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Circulating PCSK9 and Risk of Myocardial Infarction: The HUNT Study in Norway

Lars E Laugsand1,2, Bjørn O Åsvold1,3, Lars J Vatten1

  • 1Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.

JACC. Basic to Translational Science
|September 1, 2018
PubMed

Insights

Circulating proprotein convertase subtilisin-kexin type 9 (PCSK9) levels do not predict coronary heart disease risk in the general population. Measuring PCSK9 adds no value beyond standard lipid measurements for assessing myocardial infarction risk.

Area of Science:

  • Cardiovascular Medicine
  • Biomarkers
  • Epidemiology

Background:

  • The role of circulating proprotein convertase subtilisin-kexin type 9 (PCSK9) as a coronary heart disease (CHD) risk marker in the general population is not well-established.
  • PCSK9 influences low-density lipoprotein cholesterol (LDL-C) metabolism, a key factor in atherosclerosis.

Purpose of the Study:

  • To investigate the utility of circulating PCSK9 levels as an independent risk marker for incident myocardial infarction (MI) in a general population.
  • To determine if PCSK9 provides additional risk information beyond established lipid measurements.

Main Methods:

  • A nested case-control study design was employed in a Norwegian cohort.
  • 1,488 incident MI cases were compared with 3,819 controls over 11.3 years of follow-up.
  • Statistical analyses included adjustments for age, sex, and LDL-C levels.

Main Results:

  • Higher quartiles of circulating PCSK9 were associated with increased MI risk (47% higher in the highest vs. lowest quartile) after adjusting for age and sex.
  • This association was significantly attenuated after further adjustment for LDL-C.
  • Circulating PCSK9 levels did not provide incremental risk prediction for MI beyond lipid measurements.

Conclusions:

  • Circulating PCSK9 is not a valuable independent risk marker for myocardial infarction in the general population.
  • Lipid measurements adequately capture the risk information related to PCSK9 in cardiovascular risk assessment.

Keywords:
BMI, body mass indexCI, confidence intervalCRP, C-reactive proteinCVD, cardiovascular diseaseHDL-C, high-density lipoprotein cholesterolLDL, low-density lipoproteinLDL-C, LDL cholesterolMI, myocardial infarctionOR, odds ratioPCSK9 inflammationPCSK9, proprotein convertase subtilisin-kexin type 9epidemiologyhsCRP, high-sensitivity C-reactive proteinmyocardial infarctionprospective studyrisk factors

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