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Original research article
NT-proBNP, race and endothelial function in the Multi-Ethnic Study of Atherosclerosis
  1. Sushan Yang1,
  2. Shi Huang2,
  3. Lori B Daniels3,
  4. Joseph Yeboah4,
  5. Joao A C Lima5,
  6. Valentina Cannone6,7,
  7. John C Burnett Jr8,
  8. Joshua A Beckman9,
  9. J Jeffrey Carr10,
  10. Thomas J Wang9,
  11. Deepak K Gupta9
  1. 1 Department of Medicine-Cardiology, University of Washington System, Seattle, Washington, USA
  2. 2 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3 Department of Medicine, UC San Diego, La Jolla, California, USA
  4. 4 Medicine-Cardiovascular, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
  5. 5 Departments of Radiology and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
  6. 6 Cardiorenal Research Laboratory, Mayo Clinic Minnesota, Rochester, Minnesota, USA
  7. 7 Department of Clinical and Experimental Medicine, University of Parma Medical School, Parma, Italy
  8. 8 Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  9. 9 Department of Medicine-Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  10. 10 Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Deepak K Gupta, Medicine-Cardiology, Vanderbilt University Medical Center, Nashville, TN 37203, USA; d.gupta{at}, d.gupta{at}


Objective Natriuretic peptides (NPs) are hormones with cardioprotective effects. NP levels vary by race; however, the pathophysiological consequences of lower NP levels are not well understood. We aimed to quantify the association between NPs and endothelial function as measured by flow-mediated dilation (FMD) and the contribution of NP levels to racial differences in endothelial function.

Methods In this cross-sectional study of 2938 Multi-Ethnic Study of Atherosclerosis participants (34% Caucasian, 20% African-American, 20% Asian-American and 26% Hispanic) without cardiovascular disease at baseline, multivariable linear regression models were used to examine the association between serum N-terminal pro-B-type NP (NT-proBNP) and natural log-transformed FMD. We also tested whether NT-proBNP mediated the relationship between race and FMD using the product of coefficients method.

Results Among African-American and Chinese-American individuals, lower NT-proBNP levels were associated with lower FMD, β=0.06 (95% CI: 0.03 to 0.09; p<0.001) and β=0.06 (95% CI: 0.02 to 0.09; p=0.002), respectively. Non-significant associations between NT-proBNP and FMD were found in Hispanic and Caucasian individuals. In multivariable models, endothelial function differed by race, with African-American individuals having the lowest FMD compared with Caucasians, p<0.001. Racial differences in FMD among African-Americans and Chinese-Americans were mediated in part by NT-proBNP levels (African-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01); Chinese-Americans, mediation effect: −0.03(95% CI: −0.05 to −0.01)).

Conclusions Lower NP levels are associated with worse endothelial function among African-Americans and Chinese-Americans. A relative NP deficiency in some racial/ethnic groups may contribute to differences in vascular function.

  • cardiac risk factors and prevention
  • epidemiology

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  • Contributors All authors have substantially contributed to the study design, collection of data, analysis and interpretation, drafting the manuscript or critical revisions to the manuscript.

  • Funding This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-TR-000040 and UL1-TR-001079 from NCRR. This research was also supported by the National Heart, Lung, and Blood Institute grants K12 HL109019, 1K23HL128928-01A1, and the National Center for Advancing Translational Sciences of the National Institutes of Health award numbers UL1TR000445 (Vanderbilt University). Roche Diagnostics provided reagents for the measurement of NT-proBNP.

  • Competing interests LBD has received speaking fees from Roche and Critical Diagnostics, and consulting honoraria from Roche Diagnostics and Siemens Healthcare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement DKG had full access to all the data in the study and takes responsibility for its integrity and the data analysis.

  • Patient consent for publication Not required.