Racial differences in natriuretic peptide levels in wild type transthyretin amyloid cardiomyopathy

Black individuals have significantly lower serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels than White individuals in the general population. Racial differences in NT-proBNP have not been well-studied in transthyretin amyloid cardiomyopathy (ATTR-CM), but these differences may be clinically relevant since the NT-proBNP cut-offs used for disease staging and clinical trial inclusion are irrespective of race.

This is a multicenter retrospective study of Black and White patients diagnosed with wild type ATTR-CM from January 2018 through September 2025. The baseline NT-proBNP level was obtained within 2 months of diagnosis. Linear regression models were used to assess the association between race and baseline NT-proBNP.

We included 1350 patients (1224 White and 126 Black). Compared to the White group, the Black group had a higher proportion of female patients, a lower prevalence of AF, higher loop diuretic requirements, and worse left ventricular systolic function. The Black group also had a significantly higher unadjusted geometric mean NT-proBNP level than the White group, but this difference was attenuated after multivariable adjustment (relative difference 16%, P = 0.08).

In this study of Black and White patients with wild type ATTR-CM, racial differences in NT-proBNP levels were explained in part by differences in clinical characteristics that may reflect ATTR-CM disease severity.