Abstract 16696: Racial Differences in Cardiometabolic Determinants of Natriuretic Peptide Levels in Clinically Referred Patients With and Without Heart Failure

Abstract

Background: Relative natriuretic peptide (NP) deficiencies are associated with hypertension, diabetes, and obesity. The prevalence of these conditions varies by race, affecting more black than white individuals. We assessed whether circulating NP levels and factors associated with NP levels differ by race in clinically referred patients. Methods: Using Vanderbilt University Medical Center electronic health records from 2002 to 2013, we examined plasma B-type natriuretic peptide (BNP) levels and correlates in 30,487 black (17%) or white adult patients. Multivariable-adjusted models including interaction terms by race and stratification by heart failure (HF) status were used. Results: In 18,850 patients without HF, BNP levels were lower in black [median 58 pg/ml (25 th , 75 th percentile: 23, 179)] compared with white individuals [97 pg/ml (38, 247)], p< 0.001. Factors most strongly correlated with BNP differed between black (creatinine, age, chronic kidney disease, body mass index (BMI), left ventricular [LV] ejection fraction) and white (age, BMI, LV mass, chronic kidney disease, sex) patients ( Figure ). Lower BNP levels in black patients were observed across the spectrum of heart rate, blood pressure, body mass index, glucose, LV ejection fraction and mass, and renal function. The directional association of cardiometabolic risk factors with BNP levels was largely similar by race, with exceptions of significant interactions by BMI and creatinine. Higher BMI was associated with lower BNP levels in whites, while among black patients beyond a BMI of approximately 35 kg/m 2 , BNP levels did not decline any further. With higher creatinine, the rise in BNP levels was steeper in black compared with white patients. In contrast to patients without HF, among patients with HF (n = 11,637), BNP levels and its correlates were similar between black and white patients ( Figure ). Conclusion: The associations between cardiometabolic factors and BNP levels vary by race and HF status.