Heart Failure Risk Estimates Shift for Black Men, White Women

Peder Langeland Myhre, MD PhD

Risk estimates of incident heart failure and death for Black men and White women by N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration are often miscalculated, according to a paper published in JAMA Cardiology.

Investigators from Brigham and Women’s Hospital used data from visits 2 and 5 from the longitudinal Atherosclerosis Risk in Communities study in order to better understand the sex- and race-based differences in NT-proBNP concentrations and the risk of heart failure.

“NT-proBNP has been known to be lower in men compared to women, and lower in those identifying as Black race compared to White race,” explained study author Peder Langeland Myhre, MD PhD in an interview with HCPLive®. “However, the risk of heart failure is generally higher in men and higher in Black individuals. Despite these differences, guideline-recommended thresholds for defining heart failure risk and heart failure vary by age but not sex or race.”

Visit 2 from the original study included 12,750 participants and visit 5 included 5,191 participants plus a collection of clinical, anthropometric, echocardiographic, and laboratory data as related to sex- and race-based differences in NT-proBNP, the study authors noted. The participants were free of heart failure at the midlife visit 2 marker and the late life visit 5 marker. The investigators also wanted to be able to more uniformly predict heart failure risk using NT-proBNP in different populations.

The mean age at visit 5 for the participants was 76 years, with study authors adding that 41% were male, 20% were Black, and the NT-proBNP concentration was 124 pg/mL.

Black men had the lowest NT-proBNP concentration at both the midlife (30 pg/mL) and late life (74 pg/mL) checkpoints and White women had the highest at both visits 2 and 5 (70 pg/mL and 154 pg/mL, respectively), the study authors found.

These sex- and race-based differences continued to persist even after the investigators analyzed NT-proBNP concentrations 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.

“When considering risk of developing heart failure, our findings indicate that NT-proBNP concentrations should be considered in the context of sex and race to allow for more uniform risk prediction," Mhyre added. "NT-proBNP associated with any given absolute risk of developing heart failure will be lower for Black men and higher for White women. These observations become particularly important given emerging therapies for heart failure prevention.”

Dr. Myhre also noted that the investigators additionally analyzed genetic ancestry, including differences in race, and found that the differences by sex and race persisted. The study authors observed a difference of 40% between men and women and 30% between Black and White individuals, they wrote.

Moreover, the study authors discovered what they called “substantial differences” in the absolute risk of incident heart failure or death across the sex- and race-based categories at any concentration of NT-proBNP. The higher risk was consistently observed among Black men and they saw a lower risk for White women.

“Further research is necessary to understand why these differences in circulating concentrations of NT-proBNP between groups based on sex and race exist,” Myhre concluded.

The study, "Sex and Race Differences in N-Terminal Pro–B-type Natriuretic Peptide Concentration and Absolute Risk of Heart Failure in the Community," was published in JAMA Cardiology.