Risk burdens of modifiable risk factors incorporating lipoprotein (a) and low serum albumin concentrations for first incident acute myocardial infarction

Fibrinogen/albumin ratio is associated with first-ever cardiovascular events in patients with peritoneal dialysis

OBJECTIVE

The fibrinogen/albumin ratio (FAR) is a novel inflammatory indicator, which has been associated with cardiovascular disease. However, the relationship between FAR and cardiovascular event (CVE) in patients with peritoneal dialysis (PD) remains unclear. This study aims to clarify the relationship between FAR and first-ever CVE in patients with PD.

METHODS

A total of 278 patients were enrolled between January 2012 and June 2021. They were defined as the high FAR group and the low FAR group based on the median FAR value (0.107). The primary outcome was the occurrence of first-ever CVE. Kaplan-Meier's curves and Cox regression analysis were used to analyse the relationship between FAR and first-ever CVE in patients with PD. Forest plots were employed to depict the relationship between FAR and first-ever CVE in each subgroup.

RESULTS

The average follow-up period was 40.26 ± 28.27 months. A total of 101 (36.3%) patients developed first-ever CVE. Kaplan-Meier's analysis showed that there was a higher risk of first-ever CVE (p = .002) in the high FAR group. Multivariate Cox regression analysis showed that FAR ≥ 0.107 and age were independently associated with the risk of first-ever CVE in patients with PD. Receiver operating characteristic (ROC) analysis showed that FAR had a greater predicting value on the first-ever CVE.

CONCLUSIONS

High levels of FAR are independently associated with an increased risk of first-ever CVE in patients with PD.

An inflammatory prognostic scoring system to predict the risk for adults with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

This study aimed to investigate the value of the inflammatory prognostic score (IPS) system for predicting the risk of all-cause major adverse cardiovascular events (MACEs) and cardiac-related MACEs in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

METHODS

Overall, 1384 patients with ACS who underwent PCI between January 2016 and December 2018 were consecutively enrolled. Demographic characteristics and related laboratory results for 11 inflammatory markers were collected. Least absolute shrinkage and selection operator (LASSO)-COX regression, Kaplan- Meier, restricted cubic spline (RCS), receiver operator characteristic curve (ROC), time-dependent ROC, and Cox hazard proportional regression were applied to explore the values of individual and IPS parameters.

RESULTS

Based on the LASSO analysis, albumin (ALB) and monocyte-to-lymphocyte ratio (MLR) were included in the construction of the IPS system. A higher IPS was associated with a significantly worse long-term prognosis in the Kaplan-Meier analysis (log-rank p < 0.001). The Cox proportional hazards model demonstrated that the IPS was an independent risk factor for patients with ACS undergoing PCI. In addition, the IPS remained an independent prognosticator compared to the lowest tertiles. The time-dependent ROC showed satisfactory values for the long-term prognosis of different MACEs. Additionally, RCS showed a linear association with IPS, all-cause MACEs, and cardiac-related MACEs.

CONCLUSIONS

A higher IPS level was associated with an increased risk in patients with ACS undergoing PCI, suggesting that the IPS may be a useful method for risk stratification in the assessment of the long-term prognosis of ACS.

Longitudinal assessment of serum albumin levels with the risk of coronary artery calcification progression in an asymptomatic population of Korean adults: an observational cohort study

OBJECTIVES

This study evaluated the association between serum albumin levels and coronary artery calcification (CAC) progression in asymptomatic adults without hypoalbuminaemia at baseline.

DESIGN

Observational cohort study.

SETTING

Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) which is a retrospective, single ethnicity, multicentre and observational registry were analysed.

PARTICIPANTS

A total of 12 344 Korean adults with baseline albumin level of ≥3.5 g/dL (51.7±8.5 years; 84.3% male) were included. The median interscan period was 3.0 (2.0-4.8) years. All participants were stratified into three groups based on serum albumin tertile.

