Physicians' Academy for Cardiovascular Education

IL-6 receptor antagonism modifies PCSK9 levels in NSTEMI patients with hypercholesterolemia

Serum PCSK9 is modified by interleukin-6 receptor antagonism in patients with hypercholesterolaemia following non-ST-elevation myocardial infarction

Literature - Ueland T, Kleveland O, Michelsen AE et al. - Open Heart 2018;5:e000765

Introduction and methods

Inhibition of the enzyme proprotein convertase subtilisin-kexin type 9 (PCSK9) leads to significant reductions of low density lipoprotein cholesterol (LDL-c) levels and decreased incidence of CVD in high-risk patients with hyperlipidemia [1-3]. Although several studies link PCSK9 to inflammation independent of lipids, it is unclear whether PCSK9 levels are altered by inflammatory pathways. This study investigated the effects of the humanized anti-IL-6 receptor (IL-6R) antibody, tocilizumab, on serum PCSK9 levels in non-ST elevation myocardial infarction (NSTEMI) patients.

In the context of a randomized, double-blind, placebo-controlled study [4], in which 117 NSTEMI patients, aged 18-80 years, were randomized to receive either an intravenous infusion of tocilizumab 280 mg or matching placebo prior to coronary angiography, the following analyses were performed:

Main results


In patients with an established diagnosis of hypercholesterolemia, tocilizumab blunted the NSTEMI-associated increase in PCSK9 levels and this was correlated with a decrease in neutrophil numbers. Serum PCSK9 levels were not modified by anti-inflammatory treatment and not associated with change in inflammatory markers suggesting a limited influence of inflammation on PCSK9.


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