Key result
Higher plasma PCSK9 concentrations were independently associated with an increased risk of recurrent cardiovascular events in familial hypercholesterolemia patients (HR 1.45; 95% CI 1.11-1.88).
Why the study?
The prognostic value of plasma proprotein convertase subtilisin/kexin type 9 for predicting recurrent cardiovascular events in familial hypercholesterolemia patients remained undetermined.
Does plasma PCSK9 concentration predict recurrent cardiovascular events in patients with familial hypercholesterolemia?
Cohort (n=249)
Does plasma PCSK9 concentration predict recurrent cardiovascular events in patients with familial hypercholesterolemia?
Elevated plasma PCSK9 concentrations independently predict recurrent cardiovascular events in patients with familial hypercholesterolemia on standard lipid-lowering therapy.
AIMS: Familial hypercholesterolemia patients are characterized by early onset of coronary artery calcification and atherosclerosis, and high incidence of cardiovascular events. Plasma proprotein convertase subtilisin/kexin type 9 was reported to be a predictor for cardiovascular risk in the general population. However, its prognostic value for predicting recurrent cardiovascular events in familial hypercholesterolemia patients remains undetermined. METHODS: A total of 249 patients with molecularly and/or clinically (Dutch Lipid Clinic Network score > 6) defined familial hypercholesterolemia who had experienced a first cardiovascular event were consecutively included and plasma proprotein convertase subtilisin/kexin type 9 concentrations were measured by enzyme-linked immunosorbent assay. Coronary artery calcification was measured using Agatston method and coronary severity was assessed by Gensini score, respectively. All patients received standard lipid-lowering therapy and were followed-up for recurrent cardiovascular events. Univariate and multivariate regression and Cox analyses was used to calculate hazard ratios with 95% confidence interval. RESULTS: Circulating proprotein convertase subtilisin/kexin type 9 concentrations were positively associated with coronary artery calcification scores and Gensini score by both univariate and multivariate analyses. During a mean follow-up of 43 ± 19 months, 29 (11.51%) recurrent cardiovascular events occurred. Kaplan-Meier analysis showed that patients with the highest proprotein convertase subtilisin/kexin type 9 levels had the lowest event-free survival time. Multivariable Cox regression analysis revealed that proprotein convertase subtilisin/kexin type 9 was independently associated with recurrent cardiovascular events (hazard ratio: 1.45, 95% confidence interval: 1.11-1.88). The combination of proprotein convertase subtilisin/kexin type 9 to Cox prediction model led to an enhanced predictive value for recurrent cardiovascular events. CONCLUSIONS: Increased level of proprotein convertase subtilisin/kexin type 9 was a significant risk factor of atherosclerosis and independently predicted future recurrent cardiovascular events in familial hypercholesterolemia patients receiving standard lipid-lowering treatment.
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Cao et al. (2019) conducted a cohort in Familial hypercholesterolemia with a prior cardiovascular event (n=249). Plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) concentration vs. Lower PCSK9 concentrations was evaluated on Recurrent cardiovascular events (HR 1.45, 95% CI 1.11-1.88). Higher plasma PCSK9 concentrations were independently associated with an increased risk of recurrent cardiovascular events in familial hypercholesterolemia patients (HR 1.45; 95% CI 1.11-1.88).
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