PRIMARY AND SECONDARY OUTCOME MEASURES

Association of serum albumin with the risk of CAC progression was analysed using multivariate logistic regression models with adjustment of interscan period. CAC progression was defined as a square root (√) transformed difference between the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS) of ≥2.5. Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by interscan period.

RESULTS

With increasing serum albumin tertiles, the annualised Δ√transformed CACS (I (lowest): 0.16 (0-1.24) vs II: 0 (0-1.09) vs III (highest): 0 (0-1.01)) and the incidence of CAC progression (I: 36.6% vs II: 31.3% vs III: 25.0%) were decreased despite higher prevalence of hypertension, diabetes and hyperlipidaemia (all p<0.05). Serum albumin levels were inversely related to the annualised Δ√transformed CACS and the risk of CAC progression among overall participants. After adjusting for age, sex, hypertension, diabetes, hyperlipidaemia, obesity, current smoking, alcohol consumption, serum creatinine levels, baseline CACS and interscan period, this inverse association between serum albumin levels (per-1 g/dL increase) and the risk of CAC progression was consistently observed, especially in baseline CACS of 1-10 (OR: 0.392, 95% CI: 0.234 to 0.658) and 11-100 (OR: 0.580, 95% CI: 0.381 to 0.883) (all p<0.05).

CONCLUSIONS

Serum albumin levels were inversely associated with the risk of CAC progression. This phenomenon was predominantly observed in CACS of 1-100 at baseline.

Serum albumin and cardiovascular disease: a Mendelian randomization study

BACKGROUND

An increasing body of evidence suggests that serum albumin levels play a role in cardiovascular diseases. However, the specific causal relationship between serum albumin levels and cardiovascular disease remains partially unknown.

METHODS

Mendelian randomization (MR) was employed in this study to examine potential causal relationships between instrumental variables and cardiovascular diseases. Specifically, we utilized genetic variants of serum albumin levels within the reference range as our instrumental variables. To acquire data on genetic associations with cardiovascular diseases, we sourced information from renowned genome-wide association studies such as UK BioBank, EMBL-EBI, and FinnGen. Notably, our study leveraged summary statistics from large cohorts that have been previously described.

RESULTS

We explored the association between serum albumin levels and various conditions, including heart failure (HF), venous thromboembolism (VTE), stroke, atrial fibrillation (AF), coronary artery disease (CAD), type 2 diabetes (T2DM), and pulmonary heart disease (PHD). Genetically predicted serum albumin levels were associated with PHD (odds ratio = 0.737, 95% CI = 0.622 - 0.874, P < 0.001), AF (odds ratio = 0.922, 95% CI = 0.870 - 0.977, P = 0.006), VTE (odds ratio = 0.993, 95% CI = 0.991 - 0.995, P < 0.001), and Stroke (odds ratio = 0.997, 95% CI = 0.995 - 0.999, P = 0.002). However, genetically predicted serum albumin level traits were not associated with HF, CAD and T2DM.

CONCLUSION

Our study demonstrates a significant association between serum albumin levels and cardiovascular disease, underscoring the crucial role of low serum albumin as a predictive factor in patients with cardiovascular disease.

A Complex Interplay between Nutrition and Alcohol use Disorder: Implications for Breaking the Vicious Cycle

Approximately 16.5% of the United States population met the diagnostic criteria for substance use disorder (SUD) in 2021, including 29.5 million individuals with alcohol use disorder (AUD). Individuals with AUD are at increased risk for malnutrition, and impairments in nutritional status in chronic alcohol users can be detrimental to physical and emotional well-being. Furthermore, these nutritional deficiencies could contribute to the never-ending cycle of alcoholism and related pathologies, thereby jeopardizing the prospects of recovery and treatment outcomes. Improving nutritional status in AUD patients may not only compensate for general malnutrition but could also reduce adverse symptoms during recovery, thereby promoting abstinence and successful treatment of AUD. In this review, we briefly summarize alterations in the nutritional status of people with addictive disorders, in addition to the underlying neurobiological mechanisms and clinical implications regarding the role of nutritional intervention in recovery from alcohol use disorder.

