PCSK9
PCSK9proteinPCSK9 regulates LDL-receptor degradation, controlling LDL-C levels and subendothelial lipid retention underlying atherosclerosis.
Pathway placement
Cascade stepLipid retention & oxidation
Confidencehigh
RationaleLDL-receptor regulation; elevated PCSK9 increases LDL retention in subendothelium.
Druggability
DruggableYes
Known drugs / candidates10
Small-molecule tractableYes
Antibody tractableYes
EnsemblENSG00000169174
Type I vs Type II discrimination
ScoresShared / rises in both
R — rupture / Type-I67
C — confounder / Type-II50
A — assay feasibility72
E — evidence strength95
T1DI (composite)40
Specificity differential (R−C)+16.7
Confounder panel (Type-II drivers)
1sepsis / systemic inflammationmag 2
2anemia / acute blood lossn/a
3hypovolemia / dehydrationn/a
4tachyarrhythmian/a
5hypoxemia / respiratory failuren/a
6hypertensive emergencyn/a
7high-demand / peri-operative stressmag 1
Coverage: 2/7 confounders with evidence
Tier: deep-scored (abstract-extracted) · 6 supporting references. See the discrimination table for all markers.
Assay & specimen
Validated clinical assay
Specimen
Serum or plasma
Collection tube
Serum separator (gold/red-top, SST) · K2/K3-EDTA (lavender-top)
Method / principle
Sandwich ELISA / immunoassay
Reagent / substrate
Anti-PCSK9 antibody pair
Platform
ELISA/automated
Turnaround · availability
Send-out · Research/clinical
Human genetic evidence
0.670
Open Targets association (myocardial_infarction)
5
GWAS associations
Traits: myocardial infarction
Literature evidence(25)
- Integrative Proteomic and Lipidomic Analysis of Patients With Acute Myocardial Infarction Treated With PCSK9 Antibodies and Statins.Circulation. Genomic and precision medicine · 2026 · PMID 41664920 · doi
- Intracoronary Imaging and Transcriptomic Characteristics Before and After Maximum Lipid-Lowering Therapy: YELLOW-III Study of Evolocumab and Maximum Statin Therapy in Chronic Coronary Disease.JACC. Cardiovascular imaging · 2026 · PMID 41758107 · doi
- Proteogenomic Analysis of Coronary Artery Calcification in Human Populations.Arteriosclerosis, thrombosis, and vascular biology · 2026 · PMID 41924874 · doi
- Bioactive lipids in plasma and atherogenic apoB-containing lipoproteins: Effects of statins and PCSK9 inhibitors and relevance to residual cardiovascular risk.Pharmacology & therapeutics · 2026 · PMID 42162924 · doi
- Soluble endoglin reflects endothelial dysfunction in myocardial infarction patients: a retrospective observational study.International journal of medical sciences · 2025 · PMID 40765559 · doi
- Plasma Protein Profile Associated With a Family History of Early-Onset Coronary Heart Disease.Circulation. Genomic and precision medicine · 2025 · PMID 41200820 · doi
- Integrated high-throughput miRNomics and lipidomics in mice with altered lipoprotein metabolism.Atherosclerosis · 2025 · PMID 41570408 · doi
- ​Comprehensive mendelian randomization analysis of plasma proteomics to identify new therapeutic targets for the treatment of coronary heart disease and myocardial infarction.Journal of translational medicine · 2024 · PMID 38689297 · doi
- Platelets as an inter-player between hyperlipidaemia and atherosclerosis.Journal of internal medicine · 2024 · PMID 38704820 · doi
- Platelet activation and endothelial dysfunction biomarkers in acute coronary syndrome: the impact of PCSK9 inhibition.European heart journal. Cardiovascular pharmacotherapy · 2023 · PMID 37468450 · doi
- Proteomic insights into the associations between obesity, lifestyle factors, and coronary artery disease.BMC medicine · 2023 · PMID 38049831 · doi
- Proprotein convertase subtilisin/kexin type 9 inhibition after acute coronary syndrome or prior myocardial infarction.Current opinion in lipidology · 2022 · PMID 35695614 · doi
- Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation.Clinical chemistry · 2021 · PMID 33257928 · doi
- Translating genetic association of lipid levels for biological and clinical application.Cardiovascular drugs and therapy · 2021 · PMID 33604704 · doi
