OBJECTIVE Aim of this study was to evaluate the relationship of plasma PCSK9 with metabolic and inflammatory profile and coronary atherosclerotic burden in patients with suspected CAD enrolled in the EVINCI study. METHODS PCSK9 was measured in 539 patients (60.3 ± 8.6 years, 256 males) with symptoms of CAD characterized by risk factors, bio-humoral profiles, and treatment. N = 412 patients underwent coronary computed tomography angiography (CTA) to assess the presence and characteristics of coronary atherosclerosis. A CTA score, combining extent, severity, composition, and location of plaques was computed. RESULTS Patients were divided according to PCSK9 quartiles: I (< 136 ng/mL), II-III (136-266 ng/mL), and IV quartile (> 266 ng/mL). Compared with patients in quartile IV, patients in quartile I had a higher prevalence of the metabolic syndrome and higher values of body mass index. LDL- and HDL-cholesterol were significantly lower in patients in the quartile I than in those in quartile IV. Coronary CTA documented normal vessels in 30% and obstructive CAD in 35% of cases without differences among PCSK9 quartiles. Compared with patients with the highest levels, patients with the lowest PCSK9 levels had a higher CTA score mainly due to higher number of mixed non-obstructive coronary plaques. At multivariable analysis including clinical, medications, and lipid variables, PCSK9 was an independent predictor of the CTA score (coefficient - 0.129, SE 0.03, P < 0.0001), together with age, male gender, statins, interleukin-6, and leptin. CONCLUSION In patients with stable CAD, low PCSK9 plasma levels are associated with a particular metabolic phenotype (low HDL cholesterol, the metabolic syndrome, obesity, insulin resistance and diabetes) and diffuse non-obstructive coronary atherosclerosis. Trial registration ClinicalTrials.gov NCT00979199. Registered September 17, 2009.

中文翻译：

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稳定型心绞痛患者PCSK9血浆水平与代谢模式和冠状动脉粥样硬化的关系。

这项研究的目的是评估参与EVINCI研究的可疑CAD患者血浆PCSK9与代谢和炎症状况以及冠状动脉粥样硬化负担的关系。方法对539例具有危险因素，生物体液特征和治疗特征的CAD症状的患者（60.3±8.6岁，256例男性）进行PCSK9测定。N = 412例患者接受了冠状动脉计算机断层血管造影（CTA），以评估冠状动脉粥样硬化的存在和特征。计算CTA得分，结合程度，严重程度，组成和斑块位置。结果按PCSK9四分位数对患者进行划分：I（<136 ng / mL），II-III（136-266 ng / mL）和IV四分位数（> 266 ng / mL）。与四分之四的患者相比，四分之一患者的代谢综合征患病率较高，体重指数较高。四分位数I患者的LDL-和HDL-胆固醇水平显着低于四分位数IV患者。冠脉CTA记录的正常血管占30％，阻塞性CAD占35％，PCSK9四分位数之间无差异。与最高水平的患者相比，PCSK9最低的患者具有较高的CTA评分，这主要是由于混合的非阻塞性冠状动脉斑块数量增加所致。在包括临床，药物和脂质变量在内的多变量分析中，PCSK9是CTA评分（系数-0.129，SE 0.03，P <0.0001）以及年龄，男性，他汀类，他汀，白介素6和瘦素的独立预测因子。结论对于稳定的CAD患者，低PCSK9血浆水平与特定的代谢表型（低HDL胆固醇，代谢综合征，肥胖症，胰岛素抵抗和糖尿病）和弥漫性非阻塞性冠状动脉粥样硬化相关。试用注册ClinicalTrials.gov NCT00979199。2009年9月17日注册。