Association between Malnutrition and Coronary Plaque Characteristics in Patients with Acute Coronary Syndrome: An Optical Coherence Tomography Study

Background

Malnutrition has a negative impact on patients with arteriosclerotic cardiovascular disease (ASCVD); however, only a few studies have confirmed the effect of malnutrition on atherosclerosis. We aimed to investigate the association between malnutrition and vulnerable plaques via optical coherence tomography (OCT).

Methods

Overall, 142 acute coronary syndrome (ACS) patients were included in this study. Malnutrition was assessed using the Controlled Nutritional Status Score (CONUT), and plaque vulnerability was measured using OCT. Finally, patients were divided into four groups according to their CONUT scores and body mass index (BMI) ≥ 25.0 or not, to further compare the effects of both factors on plaque characteristics in patients.

Results

OCT results showed that there were significant differences in plaque rupture, thin cap fibroatheroma (TCFA), minimal fiber cap thickness (FCT), thrombus, and macrophage infiltration between different nutritional states [Absent (0-1) vs Mild (2-4) vs Moderate (5-8), plaque rupture: 34.8% vs 52.5% vs 66.7%, p = 0.038; TCFA: 10.1% vs 24.6% vs 33.3%, p = 0.039; minimal FCT: 125.0 vs 110.4 vs 96.9, p = 0.022; thrombus: 50.7% vs 70.5% vs 83.3%, p = 0.019]. Multivariate logistic regression showed that malnutrition was a significant predictor of plaque vulnerability. Plaque rupture: CONUT score (odds ratio [OR]: 1.448, 95% confidence interval [CI]: 1.136-1.845, p = 0.003), Mild (OR: 1.981, 95% CI: 0.932-4.210, p = 0.075), and Moderate (OR: 4.375, 95% CI: 1.048-18.255, p = 0.043); TCFA: CONUT score (OR: 1.334, 95% CI: 1.029-1.730, p = 0.030), Mild (OR: 3.518, 95% CI: 1.251-9.897, p = 0.017), and Moderate (OR: 4.863, 95% CI: 1.019-23.208, p = 0.047); and macrophage: CONUT score (OR: 1.343, 95% CI: 1.060-1.700, p = 0.015), Mild (OR: 3.016, 95% CI: 1.305-6.974, p = 0.010), and Moderate (OR: 4.637, 95% CI: 1.159-18.552, p = 0.030). Combined CONUT score and BMI showed an independent association with macrophages in the malnourished and overweight group (OR: 4.010, 95% CI: 1.188-13.537, p = 0.025).

Conclusions

Malnutrition is a predictor of vulnerable plaques and is associated with inflammatory progression.

Analysis of risk characteristics for metachronous metastasis in different period of nasopharyngeal carcinoma

OBJECTIVE

To identify the main risk factors for metachronous metastatic nasopharyngeal carcinoma (NPC) in different periods after radiotherapy and estimate the weight of various factors in the early or late metachronous metastasis (EMM/LMM) groups.

METHODS

This retrospective registry consists of 4434 patients with newly diagnosed NPC. Cox regression analysis was used to assess the independent significance of various risk factors. The Interactive Risk Attributable Program (IRAP) was used to calculate the attributable risks (ARs) for metastatic patients during different periods.

RESULTS

Among 514 metastatic patients, 346 (67.32%) patients diagnosed with metastasis within 2 years after treatment were classified into the EMM group, while other 168 patients were classified into the LMM group. The ARs of T-stage, N-stage, pre-Epstein-Barr virus (EBV) DNA, post-EBV DNA, age, sex, pre-neutrophil-to-lymphocyte ratio, pre-platelet-to-lymphocyte ratio, pre-hemoglobin (HB), and post-HB were 20.19, 67.25, 2.81, 14.28, 18.50, - 11.17%, 14.54, 9.60, 3.74% and - 9.79%, respectively, in the EMM group. In the LMM group, the corresponding ARs were 3.68, 49.11, - 18.04%, 2.19, 6.11, 0.36, 4.62, 19.77, 9.57 and 7.76%, respectively. After multivariable adjustment, the total AR for tumor-related factors was 78.19%, and that for patient-related factors was 26.07% in the EMM group. In the LMM group, the total AR of tumor-related factors was 43.85%, while the weights of patient-related factors was 39.97%. In addition, except for these identified tumor- and patient-related factors, other unevaluated factors played a more important role in patients with late metastasis, with the weight increasing by 15.77%, from 17.76% in the EMM group to 33.53% in the LMM group.

