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Perrot N, Moschetta D, Boekholdt SM, Valerio V, Martinsson A, Capoulade R, Mass E, Mathieu P, Bosse Y, Pibarot P, Smith JG, Camera M, Theriault Y, Poggio P, Arsenault B. P4667Loss of function in PCSK9, atherogenic lipoprotein concentrations, and calcific aortic valve stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition reduces plasma concentrations of most atherogenic lipoproteins such as low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)]. Atherogenic lipoprotein concentrations have also been linked with calcific aortic valve stenosis (CAVS).
Purpose
1) To determine the association between genetic variants in PCSK9 and lipoprotein-lipid levels, 2) to determine whether loss of function (LOF) in PCSK9 is associated with CAVS and 3) to evaluate if PCSK9 could be implicated in aortic valve interstitial cells (VICs) calcification.
Methods
We built a weighted genetic risk score (wGRS) using 10 single nucleotide polymorphisms at the PCSK9 locus associated with LDL-C in the Global Lipids Genetics Consortium. We determined the association between the wGRS and LDL-C, apoB and Lp(a)] in 9692 participants of the EPIC-Norfolk study using linear regression. We investigated the association between the LOF PCSK9 R46L variant and CAVS risk in a meta-analysis of published (three Copenhagen studies, 1463 cases and 101,620 controls) and unpublished studies (UK Biobank, 1350 cases and 349,043 controls, Malmö Diet and Cancer study, 682 cases and 5963 controls and EPIC-Norfolk, 508 cases and 20,421 controls) prospective, population-based studies using logistic regression adjusted for age and sex. We evaluated PCSK9 expression and localization in explanted aortic valves by capillary Western blot and immunohistochemistry in patients with and without CAVS. Von Kossa staining was used to visualize aortic leaflet calcium deposits. We also assessed VICs calcification potential under oxidative stress condition.
Results
In EPIC-Norfolk, the wGRS was significantly associated with TC, LDL-C, and apoB (all p<0.0001), but not with VLDL-C, HDL-C, triglycerides apoA-I, or Lp(a). Carriers of the R46L variant were at lower CAVS risk (odds ratio=0.71 (95% CI, 0.57–0.88, p<0.001)). Aortic valves of patients with aortic sclerosis (n=12) and CAVS (n=8) presented elevated PCSK9 levels (log2 fold change [FC]=+28.6±5.1, p=0.008 and FC=+39.3±15.2, p=0.02, respectively) compared to controls (n=4).In calcified leaflets, PCSK9 expression co-localized with calcium deposits. PCSK9 expression in VICs was induced by oxidative stress (FC=+2.3±0.4, p=0.02), and subsequent increment in calcification potential was observed.
Conclusion
PCSK9LOF variants are associated with lifelong reductions in non-Lp(a) apoB-containing lipoprotein levels and a lower risk of coronary artery disease and CAVS. PCSK9 is abundant in fibrotic and calcified aortic leaflets. Oxidative stress increases PCSK9 expression in VICs. These results support randomized clinical trials of PCSK9 inhibition in the prevention of CAVS.
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Affiliation(s)
- N Perrot
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - D Moschetta
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S M Boekholdt
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - V Valerio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | - E Mass
- University of Bonn, Bonn, Germany
| | - P Mathieu
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - Y Bosse
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - P Pibarot
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - J G Smith
- Skane University Hospital, Lund, Sweden
| | - M Camera
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - Y Theriault
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - P Poggio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - B Arsenault
- Quebec Heart and Lung Institute research centre, Quebec, Canada
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Després A, Perrot N, Tastet L, Pouliot A, Shen M, Chen H, Bourgeois R, Trottier M, Guimond J, Tessier M, Nadeau M, Sebastien T, Couture P, Dweck M, Tsimikas S, Thanassoulis G, Pibarot P, Marie-Annick Clavel M, Arsenault B. Lipoprotein(A), Oxidized Phospholipids, And Aortic Valve Microcalcification Assessed By 18f-Naf Pet/Ct. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Devillers R, Bourgeois R, Perrot N, Boulanger M, Rosa M, Bossé Y, Thériault S, Pibarot P, Arsenault B, Mathieu P. AUTOTAXIN CARRIED BY LP(A): A NEW BIOMARKER OF THE CALCIFIC AORTIC VALVE STENOSIS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Arsenault B, Perrot N, Wareham N, Khaw K, Boekholdt S. P182Ideal cardiovascular health and aortic valve stenosis incidence in apparently healthy men and women. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Boyer M, Auclair A, Mathieu P, Poirier P, Piché M, Arsenault B. IMPACT OF BARIATRIC SURGERY ON PLASMA LDL CHOLESTEROL AND PCSK9 LEVELS IN PATIENTS WITH SEVERE OBESITY. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Perrot N, Boyer M, Lévesque V, Poirier P, Marette A, Mathieu P, Després J, Larose E, Arsenault B. IMPACT OF 1-YEAR LIFESTYLE MODIFICATION PROGRAM ON PLASMA LIPOPROTEIN(A) LEVELS IN PATIENTS WITH CORONARY ARTERY DISEASE. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Arsenault B, Pelletier-Beaumont E, Alméras N, Tremblay A, Poirier P, Bergeron J, Després J. PCSK9 levels in abdominally obese men: association with parameters of the glucose-insulin homeostasis and effects of a lifestyle modification program. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Arsenault B, Boekholdt SM, Dube MP, Rheaume E, Sandhu MS, Wareham NJ, Khaw KT, Tardif JC. Lipoprotein(a) levels, genotype and incident aortic stenosis: a prospective Mendelian randomization study and replication in a case-control cohort. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Arsenault B, Boekholdt SM, Mora S, Demicco DA, Bao W, Tardif JC, Amarenco P, Pedersen TR, Barter P, Waters D. Clinical determinants of incident aortic valve stenosis in patients treated with atorvastatin: results from three large randomized clinical trials. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Affiliation(s)
- H Barbeau
- School of Physical and Occupational Therapy, McGill University. Montreal, Quebec, H3G 1Y5 (Canada) and Service de Physiothérapie, Institul de Readaptation de Montréal, Montréal, Québec, H3S 2J4 (Canada)
