Serum Atrial Natriuretic Peptide, 'NPPA' Promoter Methylation, and Cardiovascular Disease: A 10-year Follow-Up Study in Chinese Adults

Background: Atrial natriuretic peptide (ANP) has been associated with cardiovascular disease (CVD) and related risk factors, but the clinical application is limited and the underlying mechanisms are not very clear. Here, we aimed to examine whether proANP and its coding gene methylation were associated with CVD in the Chinese population. Methods: Serum proANP and peripheral blood DNA methylation of natriuretic peptide A gene ('NPPA') promoter was quantified at baseline for 2,498 community members (mean aged 53 years, 38% men) in the Gusu cohort. CVD events were obtained during 10 years of follow-up. A competing-risks survival regression model was applied to examine the prospective associations of proANP and 'NPPA' promoter methylation with incident CVD. Results: During follow-up, 210 participants developed CVD events, 50 participants died from non-cardiovascular causes, and 214 participants were lost. Per 1-nmol/L increment of serum proANP was associated with a 22% (HR = 1.22, 95%CI: 1.03–1.44, 'P' = 0.025) higher risk of CVD during follow-up. Of the 9 CpG sites assayed, per 2-fold increment of DNA methylation at CpG3 (located at Chr1:11908299) was significantly associated with a half lower risk of CVD (HR = 0.50, 95%CI: 0.30–0.82, 'P' = 0.006). The gene-based analysis found that DNA methylation of the 9 CpGs at 'NPPA' promoter as a whole was significantly associated with incident CVD ('P' < 0.05). Conclusions: Increased proANP and hypomethylation at 'NPPA' promoter at baseline predicted an increased future risk of CVD in Chinese adults. Aberrant DNA methylation of the 'NPPA' gene may participate in the mechanisms of CVD.