J-shaped association between serum albumin levels and long-term mortality of cardiovascular disease: Experience in National Health and Nutrition Examination Survey (2011-2014)

Association between mortality and the ratio of red blood cell distribution width to albumin concentration in pre-hypertension and hypertension: A population-based cohort study

OBJECTIVES

The ratio of red blood cell distribution width to albumin concentration (RAR) is a novel indicator of systemic inflammation and nutritional status. Its association with mortality in pre-hypertensive and hypertensive individuals remains unexplored.

METHODS

This study investigates the relationship between RAR and all-cause as well as cause-specific mortality in a pre-hypertensive and hypertensive population using data from the National Health and Nutrition Examination Survey. Cox proportional hazard models assessed the relationship between RAR and mortality, with results reported as hazard ratios (HRs) and corresponding confidence intervals (CIs). Kaplan-Meier survival curves illustrated survival probabilities across quartiles, while restricted cubic spline (RCS) analysis examined potential non-linear associations.

RESULTS

Elevated RAR was significantly associated with an increased risk of mortality. Each one-unit increase in RAR corresponded to an adjusted HR of 2.03 (95 % CI: 1.85-2.23) for all-cause mortality, 2.21 (95 % CI: 1.99-2.45) for heart disease, 1.86 (95 % CI: 1.65-2.10) for cancer, and 2.03 (95 % CI: 1.83-2.24) for other-cause mortality (P < 0.001). Participants in the highest RAR quartile had a 178 % increased risk of all-cause mortality (HR = 2.78, 95 % CI: 2.51-3.08). Kaplan-Meier curves depicting the survival probabilities of pre-hypertensive and hypertensive participants across RAR quartiles substantiated these associations. RCS analysis also confirmed a positive association, demonstrating distinct linear or non-linear patterns in the associations with all-cause and cause-specific mortality.

CONCLUSIONS

RAR is independently associated with all-cause and cause-specific mortality in adults with pre-hypertension and hypertension, warranting its consideration for clinical risk stratification.

Phloretin and Enalapril co-administration ameliorates hyperglycemia mediated exacerbation of myocardial injury in rats

Hyperglycemia exacerbates myocardial injury by amplifying oxidative stress, inflammation and apoptosis. This study explores the therapeutic potential of phloretin and enalapril co-administration in mitigating hyperglycemia-exacerbated myocardial damage. Using network pharmacology, 47 therapeutic targets and 10 hub genes, including albumin, insulin, prostaglandin endoperoxide synthase 2, matrix metallopeptidase 9, caspase3, tumor protein p53, insulin like growth factor 1, transforming growth factor beta 1, matrix metallopeptidase 2 and glycogen synthase kinase 3, were identified as critical to the drugs' synergistic action. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses highlighted key pathways, such as Interleukin-17 (IL-17), Advanced Glycation End Product-Receptor for Advanced Glycation End Products (AGE-RAGE), Mitogen activated protein kinase (MAPK), Phosphatidylinositol 3-kinase-protein kinase B (PI3K-Akt), Tumor necrosis factor (TNF) and Forkhead box O (FoxO), involved in angiogenesis, glucose metabolism, oxidative stress regulation and inflammation. Molecular docking confirmed strong affinities of phloretin and enalapril for key targets like insulin (INS), matrix metallopeptidase 9 (MMP9), prostaglandin endoperoxide synthase 2 (PTGS2) and insulin like growth factor 1 (IGF1). In-vivo studies using hyperglycemic rats with isoproterenol-induced myocardial ischemia validated the therapeutic efficacy of the combination. Co-treatment significantly enhanced antioxidant enzyme levels, reduced myocardial injury markers and improved histopathological features. These findings demonstrate the synergistic cardioprotective effects of phloretin and enalapril, offering a promising strategy for managing hyperglycemia and cardiac injury. The study provides a foundation for further preclinical and clinical evaluations to optimize the use of this combination in cardiovascular therapies.

