Key result
Ethnicity significantly modified the association between biomarkers and coronary artery disease severity, with NTproBNP associating more strongly with SYNTAX scores in Malays than Caucasians (p=0.032).
Observational (n=2,033)
Yes
Absolute Event Rate: 0.132% vs 0.02%
p-value: p=0.032
Cardiovascular biomarkers associate differently with angiographic CAD severity across ethnic groups, suggesting that ethnicity-specific cut-off values should be considered in clinical practice.
Ethnic differences in NTproBNP–CAD associations suggest caution with uniform thresholds; leaves open whether ethnicity-specific cut-offs improve stratification.
BACKGROUND: 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. METHODS: In 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. RESULTS: Adjusted 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. CONCLUSION: When 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.
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Gijsberts et al. (2016) conducted an observational in Coronary artery disease (n=2,033). Ethnicity and cardiovascular biomarkers vs. Caucasian ethnicity was evaluated on Association of NTproBNP with SYNTAX score (beta per 100 pmol/l increase) (p=0.032). Ethnicity significantly modified the association between biomarkers and coronary artery disease severity, with NTproBNP associating more strongly with SYNTAX scores in Malays than Caucasians (p=0.032).
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