449: Longitudinal measurements of proprotein convertase subtilisin kexin 9 (PCSK-9) in patients with and without preeclampsia

Abstract

Cholesterol (CHOL) synthesis is necessary for healthy fetal and placental maturation and growth in pregnancy, and adverse pregnancy outcomes (APO) have been identified in women with significantly elevated or depressed lipid profiles. Proprotein convertase subtilisin kexin 9 (PCSK-9) enzyme degrades the low density receptor (LDL)-receptor found in hepatic and endothelial tissue, thus increases serum LDL through decreased receptor binding and is a surrogate marker for CHOL metabolism. Elevated PCSK-9 levels are associated with hypercholesterolemia and atherosclerosis but its characteristics during pregnancy are not well established. Our goal was to measure PCSK-9 during and late after normal and preeclamptic pregnancy to characterize biomarker levels associated with normal and abnormal pregnancy. We performed a single institution prospective cohort study. Inclusion criteria were women with singleton pregnancies > 23 weeks and diagnosis of preeclampsia with severe features (PEC), per ACOG guidelines. Controls were women with uncomplicated singleton gestations > 23 weeks. We excluded women with known hyperlipidemia. Longitudinal data were collected during pregnancy (2015) and non-pregnancy 4 years later (2019). Statistical analyses were performed using a paired t-test for longitudinal data, and all parametric and nonparametric data were analyzed appropriately with Graphpad, Version 8. The sample size was adequate to detect significance at p< 0.05 with a power of 80%. Demographic characteristics between groups were similar except for race (Table). There was a statistically significant decrease in longitudinal PCSK-9 levels from pregnancy to 4 year follow up (non-pregnancy), (114 (32.3) vs 63 (11.3), p=0.004). In contrast, this longitudinal decrease was not observed in patients with preeclampsia, (83 (19.0) vs 75 (24.4), p=0.381). (Figure) PCSK-9 levels are higher during normal pregnancy than in the non-pregnant state. However, patients with PEC do not have a higher level. PCSK-9 and CHOL metabolism should be further evaluated for associations with APO.View Large Image Figure ViewerDownload Hi-res image Download (PPT)