Introduction
coronary artery by-pass
CVD, SECONDARY, HYPERCHOLESTEROLEMIA, DYSLIPIDEMIA
Cardiac rehabilitation (CR) has been established as an integral part of management in secondary prevention for patients after coronary artery by-pass graft (CABG) surgery [A reduction in low density lipoprotein (LDL) cholesterol is also considered as one of the target achievements in secondary preventive strategies in CVD. In the last decade, plasma LDL has been well-associated with Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) level. PCSK9 is an enzyme produced by hepatocyte, renal mesenchyme, small intestine, and colon epithelial cells. It plays a vital role in the regulation of cholesterol homeostasis by binding to epidermal growth factor-like repeat-A domain of LDL receptor, which targets it for lysosomal destruction. Therefore, a low level of PCSK9 correlates with reduced LDL level. Although the use of statin has been widely recommended to manage dyslipidemia, statin resistance has become clinically relevant. This phenomenon might be attributed to statin-induced upregulation of PCSK9 levels [However, the intensity of exercise training that offers the most optimal benefit on the lipid profile remains questionable [There is still limited evidence on how RT mediates improvement in LDL levels via reduction of PCSK9 level in post CABG patients. Therefore, this study aims to analyze how resistance training influences PCSK9 level in post CABG patients. This study will add value to the mounting evidence on the possible novel therapeutic effect on PCSK9 in the treatment of hypercholesterolemia, especially in post CABG patients.