PCSK9 and Lp(a) levels independently predict coronary calcium buildup in statin-treated FH patients, a study of 161 patients (Atherosclerosis 2016)

Original title: PCSK9 and lipoprotein (a) levels are two predictors of coronary artery calcification in asymptomatic patients with familial hypercholesterolemia

Atherosclerosis · 27 August 2016 · 7

Alonso R, Mata P, Muñiz O, Fuentes-Jimenez F, Díaz JL, Zambón D, Tomás M, Martin C, Moyon T, Croyal M, Thedrez A, Lambert G

This study measured PCSK9 and Lp(a) in 161 molecularly defined familial hypercholesterolaemia (FH) patients treated with stable statin doses for over a year, to assess their association with coronary artery calcification (CAC), a marker of atherosclerosis burden. Circulating PCSK9 was significantly lower in patients without CAC (n=63) than those with CAC (n=99), and patients with the highest CAC scores (above 100) had the highest PCSK9 and Lp(a) levels. In multivariable analysis, after age and sex, circulating PCSK9 and Lp(a) were the leading predictors of a positive CAC score. The findings show elevated PCSK9 and Lp(a) are independently associated with the presence and severity of coronary artery calcification in statin-treated, asymptomatic FH patients.

Original abstract

Background And Aims: We aimed to assess whether elevated PCSK9 and lipoprotein (a) [Lp(a)] levels associate with coronary artery calcification (CAC), a good marker of atherosclerosis burden, in asymptomatic familial hypercholesterolemia.

Methods: We selected 161 molecularly defined FH patients treated with stable doses of statins for more than a year. CAC was measured using the Agatston method and quantified as categorical variable. Fasting plasma samples were collected and analyzed for lipids and lipoproteins. PCSK9 was measured by ELISA, Lp(a) and apolipoprotein (a) concentrations by inmunoturbidimetry and LC-MS/MS, respectively.

Results: Circulating PCSK9 levels were significantly reduced in patients without CAC (n = 63), compared to those with CAC (n = 99). Patients with the highest CAC scores (above 100) had the highest levels of circulating PCSK9 and Lp(a). In multivariable regression analyses, the main predictors for a positive CAC score was age and sex followed by circulating PCSK9 and Lp(a) levels.

Conclusions: In statin treated asymptomatic FH patients, elevated PCSK9 and Lp(a) levels are independently associated with the presence and severity of CAC, a good predictor of coronary artery disease.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.