Impact of bariatric surgery-induced weight loss on circulating PCSK9 levels in obese patients

Zenti, Maria Grazia; Lupo, Maria Giovanna; Martin, Sara De; Altomari, Anna; Galvan, Serena; Aventaggiato, Marta; Maneschi, Chiara; Sandri, Damiano; Paiola, E; Battistoni, Marco; Eccher, Albino; Targher, Giovanni; Bonora, Enzo; Ruscica, Massimiliano; Ferri, Nicola

doi:10.1016/j.numecd.2020.07.013

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Therefore, in obese people, normal LDL-C levels may suggest that increased adipocytes are maintaining cholesterol homeostasis. In addition, proprotein convertase subtilisin/kexin type 9 (PCSK9) is positively associated with BMI and LDL-C levels, which confirms the association between BMI and LDL-C [ 36 , 37 ]. It has been reported that PCSK9 concentrations are correlated with age, gender, MS, and menopausal status, which may lead to alterations in the linear association [ 38 ].…”

Section: Discussionmentioning

confidence: 83%

Sex differences in the non-linear association between BMI and LDL cholesterol in middle-aged and older adults: findings from two nationally representative surveys in China

Zheng

et al. 2021

Lipids Health Dis

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Background The relationship between body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C) has not been clearly elucidated in middle-aged and older adults. This study aimed to evaluate the non-linear dose-response relationship between BMI and LDL-C in males and females. Methods Data was obtained from two nationally representative surveys in China—the China Health and Nutrition Survey (CHNS, 2009) and China Health and Retirement Longitudinal Study (CHARLS, 2011–2012). To evaluate the sex differences in the association between BMI and LDL-C, the generalized additive models with a smooth function for continuous BMI and smooth-factor interaction for sexes with BMI were used. Segmented regressions were fitted to calculate the slopes with different estimated breakpoints among females and males. Results A total of 12,273 participants (47.1% male) aged 45 to 75 years were included. The generalized additive models revealed that a non-linear relationship between BMI and LDL-C level in both sexes after adjustment for age, residence, education levels, marital status, drinking, smoking status, and cohort (CHNS or CHARLS). Slopes of the association between BMI and LDL-C association changed at BMI 20.3 kg/m2 (95% CI: 18.8 to 21.8) in females and 27.1 kg/m2 (95% CI: 25. 8 to 28.4) in males. Below these BMI breakpoints, LDL-C levels increased 1.84 (95% CI: 1.45 to 2.31) in males and 3.49 (95% CI: 1.54 to 5.45) mg/dL per kg/m2 in females. However, LDL-C levels declined − 1.50 (95% CI: − 2.92 to − 0.09) mg/dL per kg/m2 above BMI of 27.1 kg/m2 in males. The non-linear association BMI and LDL-C in males and females was varied by cohort source, age groups, and the number of metabolic syndrome criteria. Conclusions In the Chinese middle aged and older adults, the BMI and LDL-C relationship was inverted U-shaped with a high level of LDL-C at a BMI of 27.1 kg/m2 in males, and an approximately linear association was observed in females.

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Section: Discussionmentioning

confidence: 83%

Sex differences in the non-linear association between BMI and LDL cholesterol in middle-aged and older adults: findings from two nationally representative surveys in China

Zheng

et al. 2021

Lipids Health Dis

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“…Previous data suggested that insulin resistance and subsequent hyperinsulinemia could enhance PCSK9 expression and increased plasma levels of PCSK9 were related to poor glycemic control in DM [42]. Besides, it has been demonstrated that insulin resistance plays a pivotal role in PCSK9 homeostasis in severely obese patients [43]. PCSK9 critically controls LDLR expression in pancreas perhaps contributing to the maintenance of a proper physiological balance to limit cholesterol overload in beta cells [44].…”

Section: Discussionmentioning

confidence: 99%

Association of circulating PCSK9 concentration with cardiovascular metabolic markers and outcomes in stable coronary artery disease patients with or without diabetes: a prospective, observational cohort study