CONCLUSION

Most metachronous metastatic NPC cases occurred in the first 2 years after treatment. Early metastasis was mainly affected by tumor-related factors, which accounted for a declining percentage in the LMM group.

The negative association between serum albumin levels and coronary heart disease risk in adults over 45 years old: a cross-sectional survey

This study aimed to assess the correlation between serum albumin levels and coronary heart disease (CHD) risk in adults aged over 45 years. This cross-sectional study used the non-institutionalized US population from the National Health and Nutrition Examination Survey (NHANES 2011-2018) as the sample source. Multiple logistic regression was performed to evaluate the association between serum albumin levels and CHD risk. Smooth curve fitting was performed to explore potential nonlinear relationships. When nonlinear relationships were found, a recursive algorithm was used to calculate inflection points. Additionally, a piecewise logistic regression model was constructed. After adjusting for confounders, multiple logistic regression and smooth curve fitting indicated an inverse association between serum albumin levels and CHD risk [OR = 0.970, 95% CI = (0.948, 0.992)]. Subgroup analysis revealed that the negative correlation was statistically significant in the population of female patients, over 60 years, with hypertension, without diabetes. There was a correlation between serum albumin levels and CHD risk. Lower serum albumin levels were associated with a higher CHD risk.

Development and validation of a nomogram to predict mortality risk in patients with ischemic heart disease

Background

Ischemic Heart Disease (IHD) is the leading cause of death from cardiovascular disease. Currently, most studies have focused on factors influencing IDH or mortality risk, while few predictive models have been used for mortality risk in IHD patients. In this study, we constructed an effective nomogram prediction model to predict the risk of death in IHD patients by machine learning.

Methods

We conducted a retrospective study of 1,663 patients with IHD. The data were divided into training and validation sets in a 3:1 ratio. The least absolute shrinkage and selection operator (LASSO) regression method was used to screen the variables to test the accuracy of the risk prediction model. Data from the training and validation sets were used to calculate receiver operating characteristic (ROC) curves, C-index, calibration plots, and dynamic component analysis (DCA), respectively.

Results

Using LASSO regression, we selected six representative features, age, uric acid, serum total bilirubin, albumin, alkaline phosphatase, and left ventricular ejection fraction, from 31 variables to predict the risk of death at 1, 3, and 5 years in patients with IHD, and constructed the nomogram model. In the reliability of the validated model, the C-index at 1, 3, and 5 years was 0.705 (0.658-0.751), 0.705 (0.671-0.739), and 0.694 (0.656-0.733) for the training set, respectively; the C-index at 1, 3, and 5 years based on the validation set was 0.720 (0.654-0.786), 0.708 (0.650-0.765), and 0.683 (0.613-0.754), respectively. Both the calibration plot and the DCA curve are well-behaved.

Conclusion

Age, uric acid, total serum bilirubin, serum albumin, alkaline phosphatase, and left ventricular ejection fraction were significantly associated with the risk of death in patients with IHD. We constructed a simple nomogram model to predict the risk of death at 1, 3, and 5 years for patients with IHD. Clinicians can use this simple model to assess the prognosis of patients at the time of admission to make better clinical decisions in tertiary prevention of the disease.

