Impact of a 1-year lifestyle modification program on plasma lipoprotein and PCSK9 concentrations in patients with coronary artery disease

BACKGROUND: Patients with coronary artery disease (CAD) are characterized by an impaired cardiometabolic risk profile including high levels of atherogenic apolipoprotein (apo) B-containing lipoprotein levels. Genetic studies have highlighted a critical role for proprotein convertase subtilisin/kexin type 9 (PCSK9) in lipoprotein metabolism and CAD risk. OBJECTIVE: To determine whether improving dietary quality and increasing physical activity levels improve parameters of the cardiometabolic risk profile such as plasma apoB and PCSK9 levels in patients with CAD. METHODS: We recruited 86 men aged between 39 and 80 years (82 of them on statins) undergoing coronary artery bypass graft (CABG) surgery. These patients participated in a 1-year lifestyle modification program aiming at achieving a minimum of 150 minutes/week of physical activity and improving diet quality by following dietary guidelines. We used magnetic resonance imaging to measure visceral adipose tissue and a modified Bruce protocol to measure fitness levels before and after the intervention. RESULTS: Plasma apoB and low-density lipoprotein cholesterol levels were not modified by the intervention (-3.0%, P =.08 and 1.3%, P =.56, respectively), whereas non-HDL cholesterol decreased by 4.5% (P =.04) and triglycerides by 13% (P =.002). In contrast, PCSK9 levels increased by 5.2% after the intervention (P =.05). HDL cholesterol and apolipoprotein A-I levels also increased (+12%, P <.0001 and + 6%, P <.0001, respectively). PCSK9 levels increased with improvements in fitness (r = 0.23, P =.04) and visceral fat mobilization (r = 0.23, P =.04). CONCLUSION: In post-CABG patients, a lifestyle modification program lead to significant improvements in some parameters of the lipoprotein profile but unexpectedly increased plasma PCSK9 levels. (C) 2016 National Lipid Association. All rights reserved.