Jia

Liu

Jin

et al. 2020

Cardiovasc Diabetol

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Background Whether plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) levels is a predictor for cardiovascular outcomes has currently been controversial. No data is currently available regarding the relation of PCSK9 to cardiovascular metabolic markers (CVMMs) and major adverse cardiovascular events (MACEs) in stable coronary artery disease (CAD) patients with diabetes or without diabetes. Methods A total 1225 untreated patients with stable CAD were consecutively enrolled and their baseline plasma PCSK9 levels were determined by ELISA. Patients were divided into high and low PCSK9 groups according to PCSK9 median. All patients followed up for the occurrence of MACEs and received standard therapy after admission. The associations of PCSK9 with CVMMs and MACEs were evaluated. Results PCSK9 levels were positively correlated with multiple CVMMs including total cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and hemoglobin A1c at baseline (all p < 0.05). During a median follow-up of 3.3 years, 103 (8.4%) events occurred. PCSK9 levels were higher in patients with events compared to those without (p < 0.05). The Kaplan–Meier analysis displayed that patients in high PCSK9 group had lower event-free survival than that in low group (p < 0.05). Multivariable Cox regression analysis revealed that PCSK9 levels were independently associated with MACEs in diabetic patients (adjusted hazard ratio [HR]: 1.361, 95% confidence interval [CI]: 1.037–1.785, p < 0.05). When added the combination of PCSK9 levels and diabetic status to stratifying factors, patients in high PCSK9 group appeared to have extremely high risk of subsequent MACEs with diabetes (adjusted HR: 5.233, 95% CI: 2.546–10.757, p < 0.01). Conclusions The present study firstly showed that elevated PCSK9 levels were related to multiple CVMMs and MACEs in stable CAD with diabetes, suggesting that plasma PCSK9 measurement could help to identify diabetic patients with CAD at higher cardiovascular risk. More studies may be needed to confirm our findings.

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“…Among them, 30 studies were excluded after careful evaluation (20 studies were reviews, 7 studies did not match the inclusion criteria and 3 studies did not report sufficient data). Therefore, 4 studies which evaluated PCSK9 after bariatric surgery were included ( Table I ) [ 16 ]. Figure 1 depicts the process of study selection.…”

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confidence: 99%

“…Previous research also revealed that in response to bariatric surgery-induced weight loss and insulin sensitivity, adipose tissue plays an undetected role in PCSK9 homeostasis. Thus, it is feasible to speculate that physiological insulin levels may influence expression of hepatic PCSK9 and its circulating levels [ 16 ]. Alternatively, it is possible that the observed alterations in plasma PCSK9 levels are attributable to a change in metabolism of bile acids.…”

mentioning

confidence: 99%

Impact of bariatric surgery on circulating PCSK9 levels as marker of cardiovascular disease risk: a meta-analysis

Jamialahmadi

Banach

Almahmeed³

et al. 2022

Arch Med Sci

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IntroductionThis systematic review and meta-analysis focuses on PCSK9 changes in obese patients following bariatric surgery.Material and methodsA systematic literature search in four databases was performed.ResultsThe results of meta-analysis on 4 trials including 260 individuals demonstrated a remarkable decline of PCSK9 after bariatric surgery (WMD: -57.34 ng/ml, 95% CI: -87.97, -26.71, p<0.001; I2:96.25%). Consistently, a significant decrease of LDL-C after bariatric surgery (WMD: -22.57 mg/dl, 95% CI: -27.5, -17.574, p<0.001; I2: 86.35%) was observed.ConclusionsPCSK9 is reduced significantly after bariatric surgery. The decrease of PCSK9 might be utilized as an independent surrogate marker of improvement of ASCVD risk after bariatric surgery.

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Impact of bariatric surgery-induced weight loss on circulating PCSK9 levels in obese patients

Cited by 6 publications

References 29 publications

Sex differences in the non-linear association between BMI and LDL cholesterol in middle-aged and older adults: findings from two nationally representative surveys in China

Sex differences in the non-linear association between BMI and LDL cholesterol in middle-aged and older adults: findings from two nationally representative surveys in China

Association of circulating PCSK9 concentration with cardiovascular metabolic markers and outcomes in stable coronary artery disease patients with or without diabetes: a prospective, observational cohort study

Impact of bariatric surgery on circulating PCSK9 levels as marker of cardiovascular disease risk: a meta-analysis

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