Clinical and community factors' correlation with NT-proBNP in First Nations: a cross-sectional analysis of the CAHHM-FN cohort

Background
In Canada, Indigenous populations face inequities in cardiovascular care, and have disparate heart failure (HF) outcomes. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker that has been demonstrated to predict sub-clinical left ventricular (LV) dysfunction, clinical HF and cardiovascular events. Given disparities in HF outcomes and care between Indigenous and non-Indigenous people in Canada, this study sought to understand the unique sociocultural, clinical and community factors that are associated with circulating NT-proBNP levels.
Methods
We conducted a cross-sectional analysis of 579 First Nations adults from the Canadian Alliance for Healthy Hearts and Minds First Nations study, who completed detailed questionnaires, physical measures, community audits, cardiac MRI, and biomarker testing. We examined associations between NT-proBNP levels and clinical, sociocultural, and community factors, and subsequently evaluated the association between NT-proBNP and LV size, mass and function on cardiac MRI.
Results
Increased access to primary care and cardiovascular risk factor screening were associated with lower NT-proBNP levels. Higher NT-proBNP was associated with older age, female sex, cardiovascular disease, and second-hand smoke exposure. Participants in the highest NT-proBNP tertile were more likely to have increased LV dimensions and mass and reduced ejection fraction.
Conclusions
In this unique Indigenous cohort, several clinical, community and sociocultural factors were associated with NT-proBNP elevation, which was also associated with subclinical LV abnormalities. These findings may explain some of the disparities in HF outcomes faced by Indigenous populations. Longitudinal follow-up is needed to assess these factors’ predictive value on the development of incident clinical HF.