Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Review

Volume 17, Number 6, December 2026, pages 587-600

Prognostic Value of Serum Albumin in Elderly Cardiovascular Disease Management

↓ Figure 1. Proposed interaction between SA and CV outcomes (pathophysiological mechanisms by which SA leads to CVD). SA: serum albumin; CV: cardiovascular; CVD: cardiovascular disease.

↓ **Table 1.** Summary of Studies Assessing the Prognostic Value of Serum Albumin Levels in Patients with CVD
Study	Population	CVD type	Albumin threshold	Key findings	References
A/G ratio: albumin-to-globulin ratio; ADHF: acute decompensated heart failure; aHR: adjusted hazard ratio; AIS: acute ischemic stroke; aOR: adjusted odds ratio; CAD: coronary artery disease; CHF: congestive heart failure; CHD: coronary heart disease; CRT-D: cardiac resynchronization therapy defibrillator; CV: cardiovascular; CVD: cardiovascular disease; HF: heart failure; hHF: hospitalization for heart failure; MACE: major adverse cardiovascular events; mRS: modified Rankin scale; NIDCM: nonischemic dilated cardiomyopathy; PAD: peripheral artery disease; SA: serum albumin; sACR: serum albumin-to-creatinine ratio; SD: standard deviation; SMR: secondary mitral regurgitation; TIA: transient ischemic attack.
Prospective (registry) cohort	N = 13,618; mean age, 62.2 ± 11.3 years; China; multicenter national registry; patients with AIS or TIA	AIS and TIA	< 3.5 g/dL	The relationship in each 10 g/L lower albumin with prognosis was consistently inverse (aOR, 1.17; aHR, 1.86)	Zhou et al, 2021 [48]
Cross-sectional study	N = 10,900; mean age, 63.9 ± 9.3 years; China; cross-sectional, hospital-based cohort; adult patients with hypertension	Chinese hypertensive patients	4.0 g/dL	Lower SA was associated with the prevalence of PAD only in males but not in females	Ding et al, 2020 [49]
Retrospective study	N = 378; mean age, 67.1 ± 11.2 years; Italy; single-center cohort; patients with chronic HF	HF	3.5 g/dL	Patients with chronic HF who exhibited low SA levels showed a higher risk of MACE, hHF, and total mortality	Armentaro et al, 2024 [50]
Randomized COAPT trial	N = 614; mean age, 71–74 years; multinational; randomized controlled trial; HF with SMR	HF and SMR	4.0 g/dL	559 patients (91.0%) had baseline SA levels (median, 4.0 g/dL; interquartile range (IQR) 3.7–4.2 g/dL). Patients with albumin levels < 4.0 g/dL were older and more likely to have ischemic cardiomyopathy and hospitalization within the year before enrolment compared with those with albumin levels ≥ 4.0 g/dL	Feng et al, 2023 [51]
Retrospective study	N = 3,057; median age, 58 years; Turkey; multicenter cohort; patients with ST-segment, elevation myocardial infarction undergoing PCI	ST-segment elevation myocardial infarction	-	sACR was inversely associated with short-term clinical outcomes in patients with STEMI after PCI	Turkyilmaz et al, 2022 [52]
Retrospective study	N = 1,058; mean age, 67–69 years; China; hospital-based cohort; elderly patients with NIDCM	NIDCM	3.5 g/dL	Hypoalbuminemia was associated with an increased risk of in-hospital and long-term mortality in elderly patients with NIDCM	Li et al, 2023 [34]
Retrospective cohort	N = 321; age ≥ 65 years; Taiwan; single-center cohort; elderly patients with stable CAD	Stable CAD	< 3.75 vs ≥ 3.75 g/dL	Patients with albumin ≥ 3.75 g/dL had significantly lower long-term cardiovascular mortality vs those with < 3.75 g/dL. HR about 0.20 for CV mortality in the ≥ 3.75 group after adjustment	Cheng et al, 2024 [45]
Retrospective cohort	N = 119; age ≥ 65 years; United States; single-center study; patients hospitalized with ADHF	ADHF	≤ 2.9 g/dL	Low albumin (≤ 2.9) at admission was associated with increased all-cause mortality after a follow-up of 11 years	Mene-Afejuku et al, 2019 [46]
Prospective, monocenter study	N = 64; institutionalized elderly; France; monocenter prospective study; patients hospitalized with acute HF	Acute HF (in-hospital outcomes)	<3.0 g/dL (median)	SA < 3.0 g/dL was a strong predictor of in-hospital mortality; high sensitivity (94%) and moderate specificity (68%) for in-hospital mortality prediction	Arques et al, 2008 [53]
Observational cohort	N = 873; mean age, 70.9 ± 7.5 years; China; cohort study; elderly patients with chronic aortic regurgitation	Valvular heart disease, chronic aortic regurgitation	3.5 g/dL	When albumin was < 3.5 g/dL, each 1 g/L decrease corresponded to 25% increased risk of all-cause mortality; hypoproteinemia (< 3.5 g/dL) had an HR of 2.93	Li et al, 2025 [54]
Epidemiologic cohort	820 elderly men (mean age, 64–84 years)	Coronary heart disease risk/incidence and mortality	Albumin was expressed as a continuous variable; moderate reductions (per SD decrease about 2.5 g/dL)	Moderate to low albumin levels predicted incident coronary heart disease, particularly in those with high cholesterol; lower albumin levels were associated with CHD mortality and all-cause mortality in elderly men	Weijenberg et al, 1997 [55]
Cohort study	546 patients (mean age 78 ± 9 years)	Acute nonischemic HF	< 3.57 g/dL	Hypoalbuminemia (< 3.4 g/dL) was independently predictive of hospital mortality; good sensitivity (78.8%) and specificity (75%)	Ancion et al, 2017 [47]
Cohort/retrospective study	759 patients (mean age, about 68 years)	AIS	≥ 4.9 g/dL (4.9 g/dL)	Patients with lower albumin levels had higher odds of poor functional outcome (mRS > 3/death) at the 3-month follow-up period	Dziedzic et al, 2004 [56]
Prospective study	11, 298 patients; (mean age = 62 years)	AIS	A/G ratio cutoffs were 1.1 and 1.9, depending on the outcome and time point; clinically relevant cutoff, 1.38	Lower serum A/G levels were associated with poor functional outcomes and all-cause mortality at 3-month and 1-year follow-up periods in patients with AIS	Wang et al, 2023[57]
Retrospective study	477 patients; (age: T1, 62 (56–69); T2, 67 (61–76); T3, 69 (60–75))	HF patients with CRT-D	> 0.038 g/dL	Low albumin levels were associated with long-term mortality and appropriate shock treatment in patients with HF, including those treated with CRT-D	Pay et al, 2024[58]

