Serum albumin concentration and heart failure risk: The Health, Aging, and Body Composition Study

Gopal, Deepa M.; Kalogeropoulos, Andreas P.; Georgiopoulou, Vasiliki V.; Tang, Wilson W.H.; Methvin, Amanda; Smith, Andrew L.; Bauer, Douglas C.; Newman, Anne B.; Kim, Lauren; Harris, Tamara B.; Kritchevsky, Stephen B.; Butler, Javed; for the Health ABC Study,

doi:10.1016/j.ahj.2010.05.022

« Previous Next »American Heart Journal
Volume 160, Issue 2 , Pages 279-285, August 2010

Serum albumin concentration and heart failure risk:

The Health, Aging, and Body Composition Study

Deepa M. Gopal, MD, MS
- Boston University, Boston, MA
Andreas P. Kalogeropoulos, MD
- Emory University, Atlanta, GA
Vasiliki V. Georgiopoulou, MD
- Emory University, Atlanta, GA
Wilson W.H. Tang, MD
- Cleveland Clinic Foundation, Cleveland, OH
Amanda Methvin, MD
- Emory University, Atlanta, GA
Andrew L. Smith, MD
- Emory University, Atlanta, GA
Douglas C. Bauer, MD
- University of California San Francisco, San Francisco, CA
Anne B. Newman, MD, MPH
- University of Pittsburgh, Pittsburgh, PA
Lauren Kim, MD
- Intramural Research Program, National Institute of Aging, National Institutes of Health, Bethesda, MD
Tamara B. Harris, MD, MS
- Intramural Research Program, National Institute of Aging, National Institutes of Health, Bethesda, MD
Stephen B. Kritchevsky, PhD
- Sticht Center on Aging, Wake Forest University, Winston Salem, NC
Javed Butler, MD, MPH
- Emory University, Atlanta, GA
- Reprint requests: Javed Butler, MD, MPH, Emory University Hospital, 1365 Clifton Rd NE, Suite AT430, Atlanta, GA 30322.
for the Health ABC Study

Received 11 March 2010; accepted 14 May 2010.

Background

How serum albumin levels are associated with risk for heart failure (HF) in the elderly is unclear.

Methods

We evaluated 2,907 participants without HF (age 73.6 ± 2.9 years, 48.0% male, 58.7% white) from the community-based Health ABC Study. The association between baseline albumin and incident HF was assessed with standard and competing risks proportional hazards models controlling for HF predictors, inflammatory markers, and incident coronary events.

Results

During a median follow-up of 9.4 years, 342 (11.8%) participants developed HF. Albumin was a time-dependent predictor of HF, with significance retained for up to 6 years (baseline hazard ratio [HR] per −1 g/L 1.14, 95% CI 1.06-1.22, P < .001; annual rate of HR decline 2.1%, 95% CI 0.8%-3.3%, P = .001). This association persisted in models controlling for HF predictors, inflammatory markers, and incident coronary events (baseline HR per −1 g/L 1.13, 95% CI 1.05-1.22, P = .001; annual rate of HR decline 1.8%, 95% CI 0.5%-3.0%, P = .008) and when mortality was accounted for in adjusted competing risks models (baseline HR per −1 g/L 1.13, 95% CI 1.05-1.21, P = .001; annual rate of HR decline 1.9%, 95% CI 0.7%-3.1%, P = .002). The association of albumin with HF risk was similar in men (HR per −1 g/L 1.13, 95% CI 1.05-1.23, P = .002) and women (HR per −1 g/L 1.12, 95% CI 1.04-1.22, P = .005) and in whites and blacks (HR per −1 g/L 1.13, 95% CI 1.04-1.22, P< .01 for both races) in adjusted models.

Conclusions

Low serum albumin levels are associated with increased risk for HF in the elderly in a time-dependent manner independent of inflammation and incident coronary events.