Racial and ethnic differences in circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in US adults

Yvonne Commodore-Mensah; Dan Wang; Yein Jeon; Kathryn Foti; John William McEvoy; Josef Coresh; Olive Tang; Justin B Echouffo-Tcheugui; Robert Christenson; Chiadi E Ndumele; Elizabeth Selvin

doi:10.1016/j.ajpc.2023.100526

Racial and ethnic differences in circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP) in US adults

Am J Prev Cardiol. 2023 Jul 20:15:100526. doi: 10.1016/j.ajpc.2023.100526. eCollection 2023 Sep.

Authors

Yvonne Commodore-Mensah^{1

2

3}, Dan Wang^{1

2}, Yein Jeon¹, Kathryn Foti⁴, John William McEvoy⁵, Josef Coresh^{1

2}, Olive Tang⁶, Justin B Echouffo-Tcheugui⁷, Robert Christenson⁸, Chiadi E Ndumele⁹, Elizabeth Selvin^{1

2}

Affiliations

¹ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Johns Hopkins School of Nursing, Baltimore, MD, USA.
⁴ Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
⁵ Division of Cardiology & National Institute for Prevention & Cardiovascular Health, National University of Ireland, Galway, Ireland.
⁶ Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁷ Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
⁹ Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Background: The presence and interpretation of racial and ethnic differences in circulating N-terminal pro-brain-type natriuretic peptide (NT-proBNP), a diagnostic biomarker for heart failure, are controversial.

Objective: To examine racial and ethnic differences in NT-proBNP levels among the general US adult population.

Methods: We performed a cross-sectional analysis of data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES). We included 4717 non-Hispanic White, 1675 non-Hispanic Black, and 2148 Mexican American adults aged 20 years or older without a history of cardiovascular disease. We examined the associations of race and ethnicity with NT-proBNP using linear and logistic regression models in the overall population and in a younger, 'healthy' subsample.

Results: The mean age was 45 years. Median NT-proBNP levels were significantly lower among Black (29.3 pg/mL) and Mexican American adults (28.3.4 pg/mL) compared to White adults (49.1pg/mL, P-values<0.001). After adjusting for sociodemographic factors and cardiovascular risk factors, NT-proBNP was 34.4% lower (95%CI -39.2 to -29.3%) in Black adults and 22.8% lower (95%CI -29.4 to -15.5) in Mexican American adults compared to White adults. Our findings were consistent in a young, healthy subsample, suggesting non-cardiometabolic determinants of these differences.

Conclusions: NT-proBNP levels are significantly lower among Black and Mexican American adults compared with White adults, independent of cardiometabolic risk. Although race/ethnicity is a poor proxy for genetic differences, our findings may have clinical implications for the management of HF. However, studies in diverse populations are needed to characterize the biological basis of NT-proBNP variation.

Keywords: Biomarkers; Cardiovascular disease; Epidemiology; Ethnicity; Race.