The Predictive Value of Different Nutritional Indices Combined with the GRACE Score in Predicting the Risk of Long-Term Death in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Nutritional status is associated with prognosis in acute coronary syndrome (ACS) patients. Although the Global Registry of Acute Coronary Events (GRACE) risk score is regarded as a relevant risk predictor for the prognosis of ACS patients, nutritional variables are not included in the GRACE score. This study aimed to compare the prognostic ability of the Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) in predicting long-term all-cause death in ACS patients undergoing percutaneous coronary intervention (PCI) and to determine whether the GNRI or PNI could improve the predictive value of the GRACE score. A total of 799 patients with ACS who underwent PCI from May 2018 to December 2019 were included and regularly followed up. The performance of the PNI in predicting all-cause death was better than that of the GNRI [C-index, 0.677 vs. 0.638, p = 0.038]. The addition of the PNI significantly improved the predictive value of the GRACE score for all-cause death [increase in C-index from 0.722 to 0.740; IDI 0.006; NRI 0.095; p < 0.05]. The PNI was superior to the GNRI in predicting long-term all-cause death in ACS patients undergoing PCI. The addition of the PNI to the GRACE score could significantly improve the prediction of long-term all-cause death.

Neutrophil Percentage to Albumin Ratio was Associated with Clinical Outcomes in Coronary Care Unit Patients

Background

Neutrophil percentage to albumin ratio (NPAR) has been shown to be correlated with the prognosis of various diseases. This study aimed to explore the effect of NPAR on the prognosis of patients in coronary care units (CCU).

Method

All data in this study were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III, version1.4) database. All patients were divided into four groups according to their NPAR quartiles. The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality, 365-day mortality, length of CCU stay, length of hospital stay, acute kidney injury (AKI), and continuous renal replacement therapy (CRRT). A multivariate binary logistic regression analysis was performed to confirm the independent effects of NPAR. Cox regression analysis was performed to analyze the association between NPAR and 365-day mortality. The curve in line with overall trend was drawn by local weighted regression (Lowess). Subgroup analysis was used to determine the effect of NPAR on in-hospital mortality in different subgroups. Receiver operating characteristic (ROC) curves were used to evaluate the ability of NPAR to predict in-hospital mortality. Kaplan-Meier curves were constructed to compare the cumulative survival rates among different groups.

Result

A total of 2364 patients in CCU were enrolled in this study. The in-hospital mortality rate increased significantly as the NPAR quartiles increased (p < 0.001). In multivariate logistic regression analysis, NPAR was independently associated with in-hospital mortality (quartile 4 versus quartile 1: odds ratio [OR], 95% confidence interval [CI]: 1.83, 1.20-2.79, p = 0.005, p for trend < 0.001). In Cox regression analysis, NPAR was independently associated with 365-day mortality (quartile 4 versus quartile 1: OR, 95% CI: 1.62, 1.16-2.28, p = 0.005, p for trend < 0.001). The Lowess curves showed a positive relationship between NPAR and in-hospital mortality. The moderate ability of NPAR to predict in-hospital mortality was demonstrated through ROC curves. The area under the curves (AUC) of NPAR was 0.653 (p < 0.001), which is better than that of the platelet to lymphocyte ratio (PLR) (p < 0.001) and neutrophil count (p < 0.001) but lower than the Sequential Organ Failure Assessment (p = 0.046) and Simplified Acute Physiology Score II (p < 0.001). Subgroup analysis did not reveal any obvious interactions in most subgroups. However, Kaplan-Meier curves showed that as NPAR quartiles increased, the 30-day (log-rank, p < 0.001) and 365-day (log-rank, p < 0.001) cumulative survival rates decreased significantly. NPAR was also independently associated with AKI (quartile 4 versus quartile 1: OR, 95% CI: 1.57, 1.19-2.07, p = 0.002, p for trend = 0.001). The CCU and hospital stay length was significantly prolonged in the higher NPAR quartiles.

Conclusions

NPAR is an independent risk factor for in-hospital mortality in patients in CCU and has a moderate ability to predict in-hospital mortality.

