Research Blog

September 25, 2023

Mineral Biomarkers: Calcium:Albumin Ratio

Optimal Takeaways

The calcium:albumin ratio offers insights into potential protein insufficiency or excess calcium when the ratio is high and vitamin D or calcium insufficiency when it's low. A high ratio can also suggest malnutrition or a pathological process and may indicate an increased risk of cardiovascular disease (CVD) and aortic stenosis. Studies have found that an elevated ratio strongly correlates with all-cause mortality and could predict cardiovascular events in individuals with existing CVD. Furthermore, research indicates that patients post non-ST elevation myocardial infarction (NSTEMI) and those with severe aortic stenosis often have a significantly higher ratio than healthy controls.

Standard Range: 0.00 - 2.60 Ratio (0.00 – 0.06 Ratio SI)  

The ODX Range: 0.00 - 2.18 Ratio (0.00 - 0.05 Ratio SI)

Low calcium:albumin ratio may reflect a vitamin D or calcium insufficiency.

High calcium:albumin ratio may reflect a decrease or insufficiency of serum proteins, malnutrition, or a pathological process. A higher ratio may be seen with an increased risk of atherosclerosis, aortic stenosis, and CVD morbidity and mortality (Alsancak 2018 and 2019, Grandi 2012).


The calcium:albumin ratio reflects the relative association between calcium and albumin and rises as calcium increases or albumin decreases. Researchers note that elevated calcium and elevated calcium:albumin ratio is strongly associated with all-cause mortality and may predict cardiovascular events in those with cardiovascular disease (Grandi 2012).

A prospective study of 120 patients post non-ST elevation MI (NSTEMI) versus 109 healthy controls found a significantly higher uncorrected calcium:albumin ratio of 2.19 in the MI patients versus 2.11 in the controls. The higher ratio was also significantly associated with a higher SYNTAX score. The SYNTAX score measures the severity and complexity of coronary artery disease; it is considered an independent factor for predicting CVD morbidity and mortality in acute coronary syndrome patients. Ultimately, researchers concluded that the higher ratio reflected an increased atherosclerotic burden (Alsancak 2018).

The same researchers found an association between a significantly higher ratio and aortic stenosis (AS), a condition associated with progressive calcification that can eventually cause vessel obstruction. A retrospective study of 185 patients with severe AS versus 108 controls found significantly higher calcium, calcium:albumin ratio, hypertension, and CRP and significantly lower albumin, LDL-C, and triglycerides in patients. The uncorrected calcium:albumin ratio of 2.33 was significantly higher in patients versus 2.12 in controls, and the corrected ratio was significantly higher at 2.38 in patients versus 2.12 in controls (Alsancak 2019).    

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Alsancak, Yakup, et al. "Role of calcium–albumin ratio in severity of coronary artery disease assessed by angiographic SYNTAX score." Archives of Clinical and Experimental Medicine 3.3 (2018): 174-178.

ALSANCAK, YAKUP, et al. "Can the Ratio of Calcium to Albumin Predict the Severity of Aortic Stenosis?." European Journal of Therapeutics 25.1 (2019): 44-50.

Grandi, Norma Christine et al. “Calcium, phosphate and the risk of cardiovascular events and all-cause mortality in a population with stable coronary heart disease.” Heart (British Cardiac Society) vol. 98,12 (2012): 926-33. doi:10.1136/heartjnl-2011-300806


Tag(s): Biomarkers

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