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

Abstract

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. 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. We recruited 86 men aged between 39 and 80years (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 150minutes/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. 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). 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.