Hypoalbuminaemia and incident heart failure in older adults

Abstract

Aims: To test the hypothesis that baseline hypoalbuminaemia is associated with incident heart failure (HF) in community-dwelling older adults.

Methods and results: Of the 5795 community-dwelling adults aged ≥65 years in the Cardiovascular Health Study, 5450 were free of centrally adjudicated prevalent HF at baseline, and also had data on baseline serum albumin. Of these, 599 (11%) had hypoalbuminaemia, defined as baseline serum albumin levels ≤3.5 mg/dL. Propensity scores for hypoalbuminaemia were calculated for each patient and used to assemble a matched cohort of 582 pairs of participants with and without hypoalbuminaemia, who were well balanced on 58 baseline characteristics. Using Cox regression models, we estimated the association of hypoalbuminaemia with centrally adjudicated incident HF during 9.6 years of median follow-up. Matched participants had a mean (±SD) age of 74 (±6) years, 62% were women, and 16% were African Americans. Incident HF occurred in 25 and 20% of matched participants with and without hypoalbuminaemia, respectively [hazard ratio when hypoalbuminaemia was compared with normoalbuminaemia, 1.40; 95% confidence interval, 1.05-1.85; P = 0.020]. Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for incident HF associated with hypoalbuminaemia were 1.33 (1.12-1.58; P = 0.001), 1.33 (1.11-1.60; P = 0.002), and 1.25 (1.04-1.50; P= 0.016), respectively. The combined endpoint of incident HF or all-cause mortality occurred in 59 and 50% of matched participants with and without hypoalbuminaemia, respectively (hazard ratio, 1.33; 95% confidence interval, 1.11-1.61; P= 0.002).

Conclusions: Among community-dwelling older adults without HF, baseline hypoalbuminaemia was associated with increased risk of incident HF during 10 years of follow-up.

Figure 1

Absolute standardized differences before and after propensity score matching comparing covariates for patients with and without hypoalbuminaemia.

Figure 2

Kaplan–Meier plots for incident heart failure by hypoalbuminaemia in Cardiovascular Health Study.

Figure 3

Association of baseline hypoalbuminaemia (albumin ≤3.6 g/dL) with new onset heart failure in subgroups of propensity score-matched participants in the Cardiovascular Health Study (CI, confidence interval; HR, hazard ratio).