Risk prediction with proprotein convertase subtilisin/kexin type 9 (PCSK9) in patients with stable coronary disease on statin treatment

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

“…Werner et al found that PCSK9 was significantly associated with the risk of CVD events in the model unadjusted for fasting triglyceride concentration (RR, 1.44; 95% CI: 1.02-2.04; P=0.038). 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).…”

“…Further, fasting status and type of blood sample (serum or plasma) also differed across the studies, resulting in a large range of mean PCSK9 (94.3-546.5 ng/mL). 24,20 Differences in treatment regimen may have also contributed to the different results. Plasma PCSK9 predicted CVD events in CAD patients with medication alone but not in those with PCI/CABG treatment.…”

The Relationship between the Plasma PCSK9 Levels and Platelet Indices in Patients with Stable Coronary Artery Disease

“…Emerging evidence has shown that the plasma PCSK9 levels could be considered as an easy-to-measure and promising marker of clinical interest, given the clinical relevance of a higher plasma PCSK9 level to multiple cardiometabolic risk factors in different populations 9) and the recent findings that the PCSK9 levels predict recurrent cardiovascular events in patients with stable CAD, even in those with well-controlled low density lipoprotein cholesterol (LDL-C) levels 10) . Experimental studies have suggested that the harmful effect of PCSK9 on vascular biology might be mediated by mechanisms occurring via LDL-dependent 11) and LDL-independent pathways 12) , but the understanding of these pathways is limited.…”

PCSK9: A key factor modulating atherosclerosis

“…Finally, plasma PCSK9 levels are correlated with cardiovascular risk in the statin-naïve population 31) . However, on-treatment lipid levels, including apoB and apoAI levels, are no longer predictive, whereas the relative importance of nonlipid markers (e.g., age, gender, and smoking status) and non-HDL-C levels, which includes triglyceride levels, has increased [59][60][61] . Therefore, it is important to assess lipid metabolism mediators such as PCSK9 in patients receiving statins.…”

“…Therefore, it is important to assess lipid metabolism mediators such as PCSK9 in patients receiving statins. A prospective cohort study showed that elevated PCSK9 plasma levels are associated with cardiovascular events in patients with stable CAD despite statin therapy and a well-controlled LDL-C level 61) .…”