- Mapping gene and gene pathways associated with coronary artery disease: a CARDIoGRAM exome and multi-ancestry UK biobank analysis.Scientific reports · 2021 · PMID 34385509 · doi
- PCSK9 in Haemostasis and Thrombosis: Possible Pleiotropic Effects of PCSK9 Inhibitors in Cardiovascular Prevention.Thrombosis and haemostasis · 2019 · PMID 30605918 · doi
- PCSK9 and atherosclerosis burden in the coronary arteries of patients undergoing coronary angiography.Clinical biochemistry · 2019 · PMID 31493378 · doi
- PCSK9 inhibition alters the lipidome of plasma and lipoprotein fractions.Atherosclerosis · 2018 · PMID 29366988 · doi
- Endocytosis of lipoproteins.Atherosclerosis · 2018 · PMID 29980055 · doi
- [Congenital disorders of lipoprotein metabolism].Herz · 2017 · PMID 28555288 · doi
- PCSK9 inhibition and atherosclerotic cardiovascular disease prevention: does reality match the hype?Heart (British Cardiac Society) · 2017 · PMID 28596304 · doi
- Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention.European journal of preventive cardiology · 2017 · PMID 28618915 · doi
- History of lipidology and lipoprotein apheresis.Atherosclerosis. Supplements · 2017 · PMID 29096824 · doi
- Cardiometabolic risk loci share downstream cis- and trans-gene regulation across tissues and diseases.Science (New York, N.Y.) · 2016 · PMID 27540175 · doi
- Association of PCSK9 with platelet reactivity in patients with acute coronary syndrome treated with prasugrel or ticagrelor: The PCSK9-REACT study.International journal of cardiology · 2016 · PMID 27810295 · doi
Clinical trials(20)
- Relevance of Plasma PCSK9 Concentration as a Biomarker in Acute Coronary Syndrome.NCT01109706 · COMPLETED · biological parameters dosage
- Impact of the PCSK9 Inhibitor Evolocumab on the Pharmacodynamic Effects of Clopidogrel in Patients With Atherosclerotic Cardiovascular Disease and High On-Treatment Platelet ReactivityNCT03096288 · PHASE4 · COMPLETED · Evolocumab, Placebo
- Functional Improvement of Non-infarcT relaTed Coronary Artery Stenosis by Extensive LDL-C Reduction With a PCSK9 AntibodyNCT04141579 · NA · COMPLETED · Evolocumab 140 MG/ML [Repatha], Placebo
- The Cardiovascular Multi-dimensional Observational Investigation of the Use of PCSK9 Inhibitors (cvMOBIUS)NCT04197453 · TERMINATED
- Impact of PCSK9 Inhibitors on Coronary Plaque Composition and Vulnerability in Patients With Coronary Artery Disease Assessed by Optical Coherence TomographyNCT04851769 · PHASE4 · COMPLETED · PCSK9 inhibitor plus statin, standard statin therapy, Coronary imaging follow-up
- Effect of PCSK9 Inhibitor on Acute Coronary Syndrome Patients With Multivessel Disease and Relatively Low LDL-C Level in Chinese Population (CHOICE Study)NCT05043740 · NA · UNKNOWN · Repatha or Praluent
- In-hospital Initiation of PCSK9 Inhibitor and Short-term Lipid Profile Alteration, as Well as In-hospital Mortality and Readmission Rate in Patients With Acute Myocardial InfarctionNCT05184530 · COMPLETED · Evolocumab 140 MG/ML
- Effect of PCSK9 Inhibitor on Retinal Microvessels in Patients With Coronary Heart Disease After Intensive Lipid-lowering TherapyNCT05802108 · PHASE4 · UNKNOWN · Evolocumab combined with statins, Statin
- Study on the Composite Endpoint Event of PCSK9 Inhibitor in Patients With Very High Risk of ASCVD and CancerNCT05976893 · PHASE4 · UNKNOWN · Evolocumab, Statin
- The Effect of Early Administration of PCSK9 Inhibitor, Alirocumab to Acute Ischemic Stroke Patients Associated With Atherosclerosis on the Stroke Prognosis and Lipid Profile, a Single Center Study, Registry Based, Pragmatic, Prospective TrialNCT06083961 · PHASE4 · NOT_YET_RECRUITING · Alirocumab
- A Prospective Registry to Assess Atherosclerosis Risk Factors and Their Relationship With Coronary Plaque Properties and Genetic Variations in Patients With Early Atherosclerosis of Unclear Origin.NCT06393894 · RECRUITING · Near infrared spectroscopy, Genetic testing for LDLR, APOB, PCSK9 and LDLRAP1 mutations and niR-126, -145 and -155 expression.
