coronary heart disease - The Atherosclerosis Risk in Communities (ARIC) study

Various studies have reported an inverse association between serum albumin level and incident coronary heart disease (CHD), though biologic mechanisms have not been established. The authors examined the association between se rum albumin level and CHD in the Atherosclerosis Risk in Communities cohort , comprising 14,506 White and African-American middle-aged men and women. T he mean albumin level in this population was 3.9 g/dl (standard deviation 0 .3). During 5.2 years of follow-up, 470 incident CHD events occurred. The h azard ratio for incident CHD associated with a 1-standard deviation decreas e in serum albumin level was 1.26 (95% confidence interval (Cl): 1.15, 1.38 ) after adjustment for age, gender, and ethnicity and 1.18 (95% Cl: 1.07, 1 .30) after additional adjustment for covariates related to CHD. Hazard rati os were similar across gender and ethnic groups. However, there was statist ically significant effect modification by smoking status, with hazard ratio s of 1.01 (95% Cl: 0.84, 1.22) among never smokers, 1.09 (95% Cl: 0.92, 1.3 0) among former smokers, and 1.35 (95% Cl: 1.17, 1.54) among current smoker s. Further adjustment for factors related to renal disease, nutrition, plat elet aggregation, inflammation, use of angiotensin-converting enzyme inhibi tors, and hemostasis factors attenuated the albumin-CHD relation only sligh tly. In this study, serum albumin was inversely associated with incident CH D at the baseline examination in current smokers but not in never or former smokers. Albumin level may be a marker of susceptibility to the inflammato ry response that results from smoking.