Racial Differences in Natriuretic Peptide Levels

Gupta, Deepak K.; Lemos, James A. de; Ayers, Colby; Berry, Jarett D.; Wang, Thomas J.

doi:10.1016/j.jchf.2015.02.008

Cited by 80 publications

(66 citation statements)

References 46 publications

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“…Obesity is not the only cause of the NP deficiency syndrome. Several other factors, including genetic polymorphisms in the NPPA and NPPB genes [48], African ancestry [49], insulin resistance [45], increased androgens [50], and possibly even increased activity of neprilysin could all result in low levels of NPs, which contribute to and worsen the HFpEF syndrome, thereby potentially leading to a type of HFpEF consistent with pheno-group #1.…”

Section: The 3 Archetypes Of Hfpefmentioning

confidence: 99%

Precision Medicine for Heart Failure with Preserved Ejection Fraction: An Overview

Shah

2017

J. of Cardiovasc. Trans. Res.

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There are few proven therapies for heart failure with preserved ejection fraction (HFpEF). The lack of therapies, along with increased recognition of the disorder and its underlying pathophysiology, has led to the acknowledgement that HFpEF is heterogeneous and is not likely to respond to a one-size-fits-all approach. Thus, HFpEF is a prime candidate to benefit from a precision medicine approach. For this reason, we have assembled a compendium of papers on the topic of precision medicine in HFpEF in the Journal of Cardiovascular Translational Research. These papers cover a variety of topics relevant to precision medicine in HFpEF, including automated identification of HFpEF patients; machine learning, novel molecular approaches, genomics, and deep phenotyping of HFpEF; and clinical trial designs that can be used to advance precision medicine in HFpEF. In this introductory article, we provide an overview of precision medicine in HFpEF with the hope that the work described here and in the other papers in this special theme issue will stimulate investigators and clinicians to advance a more targeted approach to HFpEF classification and treatment.

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Section: The 3 Archetypes Of Hfpefmentioning

confidence: 99%

Precision Medicine for Heart Failure with Preserved Ejection Fraction: An Overview

Shah

2017

J. of Cardiovasc. Trans. Res.

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“…3–8 These cardiovascular risk factors disproportionately affect certain races/ethnicities, suggesting that relatively low NP concentrations may contribute to racial differences in susceptibility to cardiometabolic disease 9,10 However, whether NPs concentrations differ between racial/ethnic groups, with relatively low concentrations corresponding with those groups carrying the highest burden of cardiometabolic disease, has not been completely characterized. 11–13 Furthermore, a substantial proportion of the inter-individual variation in circulating NP concentrations has been attributed to genetic factors. 14 Whether genetic ancestry is also associated with NP concentrations has not been comprehensively examined.…”

Section: Introductionmentioning

confidence: 99%

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

Gupta

Daniels

Cheng

et al. 2017

The American Journal of Cardiology

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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/ethnicity. Heritable factors underlie a significant proportion of the inter-individual variation in NP concentrations, but the specific influences of race and ancestry are unknown. In 5,597 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 race/ethnicity and ancestry. Ancestry was determined using genetic ancestry informative markers. NT-proBNP concentrations differed significantly by racial/ethnicity (Black, median 43 pg/ml [IQR 17–94], Chinese 43 [17–90], Hispanic 53 [23–107], White 68 [34–136]; P = 0.0001). In multivariable models, NT-proBNP was 44% lower (95% CI, −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/ethnicity, with the lowest concentrations in Black and Chinese individuals. Racial/ethnic differences in NT-proBNP may have a genetic basis, with European and African ancestry associated with higher and lower NT-proBNP concentrations, respectively.

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“…Because we used covariates previously identified as associated with outcomes in other ASCEND‐HF analyses, we may not have included potential covariates which could affect the results. The evidence for the effect of race and sex on NT‐proBNP as a useful prognostic tool in HF is unclear and conflicting35; a substudy of the Dallas Heart Study36 found that whites had higher NT‐proBNP levels as compared with blacks and Hispanics whereas a Get With the Guidelines analysis found contradictory results 37. For example, findings of increased rates of peripheral edema and orthopnea in more‐obese patients may be attributed to confounding factors, such as venous stasis, obstructive sleep apnea, and right heart dysfunction observed in higher prevalence among obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Participants enrolled in the biomarker substudy were more often white (P<0.001), female (P=0.003), and recruited from North America (n=608; P<0.001), as compared with those not included in the biomarker substudy (Tables S1 and S2). Substudy patients had a higher BMI of 30 kg/m 2 (26,36) as compared with 28 kg/m 2 (24,33) in those who were not enrolled in the substudy (P<0.001).…”

Section: Biomarker Study Populationmentioning

confidence: 98%

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

Bhatt

Cooper

Ambrosy

et al. 2018

JAHA

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BackgroundHigher body mass index (BMI) is associated with lower circulating levels of N‐terminal‐pro‐b‐type natriuretic peptide (NT‐proBNP). The Interaction between BMI and NT‐proBNP with respect to clinical outcomes is not well characterized in patients with acute heart failure.Methods and ResultsA total of 686 patients from the biomarker substudy of the ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated HF ) clinical trial with documented NT‐proBNP levels at baseline were included in the present analysis. Patients were classified by the World Health Organization obesity classification (nonobese: BMI <30 kg/m2, Class I obesity: BMI 30–34.9 kg/m2, Class II obesity BMI 35–39.9 kg/m2, and Class III obesity BMI ≥40 kg/m2). We assessed baseline characteristics and 30‐ and 180‐day outcomes by BMI class and explored the interaction between BMI and NT‐proBNP for these outcomes. Study participants had a median age of 67 years (55, 78) and 71% were female. NT‐proBNP levels were inversely correlated with BMI (P<0.001). Higher NT‐proBNP levels were associated with higher 180‐day mortality (adjusted hazard ratio for each doubling of NT‐proBNP, 1.40; 95% confidence interval, 1.16, 1.71; P<0.001), but not 30‐day outcomes. The effect of NT‐proBNP on 180‐day death was not modified by BMI class (interaction P=0.24).ConclusionsThe prognostic value of NT‐proBNP was not modified by BMI in this acute heart failure population. NT‐proBNP remains a useful prognostic indicator of long‐term mortality in acute heart failure even in the obese patient.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852.

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Racial Differences in Natriuretic Peptide Levels

Cited by 80 publications

References 46 publications

Precision Medicine for Heart Failure with Preserved Ejection Fraction: An Overview

Precision Medicine for Heart Failure with Preserved Ejection Fraction: An Overview

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

Interaction of Body Mass Index on the Association Between N‐Terminal‐Pro‐b‐Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND‐HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure)

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