23 Nov Racial Differences in Plasma Biomarker May Partially Explain Stroke Disparities
MedicalResearch.com Interview with:
Pankaj Arora MD, FAHA
Assistant Professor, Cardiology Division
University of Alabama at Birmingham
Section Editor, Circulation: Cardiovascular Genetics
American Heart Association
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Natriuretic peptides are hormones produced by the heart in response to increased wall stress in the atria and ventricles. It is well known that blacks have increased prevalence of cardiovascular disease which contributes to racial disparities in outcomes.
In the current work, we tested the hypothesis that black race is a natriuretic peptide deficiency state using a stratified random cohort of 4,415 participants selected from the REGARDS study (a national population-based cohort study evaluating racial and geographic disparities in stroke in US adults aged ≥45 years of age or older). Next, we looked for published results on the percentage difference in N-terminal proB-type NP (NTproBNP) levels by race in participants free of cardiovascular disease from other population cohorts. Lastly, we explored whether association of natriuretic peptides with all-cause mortality and CV mortality in apparently healthy individuals from REGARDS differs by race.
We found that in multivariable adjustment, NTproBNP levels were up to 27% lower in black individuals as compared with white individuals in the REGARDS study. We pooled our results and found that in meta-analysis of the 3 cohorts, NTproBNP levels were 35% lower in black individuals than white individuals (more than 13,000 individuals in total). Lastly, we found that the higher NTproBNP levels were associated with higher incidence of all-cause mortality, and cardiovascular mortality in healthy blacks and white individuals, and this association did not differ by race.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Black race is a natriuretic peptide deficiency state. The prognostic value of natriuretic peptide levels in a population-based cohort is similar in blacks and white individuals. Endogenously suppressed natriuretic peptide system could contribute to a higher risk of hypertension and heart failure in black individuals as compared to with white individuals.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: While the differences in resting natriuretic peptide levels are suggestive, a key piece of missing information is whether natriuretic peptide production in response to dynamic physiological perturbations is reduced in blacks.
MedicalResearch.com: Is there anything else you would like to add?
Response: In an era of precision medicine, we hope to personalize the use of natriuretic peptide augmenting heart failure therapy such as sacubitril/valsartan with further studies in the natriuretic peptide deficient subgroups (e.g. obese, blacks, individuals with genetic variants associated with lower natriuretic peptide levels).
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Navkaranbir S. Bajaj, Orlando M. Gutiérrez, Garima Arora, Suzanne E. Judd, Nirav Patel, Aleena Bennett, Sumanth D. Prabhu, George Howard, Virginia J. Howard, Mary Cushman, Pankaj Arora. Racial Differences in Plasma Levels of N-Terminal Pro–B-Type Natriuretic Peptide and OutcomesThe Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. JAMA Cardiol. Published online November 22, 2017. doi:10.1001/jamacardio.2017.4207
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