Elsevier

American Heart Journal

Volume 160, Issue 2, August 2010, Pages 279-285
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Serum albumin concentration and heart failure risk: The Health, Aging, and Body Composition Study

https://doi.org/10.1016/j.ahj.2010.05.022Get rights and content

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.

Section snippets

Study population

The Health ABC Study is a population-based cohort of 3,075 well-functioning, community-dwelling men and women aged 70 to 79 years at inception. Participants were identified from black and white residents using Medicare beneficiary rolls and residing in zip codes from the metropolitan areas of Pittsburgh, PA, and Memphis, TN. The recruitment period was from March 1997 to July 1998. Eligibility criteria included the following: age 70 to 79 years at inception; no difficulties performing basic

Baseline participant characteristics

The mean age of participants was 73.6 ± 2.9 years, with 48.0% male and 58.7% white. Mean albumin was 39.8 g/L (range 28.0-50.0). Median follow-up was 9.4 years (interquartile range, 7.0-9.4 years). During this period, 342 (11.8%) of 2,907 participants developed HF (incidence rate of 14.9, 95% CI 13.4-16.5 per 1,000 person-years). Table I presents the baseline characteristics of participants. Baseline inflammatory markers (IL-6, TNF-α, and CRP) were higher in participants who developed HF. Data

Discussion

In this elderly cohort, baseline serum albumin concentration was inversely associated with risk for incident HF in a time-dependent fashion. This association persisted after controlling for other known predictors of HF, several inflammatory biomarkers, and incident coronary heart disease and was not affected when death was analyzed as a competing risk.

Interestingly, the average baseline serum albumin in participants who developed HF during the entire 10-year follow-up period was not

References (28)

  • RaymondR.J. et al.

    Elevated interleukin-6 levels in patients with asymptomatic left ventricular systolic dysfunction

    Am Heart J

    (2001)
  • El-MenyarA.A.

    Cytokines and myocardial dysfunction: state of the art

    J Card Fail

    (2008)
  • BahramiH. et al.

    Novel metabolic risk factors for incident heart failure and their relationship with obesity: the MESA (Multi-Ethnic Study of Atherosclerosis) study

    J Am Coll Cardiol

    (2008)
  • KullerL.H. et al.

    The relation between serum albumin levels and risk of coronary heart disease in the Multiple Risk Factor Intervention Trial

    Am J Epidemiol

    (1991)
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