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Mohty D, Cote C, Pibarot P, Cartier A, Arsenault B, Despres J, Mathieu P. PO9-216 AGE-DEPENDENT EFFECT ON RESISTIN BLOOD LEVEL AND ITS ROLE IN THE INFLAMMATION AND CALCIFYING PROCESS OF THE AORTIC VALVE. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71226-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hébert LJ, Gravel D, Arsenault B. Comparisons of mechanical and electromyographical muscular utilization ratios. Scand J Rehabil Med 1995; 27:83-8. [PMID: 7569825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The physical loading of a muscle during functional activities can be estimated by the muscular utilization ratio. This ratio is defined as the percentage of muscular involvement relative to the maximal capacity. Either mechanical or electromyographical approaches can be used to obtain the muscle utilization ratio. However, the non-linear relationship between electromyographical activity and muscle force, as well as the non-equivalence between agonist muscles, may create differences between the mechanical muscle utilization ratio calculated from joint moments and the electromyographical muscle utilization ratio calculated from electromyographical data. The aim of this study was to compare, during a squat test, the mechanical muscle utilization ratio and the electromyographical muscle utilization ratio estimated by three different methods; direct linear approximation, second order polynomial regression and linear interpolation. The knee extensor moment and electromyographical data of rectus femoris and vastus medialis of 11 subjects were recorded during both knee extension and squat. Both tests were performed with the knee maintained at 90 degrees of flexion. The results showed that: a) the electromyographical muscle utilization ratio, calculated from the average of vastus medialis and rectus femoris, significantly underestimates the mechanical muscle utilization ratio (ANOVA, p < 0.01), b) the differences between the mechanical muscle utilization ratio and the electromyographical muscle utilization ratio are larger for the direct linear approximation method than for the second order polynomial regression (ANOVA, p < 0.01) or the linear interpolation method (ANOVA, p < 0.01), and c) independent of the method utilized, there is no difference between the electromyographical muscle utilization ratio predicted by the vastus medialis as compared with the rectus femoris (ANOVA, p > 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L J Hébert
- Research Center, Montreal Rehabilitation Institute, Canada
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Bourbonnais D, Duval P, Gravel D, Steele C, Gauthier J, Filiatrault J, Goyette M, Arsenault B. A static dynamometer measuring multidirectional torques exerted simultaneously at the hip and knee. J Biomech 1993; 26:277-83. [PMID: 8468341 DOI: 10.1016/0021-9290(93)90366-m] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The function of a static dynamometer measuring torques exerted simultaneously in the different anatomical planes of the hip (flexion-extension, abduction-adduction and internal-external rotation) and knee (flexion-extension) is described. Muscular torques were calculated in real time using a desktop computer from measurements of orthogonal forces applied at two locations and the lever arm values measured in each subject. The reliability of the force transducers was explored by examining their output, using calibrated weights, on three different days. The results were identical over this period of time, indicating that the transducers are highly reliable. A mechanical simulator of a lower limb was constructed to generate specific or combined torques of known values at the hip and knee. The torques measured by the dynamometer were found to be highly concordant with the known torques applied by the simulator, indicating that the torque measurements were valid. The usefulness of the dynamometer is demonstrated by evaluating the activity of the rectus femoris and biceps femoris muscles during static efforts exerted in various directions at the hip. In addition, the mechanical action of biarticular muscles at the hip was evaluated by quantification of hip torques during efforts exerted at the knee. From these results, it has been concluded that the present biarticular and multidirectional dynamometer is a valid, reliable and precise instrument that may prove to be useful in evaluating the muscular function of the lower limb.
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Affiliation(s)
- D Bourbonnais
- Ecole de Réadaptation, Université de Montréal, Québec, Canada
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Abstract
The recovery of locomotion, following interactive training with graded weight support, in the adult spinal cat has led to the proposal that removal of body weight may be a therapeutic tool in human gait retraining. There would be benefits, however, in knowing normal responses of humans to partial weight bearing before applying this strategy to patients. In this study, 10 nondisabled male subjects walked on a treadmill while 0%, 30%, 50%, and 70% of their body weight was supported by a modified climbing harness. To dissociate the changes attributable to walking speed from those attributable to body weight, each subject walked at the specified body-weight-support (BWS) levels and at full weight bearing (FWB) at the same speed. Simultaneously, electromyographic data from the right leg muscles, footswitch signals, and video recording of joint motion were collected. The FWB and BWS gaits appeared similar, except at the highest level of BWS studied (ie, 70% of BWS). Significant differences among other BWS and FWB trials at comparable speeds included decreases in percentage of stance, percentage of total double-limb support time, and maximum hip and knee flexor swing angle. Other adaptations to BWS were a reduction in the mean burst amplitude of the muscles that are active during stance and an increase in the mean burst amplitude of the tibialis anterior muscle. The possible implications of this new gait retraining strategy for patients with neurological impairment are discussed. [Finch L, Barbeau H, Arsenault B. Influence of body weight support on normal human gait: development of a gait retraining strategy.
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Affiliation(s)
- L Finch
- Department of Physiotherapy, Montreal Neurological Institute, Quebec, Canada
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