Key result
In black African hemodialysis patients, circulating PCSK9 levels in the highest tertile were independently associated with an increased predicted risk of future cardiovascular events (aOR 8.9).
Why the study?
PCSK9 has been identified as a biomarker interfering in lipid homeostasis, but its association with dyslipidemia and future cardiovascular event risk in black Africans needed investigation.
Do elevated serum PCSK9 levels predict a higher future risk of cardiovascular events in black African hemodialysis patients?
Cross-Sectional (n=251)
Yes
Do elevated serum PCSK9 levels predict a higher future risk of cardiovascular events in black African hemodialysis patients?
Increased serum PCSK9 levels are independently associated with atherogenic dyslipidemia and a higher predicted 10-year risk of cardiovascular events in black African hemodialysis patients.
Answers are grounded in this paper and cite their sources.
PCSK9 levels may stratify CV risk in black African hemodialysis patients; cross-sectional data leave open prospective validation before clinical adoption.
CONTEXT AND OBJECTIVE: Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans. METHODS: A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events. RESULTS: Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06-17.3, P<0.001) and highest tertiles (aOR 8.9, 95% CI 3.02-25.08, P<0.001) presented a greater risk of cardiac event. CONCLUSION: Increased PCSK9 serum levels are associated with higher levels of TC, LDL-c, and TG and lower levels of HDL-c in black African hemodialysis patients. Serum PCSK9 levels in these patients predict increased risk of cardiovascular events, independent of traditional potential confounders.
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Kajingulu et al. (2021) conducted a cross-sectional in Chronic kidney disease grade 5 (CKD G5) on hemodialysis (n=251). Circulating Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) levels vs. Lowest PCSK9 tertile was evaluated on Future risk of cardiovascular events (predicted by Framingham equation) (aOR 8.9, 95% CI 3.02-25.08, p=<0.001). In black African hemodialysis patients, circulating PCSK9 levels in the highest tertile were independently associated with an increased predicted risk of future cardiovascular events (aOR 8.9).
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