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

Academic Article


  • 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 (a) the association of NT-proBNP with incident HF and (b) the predictive ability of NT-proBNP for incident HF across 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 2923 (weighted 20,075) non-case randomly selected participants. Multivariable Cox proportional hazard modeling was used to assess the objectives of our study. Global Wald χ 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 (HR: 1.73; 95% CI: 1.55–1.94) than Black individuals (HR: 1.51; 95% CI: 1.34–1.70), with P by race of 0.024. Higher NT-proBNP was the strongest predictor of incident HF across all BMI and eGFR categories among White individuals. In contrast, among Black individuals with obesity (BMI ≥ 30 kg/m ) or eGFR less than 60 mL/min/1.73 m , 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 the Black population with obesity or impaired kidney function highlights the need for further investigations. FUNDING. National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; National Institute on Aging; and the NIH. 2 2 2 interaction
  • Published In

  • JCI insight  Journal
  • Digital Object Identifier (doi)

    Author List

  • Patel N; Cushman M; Gutiérrez OM; Howard G; Safford MM; Muntner P; Durant RW; Prabhu SD; Arora G; Levitan EB
  • Volume

  • 4
  • Issue

  • 13