The significance of the pregnancy-associated plasma protein A and insulin like growth factor-1 system on the risk of atherosclerotic cardiovascular diseases.

BACKGROUND: The pregnancy associated plasma protein A (PAPP-A) is present at high levels in serum of pregnant women with a potential role in atherosclerosis. PAPP-A is a metalloproteinase with a well-established role in releasing bioactive insulin-like growth factor-1 (IGF-1). Little is known about their significance as biomarkers of Atherosclerotic cardiovascular diseases (ASCVDs) risk and their association with the need of revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). AIMS: To evaluate plasma levels of PAPP-A and IGF-1 in patients with increased ASCVDs risk and examine if they are associated with CAD severity as indicated by the need for revascularization. METHODS: Patients presented to the catheterization lab were grouped based on ASCVDs risk into low, moderate, high, and very high. Plasma levels of PAPP-A and IGF-1 were assessed using ELISA and correlated with ASCVDs risk and the requirement for revascularization. RESULTS: Plasma PAPP-A and IGF-1 levels were increased in CAD patients, with elevated concentrations in MI patients. A stepwise elevation in plasma PAPP-A and IGF-1 levels was observed with the elevated ASCVDs risk. An independent association was observed between plasma PAPP-A and IGF-1 levels, ASCVDs risk, and the requirement for revascularization. CONCLUSION: Our study demonstrates that plasma levels of PAPP-A and IGF-1 are associated with elevated ASCVDs risk and may serve as potential biomarkers for monitoring disease development. Their association with disease severity suggests a potential role in identifying patients more likely to undergo revascularization, pending further prospective validation.