Serum albumin and risk of venous thromboembolism.
The incidence of venous thromboembolism (VTE) is increased in patients with albuminuria. However, whether a low serum albumin concentration is associated with increased risk of VTE has been a matter of controversy. We determined the association of serum albumin with VTE incidence in two large, prospective, population-based cohorts: the Atherosclerosis Risk in Communities (ARIC) Study (n = 15,300) and the Cardiovascular Health Study (CHS) (n = 5,400). Validated VTE occurrence (n = 462 in ARIC and n = 174 in CHS) was ascertained during follow-up. In both studies, after adjustment for age, sex, race, use of hormone replacement therapy, estimated glomerular filtration rate, history of cancer, and diabetes, serum albumin tended to be associated inversely with VTE. The adjusted hazard ratio per standard deviation lower albumin was 1.18 (95% confidence interval [CI] = 1.08, 1.31) in ARIC and 1.10 (95% CI = 0.94, 1.29) in CHS. The hazard ratio for albumin below (vs. above) the fifth percentile was 1.28 (95% CI = 0.90, 1.84) in ARIC and 1.80 (95% CI = 1.11, 2.93) in CHS. In conclusion, low serum albumin was a modest marker of increased VTE risk. The observed association likely does not reflect cause and effect, but rather that low serum albumin reflects a hyperinflammatory or hypercoagulable state. Whether this association has clinical relevance warrants further study.
Folsom
Aaron R
AR
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454, USA. folso001@umn.edu
Lutsey
Pamela L
PL
Heckbert
Susan R
SR
Cushman
Mary
M
D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D014481:United States; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology* / Q000378:metabolism
D015415:Biomarkers; D012709:Serum Albumin
Am J Med. 2008 Mar;121(3):231-8
18328308
Am J Epidemiol. 1989 Apr;129(4):687-702
2646917
Kidney Int. 1985 Sep;28(3):429-39
3906225
Arch Pathol Lab Med. 1994 May;118(5):496-500
8192558
Arch Intern Med. 2002 May 27;162(10):1182-9
12020191
Thromb Haemost. 2005 Aug;94(2):362-5
16113826
Thromb Res. 2006;118(3):397-407
15990160
Clin Chem. 1995 Feb;41(2):264-70
7874780
Nephron. 1993;63(2):240-1
8450923
Ann Epidemiol. 1993 Jul;3(4):358-66
8275211
Ann Intern Med. 2009 May 5;150(9):604-12
19414839
Am J Med. 2008 Mar;121(3):226-30
18328307
Am J Kidney Dis. 2002 Feb;39(2 Suppl 1):S1-266
11904577
Clin Chim Acta. 1971 Jan;31(1):87-96
5544065
Ann Epidemiol. 1991 Feb;1(3):263-76
1669507
Am J Med. 2004 Jul 1;117(1):19-25
15210384
JAMA. 2009 May 6;301(17):1790-7
19417196
Curr Opin Pulm Med. 2009 Sep;15(5):408-12
19561505
Am J Med. 1980 Dec;69(6):819-27
7446547
Am J Med. 2002 Dec 1;113(8):636-42
12505113
Circulation. 2008 Jan 15;117(2):224-30
18158362
Pediatr Nephrol. 2000 Nov;15(1-2):74-8
11095017
Am J Gastroenterol. 2006 Jul;101(7):1524-8; quiz 1680
16863556
Am J Nephrol. 1988;8(6):457-62
3218659