Key result
Elevated circulating PCSK9 levels were independently associated with an increased risk of major cardiovascular events in patients with type 2 diabetes mellitus (adjusted HR 2.780).
Why the study?
PCSK9's ability to predict cardiovascular outcomes has been controversial, and data on PCSK9, CHD severity, and MACEs in T2DM patients were lacking.
Does elevated serum PCSK9 predict major cardiovascular events and coronary heart disease severity in patients with type 2 diabetes mellitus?
Cohort (n=2,984)
Yes
Does elevated serum PCSK9 predict major cardiovascular events and coronary heart disease severity in patients with type 2 diabetes mellitus?
Elevated serum PCSK9 levels are an independent risk factor for coronary heart disease severity and long-term major cardiovascular events in patients with type 2 diabetes mellitus.
Answers are grounded in this paper and cite their sources.
Should not alter management in T2DM; hypothesis-generating for PCSK9 as biomarker and therapeutic target.
BACKGROUND AND AIMS: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is considered a new biomarker for atherosclerosis, but its ability to predict cardiovascular outcomes has been controversial. This study aimed to address the lack of data on PCSK9, coronary heart disease (CHD) severity, and major cardiovascular events (MACEs) in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 2984 T2DM patients underwent selective coronary angiography, and their serum PCSK9 levels were measured using enzyme-linked immunosorbent assay. Correlation and logistic regression analyses were performed to investigate the association between PCSK9 expression and CHD severity. This study used Cox regression analysis to assess the association between circulating PCSK9 levels and the risk of MACEs. RESULTS: Circulating PCSK9 levels were significantly higher in the CHD group than in the non-CHD group [554.62 (265.11) ng/mL vs. 496.86 (129.05) ng/mL, p < 0.001]. Circulating PCSK9 levels positively correlated with CHD severity (diseased vessels: r = 0.35, p < 0.001; Gensini score: r = 0.46, p < 0.001). Elevated PCSK9 levels are an independent risk factor for CHD risk and severity (CHD group vs. non-CHD group: OR = 2.829, 95% CI: 1.771-4.520, p < 0.001; three vessel disease group vs. one vessel disease group: OR = 4.800, 95% CI: 2.387-9.652, p < 0.001; high GS group vs. low GS group: OR = 5.534, 95% CI: 2.733-11.208, p < 0.001). Through a six-year follow-up and multivariate Cox regression analysis, elevated circulating PCSK9 levels were found to be independently associated with MACEs in all participants (HR: 3.416, 5% CI: 2.485-4.697, p < 0.001; adjusted HR: 2.780, 95% CI: 1.930-4.004, p < 0.001). CONCLUSIONS: Serum PCSK9 levels were positively correlated with multi-vessel CHD and Gensini score. Elevated circulating PCSK9 levels are an independent risk factor for CHD and increased incidence of MACEs in T2DM.
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Huang et al. (2023) conducted a cohort in Type 2 diabetes mellitus (n=2,984). Elevated circulating PCSK9 levels (highest quartile) vs. Lowest quartile of circulating PCSK9 levels was evaluated on Major cardiovascular events (MACEs) (adjusted HR 2.780, 95% CI 1.930-4.004, p=<0.001). Elevated circulating PCSK9 levels were independently associated with an increased risk of major cardiovascular events in patients with type 2 diabetes mellitus (adjusted HR 2.780).
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