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

  • Marjorie Boyer
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Department of medicine, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
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  • Valérie Lévesque
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Department of kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
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  • Paul Poirier
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Faculty of Pharmacy, Université Laval, Quebec City, Québec, Canada
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  • André Marette
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada
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  • Patrick Mathieu
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Laboratory of Cardiovascular Pathobiology, Department of Surgery, Laval University, Quebec City, Québec, Canada
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  • Jean-Pierre Després
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Department of kinesiology, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
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  • Éric Larose
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Department of medicine, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
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  • Benoit J. Arsenault
    Correspondence
    Corresponding author. Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Y-2110, Pavillon Marguerite D'Youville, 2725 chemin Ste-Foy, Quebec City, Québec (QC) G1V 4G5, Canada.
    Affiliations
    Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Québec, Canada

    Department of medicine, Faculty of Medicine, Université Laval, Quebec City, Québec, Canada
    Search for articles by this author
Published:September 01, 2016DOI:https://doi.org/10.1016/j.jacl.2016.08.014

      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

      Keywords

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      • Questions to the article by Boyer et al.
        Journal of Clinical LipidologyVol. 11Issue 2
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          Many 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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