Department of Cardiology, Regional Hospital Unit West Jutland, Herning, Denmark.
Department of Nephrology, Aarhus University Hospital, Aarhus, Denmark.
Nephrol Dial Transplant. 2020 Apr 1;35(4):632-639. doi: 10.1093/ndt/gfy257.
Chronic kidney disease is a risk factor for premature development of coronary atherosclerosis and mortality. A high level of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a recently recognized cardiovascular risk factor and has become the target of effective inhibitory treatment. In 167 kidney transplantation candidates, we aimed to: (i) compare levels of PCSK9 with those of healthy controls, (ii) examine the association between levels of PCSK9 and low-density lipoprotein cholesterol (LDL-c) and the degree of coronary artery disease (CAD) and (iii) evaluate if levels of PCSK9 predict major adverse cardiac events (MACE) and mortality.
Kidney transplant candidates (n = 167) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) before transplantation. MACE and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. A group of 79 healthy subjects were used as controls.
Mean PCSK9 levels did not differ between healthy controls and kidney transplant candidates. In patients not receiving lipid-lowering therapy, PCSK9 correlated positively with LDL-c (rho = 0.24, P < 0.05). Mean PCSK9 was similar in patients with and without obstructive CAD at both CCTA and ICA. In a multiple regression analysis, PCSK9 was associated with neither LDL-c (β=-6.45, P = 0.44) nor coronary artery calcium score (β=2.17, P = 0.84). During a follow-up of 3.7 years, PCSK9 levels were not associated with either MACE or mortality.
The ability of PCSK9 levels to predict cardiovascular disease and prognosis does not seem to apply to a cohort of kidney transplant candidates.
慢性肾脏病是导致冠状动脉粥样硬化和死亡的过早发生的危险因素。前蛋白转化酶枯草溶菌素/ 糜蛋白酶 9 型（PCSK9）水平升高是最近发现的心血管危险因素，已成为有效抑制治疗的靶点。本研究纳入了 167 名肾移植候选者，旨在：（i）比较 PCSK9 水平与健康对照组之间的差异；（ii）研究 PCSK9 水平与低密度脂蛋白胆固醇（LDL-c）和冠状动脉疾病（CAD）严重程度之间的相关性；（iii）评估 PCSK9 水平是否可以预测主要不良心脏事件（MACE）和死亡率。
肾移植候选者（n=167）在移植前接受了冠状动脉计算机断层扫描血管造影术（CCTA）和有创性冠状动脉造影术（ICA）检查。MACE 和死亡率数据从西部丹麦心脏注册中心提取，对患者记录和患者访谈进行了审查。选择 79 名健康受试者作为对照组。
健康对照组和肾移植候选者的 PCSK9 水平没有差异。在未接受降脂治疗的患者中，PCSK9 与 LDL-c 呈正相关（rho=0.24，P<0.05）。在 CCTA 和 ICA 检查中，有和无阻塞性 CAD 的患者的 PCSK9 水平相似。在多元回归分析中，PCSK9 与 LDL-c（β=-6.45，P=0.44）或冠状动脉钙评分（β=2.17，P=0.84）均无相关性。在 3.7 年的随访期间，PCSK9 水平与 MACE 或死亡率均无相关性。
PCSK9 水平预测心血管疾病和预后的能力似乎不适用于肾移植候选者队列。
