Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) has been gaining
major attention recently after the emergence of data showing the promising role of these proteins in
lipid homeostasis and atherosclerosis process, glucose and blood pressure regulation.
Materials and Methods: PubMed, EMBASE, Scholar and Scopus databases were searched to identify
randomized controlled trials, observational studies, in-vitro trials and reviews about the role of
PCSK9 in cardiovascular homeostasis.
Results: PCSK9 was found to have major impact on lipid homeostasis and inflammatory process
through regulation of low-density lipoprotein receptors. Furthermore, inflammation was found to
stimulate the expression of PCSK9 in various cells. As for glomerular proteinuria, a positive correlation
was determined between PCSK9 levels and the degree of proteinuria. Hypertension, a major
cardiovascular risk factor, is likely affected by PCSK9 levels through their role on epithelial sodium
channel (ENaC) surface expression. Likewise, some studies show that PCSK9 is associated
with higher fasting blood glucose and plasma insulin, demonstrating a potential role of PCSK9 in
glucose homeostasis. The role of PCSK9 in cardiovascular homeostasis is one that is still not completely
Conclusion: Studies have clearly shown the implication of PCSK9 in the cardiovascular risk factors:
the higher the PCSK9 levels, the higher the risk of atherosclerosis, fasting plasma glucose and
insulin resistance. Inhibiting PCSK9 may therefore theoretically prove to present great benefits in
diabetic patients with high cardiovascular risk.