Proprotein Convertase Subtilisin/Kexin type 9, C-Reactive Protein, Coronary Severity, and Outcomes in Patients With Stable Coronary Artery Disease

Abstract

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Circulating Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Concentration and Risk of Cardiovascular Events ― Systematic Review and Meta-Analysis of Prospective Studies ―

“…20 The association, however, became non-significant after adjustment for fasting triglyceride concentration (RR, 1.32; 95% CI: 0.93-1.87; P=0.126). 21 In the present meta-analysis, we found that using the HR from the model unadjusted for fasting triglyceride concentration did not change the overall risk estimate (RR, 1.04; 95% CI: 0.99-1.10; I 2 =48.3%, P=0.060). Furthermore, Li et al reported that the association was significant in CAD patients with medication alone but not in those with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).…”

“…Plasma PCSK9 predicted CVD events in CAD patients with medication alone but not in those with PCI/CABG treatment. 21 Another study observed a significant association between PCSK9 and CVD risk in patients treated with low-dose but not high-dose atorvastatin. 19 Statins can upregulate PCSK9 expression and modify the association between PCSK9 concentration and CVD risk.…”

“…Furthermore, Li et al reported that the association was significant in CAD patients with medication alone but not in those with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). 21 We assessed the risk estimates in these 2 subgroups and the results essentially remained the same. Sensitivity analysis according to type of ELISA kit used for PCSK9 measure- Gain-of-function mutation of PCSK9 (E670G) was associated with increased LDL-C and severity of CAD hypercholesterolemia, 33-35 whereas lossof-function variants (C679X, Y142X, and R46L) were associated with reduced mean LDL-C and CAD risk.…”

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

“…In addition, we also evaluate separately the association between PCSK9 level and recurrent CV events in patients with or without reperfusion therapy during hospitalization because reperfusion therapy for AMI patients within the effective time window can improve clinical outcomes, which could impact the predictive value of PCSK9. A prior study reported that PCSK9 had significant predictive value for subjects treated with medication alone but had no predictive value for patients treated with revascularization [11]. …”

“…One study assessed the predictive value of PCSK9 in patients with acute coronary syndrome (ACS) [9], and other studies have examined the predictive value of PCSK9 in patients with stable coronary artery disease [10, 11]. The upregulation of PCSK9 at the initiation of lipid-lowering therapy has been suggested as a potential mechanism leading to statin resistance [12].…”