Racial differences in the association of NT-proBNP with risk of incident heart failure in REGARDS

Abstract

Background: Black individuals have lower natriuretic peptide levels and greater risk of heart failure (HF) than white individuals. Higher N-terminal-pro-B-type natriuretic peptide (NT-proBNP) is associated with increased risk of incident HF, but little information is available in black individuals. We examined race-specific differences in 1) the association of NT-proBNP with incident HF and 2) the predictive ability of NT-proBNP for incident HF across body mass index (BMI) and estimated glomerular filtration rate (eGFR) categories.

Methods: In a prospective case-cohort study, baseline NT-proBNP was measured among 687 participants with incident HF and 2,923 (weighted 20,075) non-case randomly selected participants. Multivariable Cox proportional hazard modeling was used to assess the objectives of our study. Global Wald Chi-square score estimated from multivariable Cox models was used to assess predictive ability of NT-proBNP across BMI and eGFR categories.

Results: In the multivariable model, a doubling of NT-proBNP concentration was associated with greater risk of incident HF among white individuals [hazard ratio (HR): 1.73; 95% CI: 1.55-1.94] than black individuals (HR: 1.51; 95% CI: 1.34-1.70); Pinteraction by race = 0.024. Higher NT-proBNP was the strongest predictor of incident HF across all BMI and eGFR categories among white individuals. By contrast, among black individuals with obesity (BMI ≥ 30 kg/m2) or eGFR < 60 mL/min/1.73 m2, the predictive ability of NT-proBNP for incident HF was attenuated.

Conclusions: The magnitude of the association of higher NT-proBNP with incident HF risk was greater among white individuals than black individuals. The diminished ability of NT-proBNP to predict the risk of HF in black population with obesity or impaired kidney function highlights the need of further investigations.

Keywords: Cardiology; Epidemiology; Heart failure.

Conflict of interest statement

Conflict of interest: EBL has received research grants from Amgen, served on Amgen advisory boards, and served as a consultant for a research study funded by Novartis. OMG has received honoraria from Amgen and Keryx and grant support from Amgen, Keryx, and GlaxoSmithKline. MMS has received grant support from Amgen.

Figures

Figure 1. Flow diagram describing the selection of participants for the case-cohort study.

*Covariates include age, race, sex, neighborhood socioeconomic status (nSES), tobacco usage, physical activity, alcohol use, systolic blood pressure, use of antihypertensive medications, aspirin use, dyslipidemia, diabetes mellitus, history of stroke or transient ischemic attack (TIA), atrial fibrillation, peripheral vascular disease, history of coronary artery disease, left ventricular hypertrophy, and eGFR.

Figure 2. The association between plasma NT-proBNP levels and other factors with incident HF across BMI categories among White individuals.

(A) Lean category, BMI 18.5–24.9 kg/m2. (B) Overweight category, BMI 25–29.9 kg/m2. (C) Obese category, BMI at least 30 kg/m2. The panels display the factors (y axis) and their percentage contribution in the global Wald χ2 score from the multivariable-adjusted Cox model. BMI, body mass index; GFR, glomerular filtration rate; LVH, left ventricular hypertrophy; nSES, neighborhood socioeconomic status at census block level; NT-proBNP, N-terminal pro–B-type natriuretic peptide; PVD, peripheral vascular disease; TIA, transient ischemic attack.

Figure 3. The association between plasma NT-proBNP levels and other factors with incident HF across BMI categories among Black individuals.

(A) Lean category, BMI 18.5–24.9 kg/m2. (B) Overweight category, BMI 25–29.9 kg/m2. (C) Obese category, BMI at least 30 kg/m2. The panels display the factors (y axis) and their percentage contribution in the global Wald χ2 score from the multivariable-adjusted Cox model. BMI, body mass index; GFR, glomerular filtration rate; LVH, left ventricular hypertrophy; nSES, neighborhood socioeconomic status at census block level; NT-proBNP, N-terminal pro–B-type natriuretic peptide; PVD, peripheral vascular disease; TIA, transient ischemic attack.

Figure 4. The association between plasma NT-proBNP levels and other factors with incident HF across eGFR categories among White and Black individuals.

(A) eGFR at least 60 mL/min/1.73 m2 and (B) eGFR less than 60 mL/min/1.73 m2 among White individuals. (C) eGFR at least 60 mL/min/1.73 m2 and (D) eGFR less than 60 mL/min/1.73 m2 among Black individuals. The panels display the factors (y axis) and their percentage contribution in the global Wald χ2 score from the multivariable-adjusted Cox model. eGFR, estimated glomerular filtration rate; LVH, left ventricular hypertrophy; nSES, neighborhood socioeconomic status at census block level; NT-proBNP, N-terminal pro–B-type natriuretic peptide; PVD, peripheral vascular disease; TIA, transient ischemic attack.

Figure 5. NPs, race, and incident HF.

NT-proBNP: N-terminal pro–B-type natriuretic peptide.