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American Journal of Epidemiology Advance Access published online on September 15, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj312
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received December 11, 2003
Accepted April 14, 2006

ORIGINAL CONTRIBUTIONS

Change of Serum Albumin and Risk of Cardiovascular Disease and All-Cause Mortality

B. W. M. Schalk 1 *, M. Visser 2, M. A. Bremmer 3, B. W. J. H. Penninx 3, L. M. Bouter 1, and D. J. H. Deeg 1

1 Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands
2 Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands; Institute of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands
3 Institute for Research in Extramural Medicine (EMGO Institute), VU University Medical Center, Amsterdam, the Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands

* To whom correspondence should be addressed.
B. W. M. Schalk, E-mail: DJH.Deeg{at}vumc.nl


  Abstract

The aim of this longitudinal study was to investigate 3-year change in serum albumin concentration as a determinant of incident cardiovascular disease (CVD) and all-cause mortality. Data were from 713 respondents of the Longitudinal Aging Study Amsterdam initially aged 55-85 years. Serum albumin was measured at baseline (1992/1993) and after 3 years. At the 6-year follow-up, incident CVD (among 456 respondents with no prevalent CVD at the 3-year follow-up) and all-cause mortality were ascertained. Overall, 18.9% developed CVD and 10.9% died. After adjustment for potential confounders, a higher level of serum albumin at the 3-year follow-up was associated with a lower risk for incident CVD (relative risk = 0.88, 95% confidence interval (CI): 0.79, 0.98). The risk of incident CVD was 0.88 (95% CI: 0.78, 0.99) per unit (g/liter) increase in change in albumin between 3-year follow-up and baseline. Chronic low serum albumin (≤43 g/liter at baseline and 3-year follow-up) was not associated with incident CVD (p = 0.22). A clinically relevant decrease in serum albumin (≥1 standard deviation (2.5 g/liter) between baseline and 3-year follow-up) tended to be associated with a twofold risk (relative risk = 2.00, 95% CI: 0.91, 4.39). For all-cause mortality, no associations were observed. These findings suggest that older persons with a decrease in serum albumin concentration, even within the normal range, might be at increased risk of incident CVD. Change in serum albumin may be used as an early marker for CVD risk.

Keywords: aging; cardiovascular diseases; longitudinal studies; mortality; serum albumin.
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