title: Proprotein convertase subtilisin-kexin type 9 as a biomarker for the severity of coronary artery disease.
abstract: OBJECTIVE
  To evaluate the relation of proprotein convertase subtilisin-kexin type 9 (PCSK9) levels to coronary artery disease (CAD).
  
  
  METHODS
  A total of 1031 consecutive individuals (552 CAD and 479 controls) were prospectively enrolled. The associations of plasma PCSK9 levels with the incidence and severity of CAD were investigated. Further, mediator analysis was performed to detect the potential mechanisms of the associations.
  
  
  RESULTS
  No difference in PCSK9 levels between CAD patients and controls was detected (median 224.75 versus 224.64 ng/mL, P > 0.05). However, the CAD group had higher PCSK9 levels than the control group when adjusting for the confounding factors (228.03 ± 1.01 versus 219.28 ± 1.02 ng/mL, P = 0.019). PCSK9 levels were also associated with the severity of CAD assessed by the Gensini score (GS) system (P for trend < 0.05). Logistic regression analysis showed that PCSK9 levels were associated with an increased CAD risk (OR 3.296 and 5.130 for the incidence and severity, respectively). Importantly, mediator analysis indicated that the effects of PCSK9 levels on CAD were mediated by lipid (around 20%) and inflammation (around 15%).
  
  
  CONCLUSIONS
  PCSK9 levels were positively associated with the severity of CAD; the relatively important mechanisms including lipid and inflammation pathways were partly involved in this association.
authors.affiliation: a Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease , Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , BeiLiShi Road 167, Beijing 100037 , China.
authors.forename: Sha
authors.initials: S
authors.lastname: Li
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Rui-Xia
authors.initials: RX
authors.lastname: Xu
authors.forename: Yuan-Lin
authors.initials: YL
authors.lastname: Guo
authors.forename: Cheng-Gang
authors.initials: CG
authors.lastname: Zhu
authors.forename: Na-Qiong
authors.initials: NQ
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Qing
authors.forename: Geng
authors.initials: G
authors.lastname: Liu
authors.forename: Qian
authors.initials: Q
authors.lastname: Dong
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Li
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D000071449:Proprotein Convertase 9; D043484:Proprotein Convertases / Q000097:blood*; D011446:Prospective Studies; D012697:Serine Endopeptidases / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D008055:Lipids; D005340:Fibrinogen; D002097:C-Reactive Protein; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9; D043484:Proprotein Convertases; D012697:Serine Endopeptidases
keywords: Coronary artery disease; inflammation; lipid; mediator; proprotein convertase subtilisin/kexin type 9