The relationship between blood urea nitrogen to serum albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in patients with diabetes mellitus

Background

The relationship between the Blood Urea Nitrogen to Albumin Ratio (BAR) and cardiovascular diseases in diabetes, as well as cardiovascular and all-cause mortality, is not yet entirely understood. This study aimed to examine the correlation between the serum urea nitrogen to albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in diabetes.

Methods

A total of 7043 adult diabetes patients were included from the NHANES database from 2001 to 2018. The relationship between BAR and cardiovascular diseases, cardiovascular mortality and all-cause mortality in patients with diabetes mellitus was verified using baseline characteristic analysis, multivariate logistic regression analysis, multivariate Cox proportional hazards model, Kaplan-Meier (K-M) analysis, smoothed fitted curves, and subgroup analysis.

Results

Results of the logistic regression analysis indicated a substantial positive association, between the BAR and the risk of cardiovascular disease in individuals with diabetes (HR, 1.09 [95% CI 1.06-1.12], p < 0.001). Cox regression analysis revealed a substantial positive association between the BAR and the risk of cardiovascular (OR, 1.13 [95% CI, 1.10-1.17], p < 0.001) and all-cause mortality (OR, 1.12 [95% CI 1.11-1.14], p < 0.001) in diabetes. The restricted cubic spline (RCS) curves indicated a non-linear relationship between BAR and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes (p < 0.01). The receiver operating characteristic (ROC) curves demonstrated that the BAR had superior predictive performance for cardiovascular risk (AUC: 0.648), cardiovascular mortality (AUC: 0.618), and all-cause mortality (AUC: 0.674) compared to the body mass index (BMI) (cardiovascular risk AUC: 0.525, cardiovascular mortality AUC: 0.563, all-cause mortality AUC: 0.571) and the weight-adjusted-waist index (WWI) (cardiovascular risk AUC: 0.579, cardiovascular mortality AUC: 0.497, all-cause mortality AUC: 0.570). These results underscore the enhanced ability of the BAR to discriminate between positive and negative outcomes, making it a more effective predictor than WWI. Kaplan-Meier analysis further verified the predictive capacity of BAR, for cardiovascular mortality and all-cause mortality in diabetes patients. Subgroup analysis revealed consistent associations between BAR and a variety of subgroups.

Conclusion

The incidence of cardiovascular disease, cardiovascular mortality, and all-cause mortality was substantially elevated, in patients with diabetes with a higher BAR level. Cardiovascular disease, cardiovascular mortality, and all-cause mortality may be more prevalent among diabetic patients with elevated BAR levels. BAR is a novel marker for the prediction of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes.

Association of Serum AGR With All-Cause and Cause-Specific Mortality Among Individuals With Diabetes

CONTEXT

There are insufficient data to support a link between serum albumin-to-globulin ratio (AGR) and mortality in individuals with diabetes.

OBJECTIVE

This prospective study sought to investigate the relationship between serum AGR and all-cause and cause-specific mortality in adult diabetics.

METHODS

This study included 8508 adults with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Hazard ratios (HR) and 95% CIs for mortality from all causes, cardiovascular disease (CVD), and cancer were estimated using weighted Cox proportional-hazards models.

RESULTS

A total of 2415 all-cause deaths, including 688 CV deaths and 413 cancer deaths, were recorded over an average of 9.61 years of follow-up. After multivariate adjustment, there was a significant and linear relationship between higher serum AGR levels and reduced all-cause and cause-specific mortality in a dose-response manner. The multivariate-adjusted HR and 95% CI for all-cause mortality (Ptrend < .0001), cardiovascular mortality (Ptrend < .001), and cancer mortality (Ptrend < .01) were 0.51 (0.42-0.60), 0.62 (0.46-0.83), and 0.57 (0.39-0.85), respectively, for individuals in the highest AGR quartile. There was a 73% decreased risk of all-cause death per 1-unit rise in natural log-transformed serum AGR, as well as a 60% and 63% decreased risk of mortality from CVD and cancer, respectively (all P < .001). Both the stratified analysis and the sensitivity analyses revealed the same relationships.

