The ethnicity-specific association of biomarkers with the angiographic severity of coronary artery disease.

C M Gijsberts,I E M Bank,M Y Chan,M Roest,P Agostoni,J A Remijn,F W Asselbergs,H M Den Ruijter,A Seneviratna,I E Hoefer,H C Kiat,G Pasterkamp,A M Richards,D P V De Kleijn

doi:10.1007/s12471-015-0798-y

Abstract

BackgroundRisk factor burden and clinical characteristics of patients with coronary artery disease (CAD) differ among ethnic groups. We related biomarkers to CAD severity in Caucasians, Chinese, Indians and Malays.MethodsIn the Dutch-Singaporean UNICORN coronary angiography cohort (n = 2033) we compared levels of five cardiovascular biomarkers: N-terminal pro-brain natriuretic peptide (NTproBNP), high-sensitivity C-reactive protein (hsCRP), cystatin C (CysC), myeloperoxidase (MPO) and high-sensitivity troponin I (hsTnI). We assessed ethnicity-specific associations of biomarkers with CAD severity, quantified by the SYNTAX score.ResultsAdjusted for baseline differences, NTproBNP levels were significantly higher in Malays than in Chinese and Caucasians (72.1 vs. 34.4 and 41.1 pmol/l, p < 0.001 and p = 0.005, respectively). MPO levels were higher in Caucasians than in Indians (32.8 vs. 27.2 ng/ml, p = 0.026), hsTnI levels were higher in Malays than in Caucasians and Indians (33.3 vs. 16.4 and 17.8 ng/l, p < 0.001 and p = 0.029) and hsTnI levels were higher in Chinese than in Caucasians (23.3 vs. 16.4, p = 0.031). We found modifying effects of ethnicity on the association of biomarkers with SYNTAX score. NTproBNP associated more strongly with the SYNTAX score in Malays than Caucasians (β 0.132 vs. β 0.020 per 100 pmol/l increase in NTproBNP, p = 0.032). For MPO levels the association was stronger in Malays than Caucasians (β 1.146 vs. β 0.016 per 10 ng/ml increase, p = 0.017). Differing biomarker cut-off levels were found for the ethnic groups.ConclusionWhen corrected for possible confounders we observe ethnicity-specific differences in biomarker levels. Moreover, biomarkers associated differently with CAD severity, suggesting that ethnicity-specific cut-off values should be considered.

Highlights

Coronary artery disease (CAD) is highly prevalent worldwide but over the few decades the majority of deaths due to coronary artery disease (CAD) will occur in Asia [1]
We evaluated five established biomarkers known to be affected by CAD: N-terminal pro-brain natriuretic peptide (NTproBNP) [8,9,10], high-sensitivity C-reactive protein [11], cystatin C (CysC) [12, 13], myeloperoxidase (MPO) [14, 15] and high-sensitivity troponin I [16, 17]
In our cohort we find the highest fully adjusted levels for Malays and very high cut-off levels were found for Indians and Malays, indicating that in those ethnic groups NTproBNP levels correspond to less severe CAD than in Chinese and Caucasians

Summary

Introduction

Coronary artery disease (CAD) is highly prevalent worldwide but over the few decades the majority of deaths due to CAD will occur in Asia [1]. Triple-vessel disease is more common in South Asians than in Caucasians [3], whilst the Chinese suffer from less severe CAD [4]. Risk factor burden and clinical characteristics of patients with coronary artery disease (CAD) differ among ethnic groups. We related biomarkers to CAD severity in Caucasians, Chinese, Indians and Malays. We assessed ethnicityspecific associations of biomarkers with CAD severity, quantified by the SYNTAX score. NTproBNP associated more strongly with the SYNTAX score in Malays than Caucasians (b 0.132 vs b 0.020 per 100 pmol/l increase in NTproBNP, p = 0.032). For MPO levels the association was stronger in Malays than Caucasians (b 1.146 vs b 0.016 per 10 ng/ml increase, p = 0.017). Biomarkers associated differently with CAD severity, suggesting that ethnicity-specific cut-off values should be considered

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