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Low serum albumin: A neglected predictor in patients with cardiovascular disease

      Highlights

      • Albumin transports drugs and substances, maintains oncotic pressure and physiological function
      • Albumin also serves as a strong predictor of cardiovascular (CV) risk in several groups of patients
      • Hypoalbuminemia increases all-cause and CV mortality in patients with or without comorbidities
      • Compared with hypoalbuminemia, normalized albumin levels before discharge lowers mortality risk
      • When albumin is combined with other risk factors (uric acid or CRP), the prognostic value is enhanced

      Abstract

      Albumin, the most abundant circulating protein in blood, is an essential protein which binds and transports various drugs and substances, maintains the oncotic pressure of blood and influences the physiological function of the circulatory system. Albumin also has anti-inflammatory, antioxidant, and antithrombotic properties. Evidence supports albumin's role as a strong predictor of cardiovascular (CV) risk in several patient groups. Its protective role extends to those with coronary artery disease, heart failure, hypertension, atrial fibrillation, peripheral artery disease or ischemic stroke, as well as those undergoing revascularization procedures or with aortic stenosis undergoing transcatheter aortic valve replacement, and patients with congenital heart disease and/or endocarditis. Hypoalbuminemia is a strong prognosticator of increased all-cause and CV mortality according to several cohort studies and meta-analyses in hospitalized and non-hospitalized patients with or without comorbidities. Normalization of albumin levels before discharge lowers mortality risk, compared with hypoalbuminemia before discharge. Modified forms of albumin, such as ischemia modified albumin, also has prognostic value in patients with coronary or peripheral artery disease. When albumin is combined with other risk factors, such as uric acid or C-reactive protein, the prognostic value is enhanced. Although albumin supplementation may be a plausible approach, its efficacy has not been established and in patients with hypoalbuminemia, priority is focused on diagnosing and managing the underlying condition. The CV effects of hypoalbuminemia and relevant issues are considered in this review. Large cohort studies and meta-analyses are tabulated and the physiologic effects of albumin and the deleterious effects of low albumin are pictorially illustrated.

      Keywords

      Abbreviations:

      ACS (acute coronary syndrome), AF (atrial fibrillation), ARDS (acute respiratory distress syndrome), CAD (coronary artery disease), CHD (congenital heart disease), CKD (chronic kidney disease), COVID-19 (corona virus disease 2019), CRP (C-reactive protein), CV (cardiovascular), CVD (cardiovascular disease), HF (heart failure), HFpEF (heart failure with preserved ejection fraction), HFrEF (heart failure with reduced ejection fraction), ICU (intensive care unit), MACE (major adverse cardiovascular events), MI (myocardial infarction), PCI (percutaneous coronary intervention), STEMI (ST-elevation myocardial infarction), TAVI (transcatheter aortic valve implantation)
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