CONCLUSION

AGR is a promising biomarker in risk predictions for long-term mortality in diabetic individuals, particularly in those younger than 60 years and heavy drinkers.

Serum Albumin-to-Creatinine Ratio Predicts One-Year Mortality in Elderly Patients with Non-ST-Elevation Acute Coronary Syndrome After Percutaneous Coronary Intervention: A Prospective Cohort Analysis

BACKGROUND Recently, the albumin-to-creatinine ratio (ACR) has been suggested as a valuable biomarker for adverse events in acute myocardial infarction. However, the prognostic value of ACR in very elderly patients (≥80 years) with non-ST-elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI) remains unclear. MATERIAL AND METHODS A total of 354 very elderly patients with NSTE-ACS who underwent PCI were included in this study and followed up for 1 year. Patients were divided into 3 groups according to ACR tertiles. Logistic regression analysis proportional hazard model was used to determine the prognostic value of ACR. RESULTS Sixty-two patients (17.5%) with 114 major adverse cardiovascular and cerebrovascular events (MACCEs) were recorded during 1-year follow-up. Patients with lower ACR tended to be older and had a lower serum albumin level and higher uric acid and creatinine levels (P<0.05). Moreover, patients with lower ACR levels had elevated all-cause mortality and MACCEs. Kaplan-Meier analysis suggested that patients with a lower ACR had a significantly lower survival rate free of all-cause mortality and MACCEs. Multivariable logistic regression analysis demonstrated that ACR was an independent predictor of all-cause mortality in these patients. ROC analysis showed that when ACR was ≤42.8, sensitivity and specificity were 75.2% and 80.2%, respectively, and the area under the ROC curve was 0.802 (95% CI: 0.745-0.859; P<0.001). CONCLUSIONS A lower ACR was associated with a higher incidence of all-cause mortality in very elderly patients with NSTE-ACS after PCI. The ACR is a promising indicator for risk stratification and prognostic assessment in these individuals.

Relationship between serum albumin level and hospitalization duration following percutaneous coronary intervention for acute coronary syndrome

Low serum albumin levels increase coronary morbidity, mortality, and postoperative cardiovascular risk. Therefore, this study investigated the relationship between these levels and the length of hospital stay in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. A total of 350 patients were divided into quartiles according to serum albumin levels. Univariate and multivariate analyses were performed to identify factors associated with the length of hospital stay. A non-linear regression analysis of serum albumin and length of hospital stay was also performed. The results of the multifactorial analysis revealed low serum albumin levels as an independent predictor of longer hospital stay, even in the fully adjusted model. In the segmented linear regression model, serum albumin level showed a U-shaped relationship with the length of hospital stay. In conclusion, low serum albumin level was an independent predictor of longer hospital stay in patients undergoing PCI for acute coronary syndrome, with shorter stays observed for increasing serum albumin levels. Low serum albumin can be used to identify patients who require longer hospitalization and may need additional nutritional support or interventions to improve their prognosis.

Serum albumin and white matter hyperintensities

People living with HIV and those diagnosed with alcohol use disorders (AUD) relative to healthy individuals commonly have low levels of serum albumin, substantiated as an independent predictor of cardiovascular events. White matter hyperintensities (WMH)-a neuroimaging feature of cerebral small vessel disease-are also related to cardiovascular disease. Despite consensus regarding associations between high levels of urine albumin and WMH prevalence, and low serum albumin levels and impaired cognitive functioning, relations between serum albumin and WMH burdens have rarely been evaluated. Here, a sample including 160 individuals with AUD, 142 living with HIV, and 102 healthy controls was used to test the hypothesis that serum albumin would be inversely related to WMH volumes and directly related to cognitive performance in the two diagnostic groups. Although serum albumin and periventricular WMH volumes showed an inverse relationship in both AUD and HIV groups, this relationship persisted only in the HIV group after consideration of traditional cardiovascular (i.e., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes), study-relevant (i.e., race, socioeconomic status, hepatitis C virus status), and disease-specific (i.e., CD4 nadir, HIV viral load, HIV duration) factors. Further, serum albumin contributed more significantly than periventricular WMH volume to variance in performance on a verbal learning and memory composite score in the HIV group only. Relations in both HIV and AUD groups between albumin and hematological red blood cell markers (e.g., hemoglobin, hematocrit) suggest that in this sample, serum albumin reflects hematological abnormalities. Albumin, a simple serum biomarker available in most clinical settings, may therefore help identify periventricular WMH burden and performance levels in specific cognitive domains in people living with HIV. Whether serum albumin contributes mechanistically to periventricular WMH in HIV will require additional investigation.

