Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2016)

Plasma Levels of Proprotein Convertase Subtilisin/Kexin Type 9 Are Elevated in Patients With Peripheral Artery Disease and Associated With Metabolic Disorders and Dysfunction in Circulating Progenitor Cells

  • Ting‐Hsing Chao,
  • I‐Chih Chen,
  • Yi‐Heng Li,
  • Po‐Tseng Lee,
  • Shih‐Ya Tseng

DOI
https://doi.org/10.1161/jaha.116.003497
Journal volume & issue
Vol. 5, no. 5

Abstract

Read online

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) is involved in cholesterol homeostasis, inflammation, and oxidative stress. This study investigated the association of plasma PCSK9 levels with the presence and severity of peripheral artery disease (PAD) and with parameters of endothelial homeostasis. Methods and ResultsA post hoc analysis of 2 randomized trials (115 patients, 44 with PAD and 71 without atherosclerotic disease) was conducted. Patients with PAD had significantly higher plasma PCSK9 levels than those without (471.6±29.6 versus 302.4±16.1 ng/mL, P<0.001). Parameters for glucose homeostasis, endothelial progenitor cell functions, apoptotic circulating endothelial cell counts, and plasma levels of vascular endothelial growth factor–A165 and oxidized low‐density lipoprotein were correlated with PCSK9 concentration. By multivariable linear regression analysis, presence of PAD, plasma glucose or hemoglobin A1c levels, apoptotic circulating endothelial cell counts, and vascular endothelial growth factor–A165 concentration were found to be associated with PCSK9 levels after multivariable adjustment. Patients with extensive involvement of PAD or with severe PAD had significantly higher PCSK9 levels than those without PAD. Computed tomographic angiography showed that the numbers of chronic total occlusion sites and vessels involved were positively associated with PCSK9 levels in patients with PAD (r=0.40, P=0.01, and r=0.36, P=0.02, respectively). ConclusionPCSK9 levels were significantly higher in patients with PAD, especially those with advanced PAD. Further large‐scale studies examining the effect of PCSK9‐targeting therapies or the modification of PCSK9 levels on cardiovascular outcomes in this clinical setting are warranted. Clinical Trial RegistrationCohort 1: URL: ClinicalTrials.gov. Unique identifier: NCT01952756; cohort 2: URL: ClinicalTrials.gov. Unique identifier: NCT02194686.

Keywords