Association Between Plasma Proprotein Convertase Subtilisin/Kexin Type 9 and the Presence of Metabolic Syndrome in a Predominantly Rural-Based Sub-Saharan African Population.

Abstract

The prevalence of metabolic syndrome (MetS) has increased dramatically in low- and middle-income countries. Proprotein convertase subtilisin/kexin type 9 (PCSK9) plays a major role in low-density lipoprotein receptor degradation, but its relationship with metabolic parameters is still poorly understood. We aimed to investigate the association between plasma PCSK9 and metabolic parameters in a Kenyan cohort. Total plasma PCSK9 levels were measured in 2016 by an in-house enzyme-linked immunosorbent assay (ELISA) using a polyclonal antibody. The International Diabetes Federation (IDF) 2009 consensus statement criteria were used to assess the presence of MetS. In 1338 Kenyans, 11% of the cohort had ≥3 MetS criteria. Total plasma PCSK9 concentration was significantly higher in subjects with MetS than in the non-MetS group (166.8 ± 4.4 vs. 148.0 ± 1.3, P < 0.0001). A progressive increase in circulating PCSK9 was observed when subjects were stratified according to the number of MetS criteria (<3, 3, 4, or 5) [P of the analysis of variance (ANOVA) <0.0001]. In a model corrected for age, sex, lifestyle factors, and body mass index, PCSK9 concentration was a significant predictor of all MetS criteria taken individually, except for waist circumference. Plasma PCSK9 levels were significantly associated with low-density lipoprotein cholesterol, but the strongest association was seen with triglycerides even after multiple adjustments. The presence of MetS was significantly associated with the PCSK9 concentration. Further studies are needed to provide a molecular connection between PCSK9 and insulin, as well as triglyceride metabolism.