Uric Acid-to-Albumin Ratio: A Novel Marker for the Extent of Coronary Artery Disease in Patients with Non-ST-Elevated Myocardial Infarction

OBJECTIVE

This research aimed to investigate the predictive value of the uric acid-to-serum albumin ratio (UAR) in establishing the severity and extent of coronary artery disease (CAD) with non-ST segment elevation myocardial infarction (NSTEMI) patients.

METHODS

A total of 402 patients (mean age 63.5 ± 11.6 years) were included in this retrospectively designed study. We compared Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery Scores (SS) between low (≤22) and intermediate-high (>22) groups. The UAR, the neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein-to-albumin ratio (CAR) were evaluated and compared.

RESULTS

SS >22 were observed in 30.8% (n = 124) of the patients, and their UAR, NLR, and CAR were significantly higher. Three separate multivariate analysis models performed as the outcome of a reliable correlation between UAR, NLR, CAR, and consequently UAR (OR = 2.08; 95% CI 1.21-3.58; p = 0.008) and CAR (OR = 3.33; 95% CI 1.85-5.9; p < 0.001) reached significance but NLR (OR = 1.26; 95% CI 0.86-1.84; p = 0.20) clinically trended significance (not statistically). Model performance comparisons demonstrated that UAR is a better predictor regarding likelihood ratios (UAR, 60.95; NLR, 57.8; and CAR, 59.0).

CONCLUSION

As a novel inflammatory marker, UAR independently predicted better outcomes than CAR and might be used reliably in prediction of the extent of CAD in NSTEMI patients.

Serum albumin and cardiovascular disease: State-of-the-art review

Cardiovascular disease is the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory conditions and oxidative stress are at the forefront of the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin has many physiological properties, including in particular antioxidant, anti-inflammatory, anticoagulant and anti-platelet aggregation activity. It also plays an essential role in the exchange of fluids across the capillary membrane. Hypoalbuminemia is a powerful prognostic marker in the general population as well as in many disease states. In the more specific context of cardiovascular disease, low serum albumin is independently associated with the development of various deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation, stroke and venous thromboembolism. Low serum albumin has also emerged as a potent prognostic parameter in patients with cardiovascular disease regardless of usual prognostic markers. Remarkably, its potent prognostic value persists after adjusting for causative confounders such as malnutrition and inflammation. This prognostic value probably refers primarily to the syndrome of malnutrition-inflammation and the severity of comorbidities. Nevertheless, several recent meta-analyses strongly support the hypothesis that hypoalbuminemia may act as an unrecognized, potentially modifiable risk factor contributing to the emergence and progression of cardiovascular disease, primarily by exacerbating oxidative stress, inflammation and platelet aggregation, and by favouring peripheral congestion and pulmonary edema. Currently, it is unknown whether prevention and correction of low serum albumin offers a benefit to patients with or at risk for cardiovascular disease, and further studies are critically needed in this setting.

Association between Neutrophil Percentage-to-Albumin Ratio and All-Cause Mortality in Critically Ill Patients with Coronary Artery Disease

Background

Neutrophil percentage-to-albumin ratio (NPAR) has been proved to be associated with clinical outcome of many diseases. This study was aimed at exploring the independent effect of NPAR on all-cause mortality of critically ill patients with coronary artery disease (CAD).

Method

NPAR was calculated as neutrophil percentage numerator divided by serum albumin concentration. Clinical endpoints were 30-day, 90-day, and 365-day all-cause mortality. Multivariable Cox proportional hazard models were performed to confirm the association between NPAR and all-cause mortality.

Result

3106 patients with CAD were enrolled. All-cause mortality rates of 30 days (P < 0.001), 90 days (P < 0.001), and 365 days (P < 0.001) increased as NPAR tertiles increased. And after adjusting for possible confounding variables, NPAR was still independently associated with 30-day (third tertile group versus first tertile group: HR, 95% CI: 1.924, 1.471-2.516; P for trend < 0.001), 90-day (third tertile group versus first tertile group: HR, 95% CI: 2.053, 1.646-2.560; P for trend < 0.001), and 365-day (third tertile group versus first tertile group: HR, 95% CI: 2.063, 1.717-2.480; P for trend < 0.001) all-cause mortality in patients with CAD. Subgroup analysis did not find obvious interaction in most subgroups.

