title: Hypoalbuminaemia and incident heart failure in older adults.
abstract: OBJECTIVE
  To test the hypothesis that baseline hypoalbuminaemia is associated with incident heart failure (HF) in community-dwelling older adults.
  
  
  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.
authors.affiliation: University of Athens, 28 Doukissis Plakentias Street, Athens, Greece. geros@otenet.gr
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Desai
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.forename: Inmaculada B
authors.initials: IB
authors.lastname: Aban
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003153:Community Health Services; D005260:Female; D006299:Health Services for the Aged; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000150:complications*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D012709:Serum Albumin; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin