期刊
EUROPEAN HEART JOURNAL
卷 37, 期 6, 页码 546-553出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehv637
关键词
Lipids; PCSK9; Acute coronary syndromes; Cohort studies; Familial hypercholesterolaemia
资金
- Swiss National Science Foundation (SPUM) [33CM30-124112, 33CM30-140 336]
- Geneva University Hospitals
- Swiss Heart Foundation
- de Reuter Foundation
- Gerbex-Bourget Foundation
- Schmidheiny Foundation
- Swiss National Science Foundation (SNSF) [320030-150025]
- Roche Diagnostics
- Eli Lilly
- AstraZeneca
- Medtronic
- Merck Sharpe and Dome (MSD)
- Sanofi-Aventis
- St. Jude Medical
- Swiss National Science Foundation (SNF) [320030_150025] Funding Source: Swiss National Science Foundation (SNF)
Aims Proprotein convertase subtilisin kexin 9 (PCSK9) is an emerging target for the treatment of hypercholesterolaemia, but the clinical utility of PCSK9 levels to guide treatment is unknown. We aimed to prospectively assess the prognostic value of plasma PCSK9 levels in patients with acute coronary syndromes (ACS). Methods and results Plasma PCSK9 levels were measured in 2030 ACS patients undergoing coronary angiography in a Swiss prospective cohort. At 1 year, the association between PCSK9 tertiles and all-cause death was assessed adjusting for the Global Registry of Acute Coronary Events (GRACE) variables, as well as the achievement of LDL cholesterol targets of <1.8 mmol/L. Patients with higher PCSK9 levels at angiography were more likely to have clinical familial hypercholesterolaemia (rate ratio, RR 1.21, 95% confidence interval, CI 1.09-1.53), be treated with lipid-lowering therapy (RR 1.46, 95% CI 1.30-1.63), present with longer time interval of chest pain (RR 1.29, 95% CI 1.09-1.53) and higher C-reactive protein levels (RR 1.22, 95% CI 1.16-1.30). PCSK9 increased 12-24 h after ACS (374 +/- 149 vs. 323 +/- 134 ng/mL, P < 0.001). At 1 year follow-up, HRs for upper vs. lower PCSK9-level tertiles were 1.13 (95% CI 0.69-1.85) for all-cause death and remained similar after adjustment for the GRACE score. Patients with higher PCSK9 levels were less likely to reach the recommended LDL cholesterol targets (RR 0.81, 95% CI 0.66-0.99). Conclusion In ACS patients, high initial PCSK9 plasma levels were associated with inflammation in the acute phase and hypercholesterolaemia, but did not predict mortality at 1 year.
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