875: The role of proprotein convertase subtilisin kexin 9 (PCSK9) in preeclampsia with severe features

Abstract

Cholesterol (CHOL) metabolism is essential in fetal and placental health. PCSK9 enzyme plays a critical role in the degradation of the low-density lipoprotein (LDL)-receptor in hepatocytes and endothelial tissue thereby controlling the number of receptors available for LDL metabolism, and in turn controls the level of circulating LDL-CHOL. Abnormal lipid profiles, specifically LDL, are associated with adverse pregnancy outcomes; thus, PCSK9 may provide insight into CHOL metabolism in pregnancy. We aimed to compare the lipid profiles and PCSK9 levels of patients with preeclampsia with severe features (PEC) to healthy pregnant controls. We conducted a single institution observational cohort study. Inclusion criteria for cases were singleton pregnancies > 23 weeks with diagnosis of PEC per current ACOG guidelines. Uncomplicated singleton pregnancies > 23 weeks served as controls. Women with known hyperlipidemia or on statins prior to pregnancy were excluded. Venipuncture and serum lipid panel studies were collected during pregnancy at active disease and compared between groups. A subgroup of this cohort was randomly chosen and underwent testing for serum PCSK9 levels to determine association with PEC. Statistical analyses were performed using appropriate parametric and non-parametric test. The sample size was adequate to detect significance at p< 0.05 with a power of 80% in both groups. We included 53 women with PEC and 39 controls for lipid studies. Maternal demographics were similar between groups with the exception of race with more black women in the PEC cohort (Table). 12 controls and 17 PEC were chosen for PCSK9 analysis. When compared to healthy pregnancy, PCSK9 and LDL levels were lower in PEC when compared to healthy controls (Table). In PEC, there are lower levels of serum PCSK9 and correspondingly lower levels of circulating lipoproteins, specifically LDL. PCSK9 may give insight into abnormal CHOL metabolism and LDL availability. Further studies of PCSK9 and CHOL at the placental level are needed to determine its role in preeclampsia.