Highlights
- •Lifestyle modification therapy led to the mobilization of visceral adipose tissue.
- •Triglycerides and high-density lipoprotein cholesterol levels were also improved.
- •Low-density lipoprotein cholesterol levels remained unchanged.
- •PCSK9 levels slightly increased following lifestyle modification therapy.
- •PCSK9 levels increased with improvements in fitness and visceral fat mobilization.
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.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: September 01, 2016
Accepted:
August 25,
2016
Received:
May 17,
2016
Identification
Copyright
© 2016 National Lipid Association. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Questions to the article by Boyer et al.Journal of Clinical LipidologyVol. 11Issue 2
- PreviewMany recent studies have found that lifestyle interventions, especially dietary change and exercise, have effects on proprotein convertase subtilisin/kexin type 9 (PCSK9).1–7 We noticed that the article published in this journal by Marjorie Boyer et al.8 was the first study to focus on changes in PCSK9 concentrations produced by lifestyle intervention in addition to statin among patients who have coronary artery disease. All male subjects (N = 86) participated in a 1-year program of lifestyle modification with increased physical activity and diet changes.
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