Association of the C-reactive protein–albumin–lymphocyte index with heart failure prevalence and mortality risk in older adults with hypertension: A cohort study

BackgroundOlder adults with hypertension have a high incidence of heart failure and poor prognosis, often accompanied with nutritional, inflammatory, and immune dysregulation. The C-reactive protein-albumin-lymphocyte (CALLY) index provides an integrated measure of these conditions. However, its association with the prevalence and prognosis of heart failure in older hypertensive populations remains unclear.ObjectiveThe core objective of this study was to explore the correlation between the CALLY index and the prevalence of heart failure as well as mortality risk in the older hypertensive population.MethodsWe included data from 5876 hypertensive individuals aged ≥60 years who participated in the National Health and Nutrition Examination Survey from 2003 to 2016. Complex sampling weights were applied for all analyses. The natural logarithmic transformation of the CALLY index (Ln CALLY) was used as the primary exposure variable to reduce skewness and meet model assumptions. The association between Ln CALLY and heart failure prevalence was assessed using a multivariable logistic regression model, while the analysis of mortality was conducted using a Cox proportional hazards model. Further analyses included restricted cubic spline modeling, stratified analyses with interaction tests, and sensitivity analyses.ResultsParticipants in the highest quartile of Ln CALLY had a 44% lower likelihood of heart failure compared with those in the lowest quartile (odds ratio = 0.56, 95% confidence interval: 0.40-0.78). Among individuals with heart failure, those in the highest quartile of Ln CALLY exhibited 54% lower all-cause mortality (hazard ratio = 0.46, 95% confidence interval: 0.31-0.68) and 64% lower cardiovascular mortality (hazard ratio = 0.36, 95% confidence interval: 0.19-0.71) than those in the lowest quartile. Restricted cubic spline modeling demonstrated a linear inverse association between Ln CALLY and heart failure prevalence, all-cause mortality, and cardiovascular mortality (all <i>p</i> for nonlinearity >0.05). The results of the subgroup analysis were consistent with the overall conclusions, and no significant interaction effects were observed (all <i>p</i>-interaction >0.05).ConclusionLn CALLY was significantly and inversely associated with both heart failure prevalence and mortality among older adults with hypertension. As a readily obtainable composite index derived from routine laboratory tests, Ln CALLY may serve as a practical tool for precision management in this high-risk population.