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. 2024 Nov 26;11(12):378.
doi: 10.3390/jcdd11120378.

Impact of Baseline Hypoalbuminemia on Long-Term Survival Following Acute Myocardial Infarction According to Body Mass Index

Alon Shechter  1   2   3 , Shani Dahan  4   5   6 , Arthur Shiyovich  2   3   7 , Harel Gilutz  6 , Ygal Plakht  8   9
Affiliations

Impact of Baseline Hypoalbuminemia on Long-Term Survival Following Acute Myocardial Infarction According to Body Mass Index

Alon Shechter et al. J Cardiovasc Dev Dis. .

Abstract

Serum albumin and body mass index (BMI, kg/m2) have been associated with outcomes following acute myocardial infarction (AMI). Aiming to assess whether the mortality risk inflicted by hypoalbuminemia (<3.5 g/dL) in this context is influenced by BMI, we conducted a retrospective analysis of AMI survivors hospitalized during 2004-2017. Stratified by admission-time albumin level and BMI, eligible cases were evaluated for all-cause mortality up to 10 years after discharge. A total of 6283 individuals (74.1% males, mean age 64.1 ± 13.1 years, 44.3% with ST-elevation MI) were included. Of them, 22.7% had hypoalbuminemia and 1.2%, 41.0%, and 28.6% were underweight (BMI < 18.5), overweight (BMI 25-30), and obese (BMI ≥ 30), respectively. Over a median of 7.9 (IQR, 4.8-10.0) years of follow-up, 42.5% of patients died. Hypoalbuminemia was independently associated with a heightened mortality risk overall (AdjHR = 1.54, 95%CI 1.42-1.67, p < 0.001), accounted for by the normal weight (AdjHR = 1.73, 95%CI 1.50-1.99, p < 0.001), overweight (AdjHR = 1.55, 95%CI 1.35-1.79, p < 0.001), and class 1 obesity (BMI 30-35) (AdjHR = 1.37, 95%CI 1.12-1.68, p = 0.002) subgroups. Upon interaction analysis, the mortality risk imposed by hypoalbuminemia was most pronounced among individuals with normal BMI. In conclusion, hypoalbuminemia constituted a negative prognostic marker for long-term survival in AMI patients with normal or mildly elevated but not reduced or severely increased BMI. Pending further research, addressing hypoalbuminemia based on BMI range may prove beneficial.

Keywords: albumin; body mass index; myocardial infarction; survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cumulative survival according to serum albumin status and body mass index category: (a) underweight; (b) normal weight; (c) overweight; (d) class 1 obesity; (e) class 2 obesity; (f) class 3 obesity. BMI = body mass index.
Figure 2
Figure 2
Hypoalbuminemia-associated risk of all-cause mortality at 10 years after acute myocardial infarction according to body mass index category: (a) per multivariable analysis in each of the BMI categories’ subgroups; (b) per interaction analysis in the total cohort. AdjHR = adjusted hazard ratio; BMI = body mass index; CI = confidence interval.
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