NT-proBNP reading Misleading If Race & Gender Not Taken into Account: JAMA
The availability of evidence-based medical interventions to prevent the onset of signs and symptoms of heart failure (HF) affords a unique opportunity to attenuate the risk of disease with substantial morbidity and mortality. Targeting the prevention of HF is an apt goal. Yet determining those at greatest risk for HF is still challenging. A recent study suggests that N-terminal pro–B-type natriuretic peptide (NT-proBNP) cut-points irrespective of sex and race may lead to misclassification of risk in certain demographic subgroups, in particular underestimation of risk in Black men and overestimation of risk in White women. The study findings were published in the JAMA Cardiology on April 27, 2022.
Sex- and race-based differences in N-terminal pro–B-type natriuretic peptide (NT-proBNP) concentrations are poorly understood. The absolute risk of incident heart failure (HF) associated with NT-proBNP concentration across these important demographic categories is unclear. Therefore, Dr Peder L. Myhre and his determine whether physiologic determinants of NT-proBNP concentrations account for sex and race differences, and to more uniformly predict HF risk using NT-proBNP in these demographic subgroups.
In the longitudinal Atherosclerosis Risk in Communities (ARIC) cohort, the researchers compared black men with white women, who had up to a seven-fold higher risk of incident HF or death in midlife than predicted based on the same guideline-recommended threshold for NT-proBNP. They assessed the contribution of clinical, anthropometric, echocardiographic, and laboratory parameters to sex- and race-based differences in NT-proBNP concentration at visit 5 using linear regression. The major outcome assessed was the incident of HF or death.
Key findings of the study:
- Upon analysis, the researchers found that in both midlife and late life, NT-proBNP concentration was lowest in Black men (median [IQR] concentration: visit 2, 30 [14-67] pg/mL; visit 5, 74 [34-153] pg/mL) and highest in White women (median [IQR] concentration: visit 2, 70 [42-111] pg/mL; visit, 5, 154 [82-268] pg/mL).
- They noted that sex and race differences in NT-proBNP concentration persisted after accounting for age, income, education, area deprivation index, cardiovascular diseases, left ventricular structure (LV), LV function, LV wall stress, weight and fat mass, and estimated glomerular filtration rate.
- They found that substantial differences in the absolute risk of incident HF or death existed across the sex- and race-based categories at any NT-proBNP concentration (eg, 7-fold [rate ratio, 6.7] and 3-fold [rate ratio, 2.7] difference at visit 2 and visit 5, respectively, at guideline-recommended thresholds) with higher risk consistently observed among Black men and lower risk in White women.
- They reported that the results were replicated in a cohort of participants from the Cardiovascular Health Study.
The authors concluded, "In this study, sex- and race-based differences in NT-proBNP persisted after accounting for known physiologic determinants. The absolute risk associated with a given value of NT-proBNP varied substantially by sex and race. Consideration of NT-proBNP values in the context of sex and race allows for more uniform prediction of absolute risk across important demographic subgroups."
For further information:
DOI:10.1001/jamacardio.2022.0680
Keywords:
N-terminal pro–B-type natriuretic peptide, NT-proBNP concentration, Gender differance, Race difference, HF, Heart failure, Patient demographic, sex- and race-based differences, ARIC cohort, JAMA Cardiology.
