Improved lifestyle led to increased PCSK9 levels in post-CABG men on statin treatment
Impact of a 1-year lifestyle modification program on plasma lipoprotein and PCSK9 concentrations in patients with coronary artery disease
Boyer M, Levesque V, Poirier P, et al.
Journal of Clinical Lipidology 2016; published online ahead of print
BackgroundMany coronary artery disease (CAD) patients are not in a good physical condition and have an elevated cardio-metabolic risk profile, including [1,2]:
- visceral fat accumulation, even within the normal BMI range
- elevated triglyceride, apoB, and apoA-I levels, as well as low HDL-c levels, despite statin treatment and target LDL-c levels.
In this study, the impact of a 1-year lifestyle modification program on plasma lipoprotein and PCSK9 levels was assessed in 86 post-CABG (coronary artery bypass grafting) statin-treated men. Moreover, the association between plasma PCSK9 levels and markers of lipoprotein-lipid metabolism before and during the lifestyle intervention program was evaluated. The lifestyle modification program included a personalized healthy eating strategy and physical activity counselling (aim of weekly minimal 150 min. aerobic activity at moderate-to-vigorous intensity) and started at least 6 weeks after CABG.
Main resultsNo modifications were observed for total and LDL-c, or for apoB. However, lifestyle modification program did result in:
- mean reduction of visceral adipose tissue from 189.7 to 174.1 mL/5mm (P=0.04)
- mean increase of peakVO2 from 24.9 to 28.6 mL O2/min/kg (P<0.0001)
- mean reduction of VLDL-c from 0.62 to 0.55 mmol/L (P=0.0009)
- mean reduction of non-HDL-c from 2.23 to 2.13 mmol/L (P=0.04)
- mean reduction of triglycerides from 1.39 to 1.21 mmol/L (P=0.002)
- mean increase of apoA-I from 1.33 to 1.41 g/L (P<0.0001)
- mean increase of HDL-c from 1.17 to 1.31 mmol/L (P<0.0001)
The lifestyle modification program led to a rise of PCSK9 by 13.9 ng/mL (P 0.05). Changes in PCSK9 levels were not associated with changes in LDL-c or apoB levels, but were correlated with:
- increases in apoA-I levels (r=0.26; P=0.02)
- increases in fasting insulin levels (r=0.33; P=0.006)
- increases in HOMA-IR index (r=0.29; P=0.02)
- increases in peakVO2 (r=0.23; P=0.05)
- changes in visceral adipose tissue (r=-0.23; P=0.04)
- changes in the ratio of total cholesterol/HDL-c (r=-0.23; P=0.03)
There were no statistical significant changes of PCSK9 levels upon changes in statin treatment.
ConclusionIn 86 post-CABG patients, increased physical activity and improved dietary habits had a modest positive influence on non-HDL-c, HDL-c, and triglyceride levels, but not on LDL-c and apoB. Moreover, PCSK9 levels were increased, which may explain the modest impact of a healthy lifestyle on atherogenic lipoproteins.
Find this article online at J Clin Lipidology
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