- Effect of PCSK9 Inhibitors on Coronary Atherosclerotic Plaques Derived From Optical Coherence Tomography in Patients With Premature Coronary Artery Disease: a Randomized Controlled TrialNCT06520904 · PHASE4 · RECRUITING · PCSK9 inhibitor, Statin
- IMpact of PCSK9 inhibitoR initiatiOn Before Percutaneous Coronary Intervention on Coronary microVascular Dysfunction and Events for Acute Myocardial Infarction: a Multi-center, Open-label, Randomized, Controlled TrialNCT06683131 · PHASE4 · NOT_YET_RECRUITING · Tafolecimab
- Multicenter Real-World Cohort Study Evaluating the Impact of Early Intensive Lipid-Lowering Therapy on the Prognosis of Acute Coronary Syndrome PatientsNCT06738758 · RECRUITING · PCSK9 inhibitor, Statin+Ezetimibe/Hybutimibe compound, Statin
- PCSK9 inhibitoRs for Early Passivation of coRonary athEroSclerotic plaqueS in Acute Coronary Syndromes (REPRESS): Study Protocol for a Multicenter Randomized Controlled TrialNCT06791031 · NA · NOT_YET_RECRUITING · PCSK9 inhibitor (PCSK9i)
- Further Lipid-Lowering With PCSK9 Inhibitors for Cardiovascular Outcomes in High-Risk Coronary Plaques Assessed by CT AngiographyNCT06863545 · NA · RECRUITING · PCSK9 inhibitors and background lipid-modifying therapy, Standard lipid-modifying therapy
- PCSK9 Inhibitor With Statin Therapy for Asymptomatic Intracranial Atherosclerosis (PISTIAS-2): A Multicenter, Open-label, Blinded-endpoint, Randomized Controlled TrialNCT06902740 · PHASE4 · RECRUITING · Recaticimab and Statin, Statin
- Impact of PCSK9 Monoclonal Antibody Very Early Administered in Hospital to Reduce Cardiovascular Events in Acute Myocardial Infarction (IMMEDIATE -MI)NCT07208006 · NA · RECRUITING · Standard Lipid-Lowering Therapy, Early Intensive Lipid-Lowering Therapy (PCSK9 Inhibitor)
- Early Administration of PCSK9 Inhibitors After Thrombectomy for Atherosclerotic Acute Ischemic Stroke: A Randomized Controlled TrialNCT07295366 · PHASE4 · COMPLETED · Elavolocumab(420 mg injections)
- PCSK9-DUO Trial: Dual PCSK9 Inhibition With Inclisiran and Alirocumab in Patients With High Cardiovascular Risk in Secondary PreventionNCT07581808 · PHASE4 · RECRUITING · Inclisiran, Alirocumab
Omics datasets(1)
- PXD069776PRIDEIntegrative Proteomics and Lipidomics Analysis of Post-Myocardial Infarction Patients Treated With PCSK9 Antibodies and Statins