Current Trends in Biohumoral Screening for the Risk of Sudden Cardiac Death: A Systematic Review

Background and Objectives: Sudden cardiac death (SCD) represents a challenge to health systems globally and is met with increased frequency in the population. Over time, multiple screening methods have been proposed, including the analysis of various plasma biomarkers. This article aims to analyze for illustrative purposes the specialized literature in terms of current biomarkers and testing trends, in the case of cardiovascular diseases and implicitly sudden cardiac death. Materials and Methods: In this regard, we searched the PubMed database from 2010 to the present time using the keywords "sudden cardiac death" and "biomarkers". The inclusion criteria were clinical trials that analyzed the effectiveness of screening methods in terms of biomarkers used in stratifying the risk of cardiac distress and/or sudden cardiac death. We excluded reviews, meta-analyses, and studies looking at the effectiveness of treatments. Results: An extended approach was found, through studies that brought to the forefront both classical markers analyzed by new, more performant methods, markers for other pathologies that also determined cardiovascular impact, non-specific molecules with effects on the cardiovascular system, and state-of-the-art markers, such as microRNA. Some molecules were analyzed simultaneously in certain groups of patients. Conclusion: The observed current trend revealed the tendency to define the clinical-biological particularities of the person to be screened.

Serum albumin and white matter hyperintensities

Urine albumin, high in kidney disease, predicts cardiovascular incidents and CNS white matter hyperintensity (WMH) burdens. Serum albumin - a more general biomarker which can be low in several disorders - including kidney and liver disease, malnutrition, and inflammation - also predicts cardiovascular events and is associated with cognitive impairment in several clinical populations; relations between serum albumin and WMH prevalence, however, have rarely been evaluated. In a sample of 160 individuals with alcohol use disorder (AUD), 142 infected with HIV, and 102 healthy controls, the hypothesis was tested that lower serum albumin levels would predict larger WMH volumes and worse cognitive performance irrespective of diagnosis. After considering traditional cardiovascular risk factors (e.g., age, sex, body mass index (BMI), nicotine use, hypertension, diabetes) and study-relevant variables (i.e., primary diagnoses, race, socioeconomic status, hepatitis C virus status), serum albumin survived false discovery rate (FDR)-correction in contributing variance to larger periventricular but not deep WMH volumes. This relationship was salient in the AUD and HIV groups, but not the control group. In secondary analyses, serum albumin and periventricular WMH along with age, sex, diagnoses, BMI, and hypertension were considered for hierarchical contribution to variance in performance in 4 cognitive domains. Albumin survived FDR-correction for significantly contributing to visual and verbal learning and memory performance after accounting for diagnosis. Relations between albumin and markers of liver integrity [e.g., aspartate transaminase (AST)] and blood status (e.g., hemoglobin, red blood cell count, red cell distribution width) suggest that in this sample, albumin reflects both liver dysfunction and hematological abnormalities. The current results suggest that albumin, a simple serum biomarker available in most clinical settings, can predict variance in periventricular WMH volumes and performance in visual and verbal learning and memory cognitive domains. Whether serum albumin contributes mechanistically to periventricular WMH prevalence will require additional investigation.