Conclusion

NPAR was independently correlated with 30-day, 60-day, and 365-day all-cause mortality in critically ill patients with CAD.

Interaction between lipoprotein (a) levels and body mass index in first incident acute myocardial infarction

BACKGROUND

Possible interaction between Lipoprotein (a) (Lp(a)) and body mass index (BMI) was investigated with regard to the risk of first incident acute myocardial infarction (AMI).

METHODS

Cross-sectional study of 1522 cases with initial AMI and 1691 controls without coronary artery disease (CAD) were retrospectively analyzed using logistic regression model. Subjects were categorized based on Lp(a) and BMI and compared with regard to occurrence of AMI by calculating odds ratios (ORs) with 95% confidence intervals (CIs). A potential interaction between Lp(a) and BMI was evaluated by the measures of effect modification on both additive (Relative excess risk due to interaction, RERI) and multiplicative scales.

RESULTS

Compared with reference group (BMI < 24 kg/m² and in the first quintile of Lp(a)), multivariable-adjusted analysis revealed that ORs(95%CI) of AMI were 2.27(1.46-3.52) for higher BMI alone; 1.79(1.11-2.90), 1.65(1.05-2.60), 1.96(1.20-3.20) and 2.34(1.47-3.71) for higher Lp(a) alone across its quintiles; and 2.86(1.85-4.40), 3.30(2.14-5.11), 4.43(2.76-7.09) and 5.98(3.72-9.60) for both higher BMI and higher Lp(a), greater than the sum of the both risks each. Prominent interaction was found between Lp(a) and BMI on additive scale (RERI = 2.45 (0.36-4.54) at the fifth quintile of Lp(a)) but not on multiplicative scale.

CONCLUSIONS

This study demonstrates that BMI and Lp(a) levels are important factors affecting the risk of AMI. Significant interaction is found between Lp(a) and BMI in initial AMI on additive scale, indicating that Lp(a) confers greater risk for initial AMI when BMI is elevated. For those whose BMIs are inadequately controlled, Lp(a) lowering may be an option.

TRIAL REGISTRATION

This clinical study was not registered in a publicly available registry because this study was a retrospective study first started in 2015. Data are available via the correspondent.

Low Serum Albumin Levels are Associated with Increased 30-Day Cardiopulmonary Complications, Reoperation, and Readmission Rates Following Total Shoulder Arthroplasty

BACKGROUND

Hypoalbuminemia has been associated with several medical complications following surgery in a variety of orthopedic procedures. Hypoalbuminemia has previously been shown to have an increased risk for transfusions, hospital stay longer than three days, and mortality following total shoulder arthroplasty (TSA). This study seeks to further assess the relationship between low serum albumin and morbidity to allow surgeons to both preoperatively optimize patients and assess the risk of surgery prior to TSA.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program® database was queried to identify 14,494 TSA patients, 6,129 (42.23%) who met inclusion criteria. Patients who had shoulder hemiarthroplasty, revision TSA, or incomplete serum albumin data were excluded. Demographic factors, preoperative comorbidities, and acute complication rates were assessed between hypoalbuminemic (n=485; 7.91%) and a propensity-matched control cohort (n=485), controlling for differences in patient demographics and comorbidities. Multivariate propensity-adjusted logistic regression analyses were used to assess hypoalbuminemia as an independent risk factor for specific postoperative complications.

RESULTS

Hypoalbuminemic patients undergoing TSA demonstrated significantly higher rates of pulmonary complications (p=0.006), unplanned intubation (p=0.014), DVT/PE (p=0.014), cardiac complications (p=0.033), infectious complications (p=0.025), blood transfusions (p<0.001), reoperation (p=0.007), extended length of stay (> 4 days) (p=0.036), unplanned readmission (p=0.001), and mortality (p=0.025) in the 30-day postoperative period when compared to the propensity-matched control cohort. On multivariate regression analyses, hypoalbuminemia independently increased the risk for pulmonary complications (OR 9.678, p=0.031), blood transfusions (OR 2.539, p<0.001), reoperation (OR 5.461, p=0.032), and readmission (OR 2.607, p=0.007).

