Serum albumin and risk of stroke, coronary heart disease, and mortality: the role of cigarette smoking

Objective: Lower levels of serum albumin are associated with increased risk of all-cause and cardiovascular mortality as well as with coronary heart disease and stroke incidence. These relationships have been examined with specific focus on the role of cigarette smoking. Study Design and Setting: A prospective study of 7,690 British men aged 40-59 years, with 16.8 years mean follow-up. Results: Cigarette smoking was strongly and inversely associated with serum albumin concentrations that reverted to levels seen in never smokers after 5 years' cessation. Only in current and former smokers were there significant inverse relationships between serum albumin and risk of major CHD and stroke events even after adjustment for potential confounders. Only in current smokers was a significant inverse relationship seen between serum albumin and mortality from cardiovascular disease, cancer, and all causes. Conclusion: The inverse association between serum albumin concentration and disease outcome appears to be related to the effects of cigarette smoking on serum albumin concentration. (C) 2004 Elsevier Inc. All rights reserved.