Acute-Phase Plasma PCSK9 Levels and Recurrent Cardiovascular Events in a Chinese Acute Myocardial Infarction Cohort

Abstract

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a promising target for lowering plasma low-density lipoprotein cholesterol and preventing cardiovascular (CV) disease. Whether plasma PCSK9 measured during the acute phase predicts recurrent CV events in patients with acute myocardial infarction (AMI) remains unresolved. Methods and Results: Plasma PCSK9 levels were measured in 1,646 patients with AMI from the China PEACE-Prospective AMI Study at the acute phase. Additionally, 248 patients were resampled and measured at 1 month post-AMI. Associations of acute-phase PCSK9 tertiles with clinical characteristics and recurrent CV events within 1 year were assessed. Female gender (OR 1.94, 95% CI 1.24–3.03), premature coronary heart disease (CHD; OR 2.12, 95% CI 1.37–3.26), higher high-sensitivity C-reactive protein (OR 1.67, 95% CI 1.44–1.95), and higher triglycerides (OR 1.46, 95% CI 1.03–2.09) were associated with higher baseline PCSK9. Plasma PCSK9 levels in the highest tertile (versus lowest) did not have an increased risk of 1-year recurrent CV events in the AMI cohort (HR 0.78, 95% CI 0.52–1.16) or any subgroup. There was also no association between percentage changes in PCSK9 over the first month and 1-year recurrent events, although there was a trend of differences between patients in the upper versus lower tertiles. Conclusion: Plasma PCSK9 levels measured during the acute phase were associated with high-sensitivity C-reactive protein, triglycerides, premature CHD, and gender in patients with AMI but did not predict recurrent CV events within 1 year. Dynamic changes in PCSK9 suggested a trend yet no significance value in predicting recurrent CV events.

Association Between Circulating Proprotein Convertase Subtilisin/Kexin Type 9 and Major Adverse Cardiovascular Events, Stroke, and All-Cause Mortality: Systemic Review and Meta-Analysis

“…After we screened titles and abstracts, 29 articles were qualified for full-text evaluation. After full-text review, nine studies were excluded, and 22 eligible cohorts from 20 eligible articles were finally included for metaanalysis (7)(8)(9)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Figure 1 demonstrates a flowchart for the study selection.…”

Association Between Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Concentrations and Cardiovascular Events in Cardiovascular Disease: A Systemic Review and Meta-Analysis

“…Of the 11 studies included, only 1 ( 22 ) was a retrospective cohort study and the others were prospective cohort studies, with a publication period from 2014 to 2020. Four trials ( 20 , 22 , 27 , 28 ) reported RRs according to continuous concentrations of PCSK9, three studies ( 19 , 24 , 26 ) reported RRs according to categorical levels, and four studies ( 8 , 21 , 23 , 28 ) reported RRs according to both continuous and categorical levels. We included 8,471 patients, and the sample size of each study ranged from 249 to 2,030.…”

“…Table 1 shows the characteristics of the included studies (8,9,(19)(20)(21)(22)(23)(24)(26)(27)(28). Of the 11 studies included, only 1 ( 22) was a retrospective cohort study and the others were prospective cohort studies, with a publication period from 2014 to 2020.…”

Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

“…29,30 The current study's strength was that the recruited subjects were better identified as a high-risk population, which is entirely different compared with other studies. 10,11,13,31 Moreover, this has been the first study to determine the association between PCSK9 E670G and R46L polymorphisms and MACCE among patients with STEMI undergoing primary PCI. Given that the current study was a single-center prospective cohort observational study and not a nationwide study, its selected population attending the tertiary hospital can be considered a limitation.…”

“…However, the study did not predict cardiovascular disease (CVD) recurrence during the 1-year follow-up period. 10 Our present study recruited only patients with STEMI, all of whom were managed with primary PCI as recommended by our medical care standards.…”