CONCLUSIONS

Hypoalbuminemic patients undergoing TSA had increased rates of overall cardiac and pulmonary complications, unplanned intubations, DVT/PE's, overall infectious complications, increased incidence of blood transfusions, reoperation, extended LOS (> 4 days), readmission, and death. Multivariate analyses demonstrated that low albumin was independently associated with increased risk for pulmonary complications, blood transfusions, reoperation, and readmission. Preoperative albumin levels in patients undergoing TSA may help with preoperative risk stratification and optimization.Level of evidence: III.

Analysis of Plasma Albumin, Vitamin D, and Apolipoproteins A and B as Predictive Coronary Risk Biomarkers in the REGICOR Study

INTRODUCTION AND OBJECTIVES

New biomarkers could improve the predictive capacity of classic risk functions. The aims of this study were to determine the association between circulating levels of apolipoprotein A1 (apoA1), apolipoprotein B (apoB), albumin, and 25-OH-vitamin D and coronary events and to analyze whether these biomarkers improve the predictive capacity of the Framingham-REGICOR risk function.

METHODS

A case-cohort study was designed. From an initial cohort of 5404 individuals aged 35 to 74 years with a 5-year follow-up, all the participants who had a coronary event (n = 117) and a random group of the cohort (subcohort; n = 667) were selected. Finally, 105 cases and 651 individuals representative of the cohort with an available biological sample were included. The events of interest were angina, fatal and nonfatal myocardial infarction and coronary deaths.

RESULTS

Case participants were older, had a higher proportion of men and cardiovascular risk factors, and showed higher levels of apoB and lower levels of apoA1, apoA1/apoB ratio, 25-OH-vitamin D and albumin than the subcohort. In multivariate analyses, plasma albumin concentration was the only biomarker independently associated with coronary events (HR, 0.73; P = .002). The inclusion of albumin in the risk function properly reclassified a significant proportion of individuals, especially in the intermediate risk group (net reclassification improvement, 32.3; P = .048).

CONCLUSIONS

Plasma albumin levels are inversely associated with coronary risk and improve the predictive capacity of classic risk functions.

[Serum albumin and cardiovascular diseases: A comprehensive review of the literature]

Cardiovascular diseases are the leading cause of death worldwide. Conceptually, endothelial dysfunction, inflammatory status and oxidative stress are at the forefront in the onset and development of most cardiovascular diseases, particularly coronary artery disease and heart failure. Serum albumin, the most abundant plasma protein, has many physiological properties, including anti-inflammatory, antioxidant and antiplatelet aggregation activity. It also plays an essential role in the fluid exchange across the capillary membrane. Definite evidence is that hypo-albuminemia is a powerful prognostic marker in the general population as well as in many pathological settings. In the more specific context of cardiovascular diseases, serum albumin is independently associated with the development of a variety of deleterious conditions such as coronary artery disease, heart failure, atrial fibrillation and stroke. Serum albumin has also emerged as a powerful prognostic parameter in patients with coronary artery disease, heart failure, congenital heart disease, infective endocarditis, cardiovascular surgery and stroke, regardless of usual prognostic markers. This prognostic value probably refers mainly to the malnutrition-inflammation syndrome and the severity of comorbidities. Nevertheless, hypo-albuminemia may act as an unknown and modifiable risk factor that contributes to the emergence and the pejorative evolution of cardiovascular diseases, mainly by exacerbation of inflammation, oxidative stress and platelet aggregation, and by pulmonary and myocardial edema. This article provides an overview of the physiological properties of serum albumin, the prevalence, causes, prognostic value and potential contribution to the emergence and aggravation of cardiovascular disease of hypoalbuminemia, as well as its clinical implications.