↓ Table 1. Summary of Studies Assessing the Prognostic Value of Serum Albumin Levels in Patients with CVD

Study

Population

CVD type

Albumin threshold

Key findings

References

A/G ratio: albumin-to-globulin ratio; ADHF: acute decompensated heart failure; aHR: adjusted hazard ratio; AIS: acute ischemic stroke; aOR: adjusted odds ratio; CAD: coronary artery disease; CHF: congestive heart failure; CHD: coronary heart disease; CRT-D: cardiac resynchronization therapy defibrillator; CV: cardiovascular; CVD: cardiovascular disease; HF: heart failure; hHF: hospitalization for heart failure; MACE: major adverse cardiovascular events; mRS: modified Rankin scale; NIDCM: nonischemic dilated cardiomyopathy; PAD: peripheral artery disease; SA: serum albumin; sACR: serum albumin-to-creatinine ratio; SD: standard deviation; SMR: secondary mitral regurgitation; TIA: transient ischemic attack.

Prospective (registry) cohort

N = 13,618; mean age, 62.2 ± 11.3 years; China; multicenter national registry; patients with AIS or TIA

AIS and TIA

< 3.5 g/dL

The relationship in each 10 g/L lower albumin with prognosis was consistently inverse (aOR, 1.17; aHR, 1.86)

Zhou et al, 2021 [48]

Cross-sectional study

N = 10,900; mean age, 63.9 ± 9.3 years; China; cross-sectional, hospital-based cohort; adult patients with hypertension

Chinese hypertensive patients

4.0 g/dL

Lower SA was associated with the prevalence of PAD only in males but not in females

Ding et al, 2020 [49]

Retrospective study

N = 378; mean age, 67.1 ± 11.2 years; Italy; single-center cohort; patients with chronic HF

3.5 g/dL

Patients with chronic HF who exhibited low SA levels showed a higher risk of MACE, hHF, and total mortality

Armentaro et al, 2024 [50]

Randomized COAPT trial

N = 614; mean age, 71–74 years; multinational; randomized controlled trial; HF with SMR

