Abstract P160: Racial Differences in the Association of NTproBNP With Risk of Incident Heart Failure in REGARDS Participants

Abstract

Background: Black individuals have lower N-terminal-pro-B-type natriuretic peptide (NTproBNP) levels than whites. Higher NTproBNP levels are associated with increased risk of incident heart failure (HF). Although, the ability of NTproBNP for risk stratification is variable in the setting of obesity and kidney disease. We studied the 1) association of NTproBNP with incident HF stratified by race and 2) tested the predictive ability across body mass index (BMI) and estimated glomerular filtration rate (eGFR) categories. Methods: Using a case-cohort design, NTproBNP levels were measured from the Reasons for Geographic And Racial Differences in Stroke study for 855 participants who subsequently developed incident HF and 3,680 randomly selected participants. Multivariable Cox proportional hazard modeling including all the factors which can affect NTproBNP levels was used to assess 1) the association of NTproBNP with incident HF; 2) interaction by race, and 3) predictive ability of NTproBNP based on percentage contribution in global Wald Chi-square score across BMI and eGFR categories. Results: The mean age of the random sub-cohort was 66.6 (12.1) years, 1,847 (50.2%) were females and 1,775 (48.2%) were blacks. The magnitude and strength of the relationship of NTproBNP with incident HF differed by race (p=0.01 for interaction). A doubling in NTproBNP levels was associated with greater risk of incident HF among whites [(hazard ratio (HR): 1.82; 95% CI: 1.62-2.04] compared with blacks (HR: 1.54; 95% CI: 1.35-1.75). NTproBNP remained a strong predictor (25%-50% Wald score) of incident HF across all BMI and eGFR categories in whites. However, among blacks with obesity (BMI ≥ 30 kg/m 2 ) and eGFR ≤60 mL/min/1.73 m 2 , NTproBNP was a weak predictor of incident HF (<7% Wald score) ( Figure ). Conclusions: Higher NTproBNP was more strongly associated with incident HF among whites compared with blacks. The predictive ability of NTproBNP levels with incident HF was preserved with obesity and impaired renal function among whites, but not in blacks.