Serum Albumin Concentration and Heart Failure Risk

• Authors: Deepa Gopal, Boston University; Andreas Kalogeropoulos, Emory University; Vasiliki (Vicki) Georgiopoulou, Emory University; Wilson W.H. Tang, Cleveland Clinic Foundation; Amanda Methvin, Emory University; Andrew L Smith, Emory University; Douglas C. Bauer, University of California; Anne B. Newman, University of Pittsburgh; Lauren Kim, National Institutes of Health; Tamara B. Harris, National Institutes of Health; Stephen B. Kritchevsky, Wake Forest University; Javed Butler, Emory University
• Journal Title: American Heart Journal
• Volume: Volume 160, Number 2
• Publisher: Elsevier: 12 months | 2010-08, Pages 279-285
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ahj.2010.05.022
• Subjects: Health Sciences, Epidemiology; Gerontology; Health Sciences, Medicine and Surgery
• Keywords: Serum Albumin; Heart Failure; Epidemiology; Elderly

Abstract

Background How serum albumin levels are associated with risk for heart failure (HF) in the elderly is unclear. Methods We evaluated 2907 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 HR per -1g/L, 1.14; 95% CI, 1.06–1.22; P<0.001; annual rate of HR decline, 2.1%; 95% CI, 0.8–3.3%; P=0.001). This association persisted in models controlling for HF predictors, inflammatory markers, and incident coronary events (baseline HR per -1g/L, 1.13; 95% CI, 1.05–1.22; P=0.001; annual rate of HR decline, 1.8%; 95% CI, 0.5–3.0%; P=0.008) and when mortality was accounted for in adjusted competing risks models (baseline HR per -1g/L, 1.13; 95% CI, 1.05–1.21; P=0.001; annual rate of HR decline, 1.9%; 95% CI, 0.7–3.1%; P=0.002). The association of albumin with HF risk was similar in men (HR per -1g/L, 1.13; 95% CI, 1.05–1.23; P=0.002) and women (HR per -1g/L, 1.12; 95% CI, 1.04–1.22; P=0.005) and in whites and blacks (HR per –1g/L, 1.13; 95% CI, 1.04–1.22; P<0.01 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.