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Observational Study
. 2017 Sep 15;120(6):1008-1015.
doi: 10.1016/j.amjcard.2017.06.030. Epub 2017 Jun 30.

Differences in Natriuretic Peptide Levels by Race/Ethnicity (From the Multi-Ethnic Study of Atherosclerosis)

Deepak K Gupta  1 , Lori B Daniels  2 , Susan Cheng  3 , Christopher R deFilippi  4 , Michael H Criqui  5 , Alan S Maisel  6 , Joao A Lima  7 , Hossein Bahrami  8 , Philip Greenland  9 , Mary Cushman  10 , Russell Tracy  11 , David Siscovick  12 , Alain G Bertoni  13 , Valentina Cannone  14 , John C Burnett  14 , John Jeffrey Carr  15 , Thomas J Wang  16
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Free PMC article
Observational Study

Differences in Natriuretic Peptide Levels by Race/Ethnicity (From the Multi-Ethnic Study of Atherosclerosis)

Deepak K Gupta et al. Am J Cardiol. .
Free PMC article

Abstract

Natriuretic peptides (NP) are cardiac-derived hormones with favorable cardiometabolic actions. Low NP levels are associated with increased risks of hypertension and diabetes mellitus, conditions with variable prevalence by race and ethnicity. Heritable factors underlie a significant proportion of the interindividual variation in NP concentrations, but the specific influences of race and ancestry are unknown. In 5597 individuals (40% white, 24% black, 23% Hispanic, and 13% Chinese) without prevalent cardiovascular disease at baseline in the Multi-Ethnic Study of Atherosclerosis, multivariable linear regression and restricted cubic splines were used to estimate differences in serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels according to, ethnicity, and ancestry. Ancestry was determined using genetic ancestry informative markers. NT-proBNP concentrations differed significantly by race and ethnicity (black, median 43 pg/ml [interquartile range 17 to 94], Chinese 43 [17 to 90], Hispanic 53 [23 to 107], white 68 [34 to 136]; p = 0.0001). In multivariable models, NT-proBNP was 44% lower (95% confidence interval -48 to -40) in black and 46% lower (-50 to -41) in Chinese, compared with white individuals. Hispanic individuals had intermediate concentrations. Self-identified blacks and Hispanics were the most genetically admixed. Among self-identified black individuals, a 20% increase in genetic European ancestry was associated with 12% higher (1% to 23%) NT-proBNP. Among Hispanic individuals, genetic European and African ancestry were positively and negatively associated with NT-proBNP levels, respectively. In conclusion, NT-proBNP levels differ according to race and ethnicity, with the lowest concentrations in black and Chinese individuals. Racial and ethnic differences in NT-proBNP may have a genetic basis, with European and African ancestry associated with higher and lower NT-proBNP concentrations, respectively.

Figures

Figure 1
Figure 1. Multivariable adjusted percent differences in serum N terminus pro B type natriuretic peptide concentrations by self-reported race/ethnicity in the Multi-Ethnic Study of Atherosclerosis
Data presented as point estimate (95% confidence interval). Adjusted for age, sex, anti-HTN medication use, diabetes mellitus, heart rate, systolic blood pressure, body mass index, estimated glomerular filtration rate, urine albumin to creatinine ratio, low density lipoprotein cholesterol, triglycerides, education, income, left ventricular mass, and left ventricular ejection fraction. P <0.001 for all race/ethnic group comparisons with white individuals.
Figure 2
Figure 2. Relationships between genetic ancestry and N terminus pro B type natriuretic peptide concentrations in the Multi-Ethnic Study of Atherosclerosis
Multivariable-adjusted restricted cubic splines with data presented as point estimate (solid line) and 95% confidence interval (dashed lines). The histograms display the distribution of genetic ancestry within a self-reported race/ethnic group. All analyses adjusted for age, sex, anti-HTN medication, diabetes mellitus, heart rate, systolic blood pressure, body mass index, estimated glomerular filtration rate, urine albumin to creatinine ratio, low density lipoprotein cholesterol, triglycerides, education, income, left ventricular mass, and left ventricular ejection fraction. Genetic ancestries were included as covariates as follows: Panel A = European, Hispanic, and Chinese; Panels B & D = European, African, and Chinese; Panel C= African, Hispanic, and Chinese.
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