Key result
In patients presenting with acute myocardial infarction, female sex was an independent predictor of 1-year major adverse cardiac events (HR 4.180), while circulating PCSK9 levels were not significantly correlated with outcomes.
Why the study?
Few studies have examined whether the role of circulating PCSK9 in the pathogenesis of acute myocardial infarction is sex specific.
Are there sex differences in circulating PCSK9 levels and 1-year MACE in patients presenting with acute myocardial infarction?
Cohort (n=281)
No
Are there sex differences in circulating PCSK9 levels and 1-year MACE in patients presenting with acute myocardial infarction?
Hazard Ratio: 4.18 (95% CI 1.136–15.374)
Absolute Event Rate: 15% vs 4.11%
p-value: p=0.031
In Chinese patients with AMI, women have higher circulating PCSK9 levels and higher 1-year MACE rates than men, but female sex, rather than PCSK9 level, is an independent predictor of MACE.
Female sex may inform post-AMI risk stratification independent of PCSK9; leaves open sex-specific prognostic factors for prospective validation.
A limited number of studies have explored whether the role of circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) in the pathogenesis of acute myocardial infarction (AMI) is sex specific. The purpose of the present study was to examine sex differences in plasma PCSK9 in Chinese patients with AMI. In this study, a total of 281 records from patients presenting with AMI were analyzed.We compared hospital data and plasma PCSK9 levels by sex difference for inpatients presenting with AMI. After 1 year of follow-up, major adverse cardiac events(MACE) were recorded. A Cox proportional hazards model was used to calculate hazard ratios with 95% confidence intervals. We found that, compared with male groups, PCSK9 levels were higher in female patients not only for overall patients with AMI but also for patients with ST-elevation myocardial infarction (STEMI) (median: 273.6 [215.6-366.8] vs. 325.1 [247.5-445.3] ng/ml, P = 0.0136; 273.4 [215.6-369.7] vs. 317.1 [249.6-450.1], P = 0.0275, respectively). The cumulative incidence of cardiac death and 1-year MACE were significantly higher in the female group compared with male group (10% vs. 2.74%, P = 0.025; 15% vs. 4.11%, P = 0.0054, respectively). On multivariate Cox regression analysis, female sex, total triglyceride, glycosylated hemoglobin A, and homocysteic acid were independent risk factors of 1-year MACE. There was no significant correlation between PCSK9 and 1-year MACE in total AMI patients. In conclusion, PCSK9 levels and 1-year MACE were higher in women with AMI than in men with AMI, however, female sex but not PCSK9 were significant correlated with the 1-year MACE. The clinical implications of this finding are worthy of further investigations and must be confirmed in larger cohorts.
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Zhang et al. (2019) conducted a cohort in Acute Myocardial Infarction (n=281). Female sex vs. Male sex was evaluated on 1-year major adverse cardiac events (MACE) (HR 4.180, 95% CI 1.136-15.374, p=0.031). In patients presenting with acute myocardial infarction, female sex was an independent predictor of 1-year major adverse cardiac events (HR 4.180), while circulating PCSK9 levels were not significantly correlated with outcomes.
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