Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study

Background-Coronary disease remains the leading cause of death in the United States. The association between serum albumin and cardiovascular disease remains controversial. We used data collected prospectively from participants of the Framingham Offspring Study to assess whether a lower concentration of serum albumin was associated with an increased risk of myocardial infarction (MI) and all-cause mortality. Methods and Results-During 21.9 years of mean follow-up, 280 cases of MI occurred. From the highest to the lowest tertile of serum albumin, crude incidence rates of MI were 26.7, 46.7, and 67.8 cases per 10 000 person-years, respectively, for men and 5.9, 15.0, and 16.8 cases per 10 000 person-years, respectively, for women. In a Mantel-Haenszel method adjusting for age, total cholesterol, and hypertension, lower serum albumin was associated with an increased risk of MI in both sexes. From the highest to the lowest tertile of albumin, the adjusted hazard ratios (95% CI) of MI were 1.0 (reference), 1.25 (0.84 to 1.84), and 1.49 (1.01 to 2.21), respectively, for men and 1.0, 1.79 (0.88 to 3.65), and 2.12 (1.06 to 4.27), respectively, for women. The albumin-MI association was stronger among hypertensive subjects in both sexes. In addition, low albumin was associated with an increased rate of all-cause mortality in women. Conclusions-Lower serum albumin concentrations appear to be associated with an increased risk of coronary disease in both sexes and with all-cause mortality in women and could help along with traditional risk factors in identifying people at risk of MI.