| Objective. Cardiovascular disease (CVD) is the leading cause of death in industrialized nations and is associated with a high economic and social burden. Contrary to traditional CVD risk factors, the role of serum albumin on the risk of CVD remains controversial and it is not known whether serum albumin interacts with bilirubin to influence CVD risk. The aim of this project is to determine (1) whether low serum albumin level is an independent determinant of myocardial infarction (MI), CVD, and total mortality, (2) whether bilirubin interacts with albumin to influence the risk of MI, and (3) whether low serum albumin is associated with the intima-media thickness (IMT) of the carotid arteries.; Methods. Using data prospectively collected on 5,124 subjects in the Framingham Offspring Study, we estimated the rates of CVD and mortality across tertiles of serum albumin and the risk of MI according to serum concentrations of albumin and bilirubin. In a cross-sectional design, we evaluated whether low serum albumin was associated with an increased carotid IMT among 4,427 subjects from the National Heart, Lung, and Blood Institute Family Heart Study.; Results. Low serum albumin was associated with an increased risk of MI in both sexes. Comparing the lowest to the highest tertile of albumin, the adjusted rate ratio (95% confidence interval) of MI was 1.7 (1.2–2.5) in men and 2.1 (1.1–4.0) in women. Low albumin was also associated with a higher risk of CVD and all-cause mortality. There was evidence of biologic interaction between albumin and bilirubin among men, but not among women. In men with lower concentrations of both albumin and bilirubin, 53.7% of MI cases were attributable to the interaction between the two risk factors [synergy index: 1.7 (1.1–2.9)]. Serum albumin was not associated with carotid IMT.; Conclusion. Our findings demonstrate that lower serum albumin is associated with an elevated risk of CVD and all-cause mortality in both sexes. The magnitude of effect was stronger in the presence of low levels of serum bilirubin in men. Low albumin was not associated with carotid IMT. Serum albumin, along with other factors, could help identify people at higher risk of CVD and mortality. |