HF and SMR

4.0 g/dL

559 patients (91.0%) had baseline SA levels (median, 4.0 g/dL; interquartile range (IQR) 3.7–4.2 g/dL). Patients with albumin levels < 4.0 g/dL were older and more likely to have ischemic cardiomyopathy and hospitalization within the year before enrolment compared with those with albumin levels ≥ 4.0 g/dL

Feng et al, 2023 [51]

Retrospective study

N = 3,057; median age, 58 years; Turkey; multicenter cohort; patients with ST-segment, elevation myocardial infarction undergoing PCI

ST-segment elevation myocardial infarction

sACR was inversely associated with short-term clinical outcomes in patients with STEMI after PCI

Turkyilmaz et al, 2022 [52]

Retrospective study

N = 1,058; mean age, 67–69 years; China; hospital-based cohort; elderly patients with NIDCM

NIDCM

3.5 g/dL

Hypoalbuminemia was associated with an increased risk of in-hospital and long-term mortality in elderly patients with NIDCM

Li et al, 2023 [34]

Retrospective cohort

N = 321; age ≥ 65 years; Taiwan; single-center cohort; elderly patients with stable CAD

Stable CAD

< 3.75 vs ≥ 3.75 g/dL

Patients with albumin ≥ 3.75 g/dL had significantly lower long-term cardiovascular mortality vs those with < 3.75 g/dL. HR about 0.20 for CV mortality in the ≥ 3.75 group after adjustment

Cheng et al, 2024 [45]

Retrospective cohort

N = 119; age ≥ 65 years; United States; single-center study; patients hospitalized with ADHF

ADHF

≤ 2.9 g/dL

Low albumin (≤ 2.9) at admission was associated with increased all-cause mortality after a follow-up of 11 years

Mene-Afejuku et al, 2019 [46]

Prospective, monocenter study

N = 64; institutionalized elderly; France; monocenter prospective study; patients hospitalized with acute HF

Acute HF (in-hospital outcomes)

<3.0 g/dL (median)

SA < 3.0 g/dL was a strong predictor of in-hospital mortality; high sensitivity (94%) and moderate specificity (68%) for in-hospital mortality prediction

Arques et al, 2008 [53]

Observational cohort

N = 873; mean age, 70.9 ± 7.5 years; China; cohort study; elderly patients with chronic aortic regurgitation

Valvular heart disease, chronic aortic regurgitation

3.5 g/dL

When albumin was < 3.5 g/dL, each 1 g/L decrease corresponded to 25% increased risk of all-cause mortality; hypoproteinemia (< 3.5 g/dL) had an HR of 2.93

Li et al, 2025 [54]

Epidemiologic cohort

820 elderly men (mean age, 64–84 years)

Coronary heart disease risk/incidence and mortality

Albumin was expressed as a continuous variable; moderate reductions (per SD decrease about 2.5 g/dL)

Moderate to low albumin levels predicted incident coronary heart disease, particularly in those with high cholesterol; lower albumin levels were associated with CHD mortality and all-cause mortality in elderly men

Weijenberg et al, 1997 [55]

Cohort study

546 patients (mean age 78 ± 9 years)

Acute nonischemic HF

< 3.57 g/dL

Hypoalbuminemia (< 3.4 g/dL) was independently predictive of hospital mortality; good sensitivity (78.8%) and specificity (75%)

Ancion et al, 2017 [47]

Cohort/retrospective study

759 patients (mean age, about 68 years)

AIS

≥ 4.9 g/dL (4.9 g/dL)

Patients with lower albumin levels had higher odds of poor functional outcome (mRS > 3/death) at the 3-month follow-up period

Dziedzic et al, 2004 [56]

Prospective study

11, 298 patients; (mean age = 62 years)

AIS

A/G ratio cutoffs were 1.1 and 1.9, depending on the outcome and time point; clinically relevant cutoff, 1.38

Lower serum A/G levels were associated with poor functional outcomes and all-cause mortality at 3-month and 1-year follow-up periods in patients with AIS

Wang et al, 2023[57]

Retrospective study

477 patients; (age: T1, 62 (56–69); T2, 67 (61–76); T3, 69 (60–75))

HF patients with CRT-D

> 0.038 g/dL

Low albumin levels were associated with long-term mortality and appropriate shock treatment in patients with HF, including those treated with CRT-D

Pay et al, 2024[58]