PCSK9 Gene Variants and Cholesterol

Just over fifteen years ago, researchers discovered that a mutation in PSCK9 gene caused really high cholesterol levels. This led to more discoveries about the gene and a fast-tracked medication for people with hypercholesterolemia.  [ref]

What does PCSK9 do?

The PCSK9 gene codes for an enzyme that is involved in cholesterol transport.  It binds to LDL particles, which transport fat molecules, including cholesterol, throughout the body.

PCSK9 plays a regulatory role in keeping cholesterol at the right level. It controls the number of LDL receptors on liver cells. The liver is where cholesterol is regulated for the body – both by synthesis and through elimination.


If you don’t have enough LDL receptors taking up cholesterol, you will have an increase in cholesterol in the bloodstream.

On the other hand, if you have more LDL receptors, your cholesterol levels in the blood will be lower.

Thus, it was quite a breakthrough when researchers figured out that blocking PCSK9 causes an increase in LDL receptors in the liver  — which causes a decrease in overall cholesterol levels.

PCSK9 genetic variants and high cholesterol:

Cholesterol levels in the bloodstream are partly due to diet, but a bigger player in cholesterol levels is genetics.

Some variants in the PCSK9 gene are linked with more PCSK9 protein (gain-of-function) and higher cholesterol levels. A few of the mutations lead to really high LDL levels, and this is known as familial hypercholesterolemia.  Other variants just increase LDL levels a little, so that they are somewhat higher than normal. [ref]

These PCSK9 gain-of-function variants that increase LDL are also linked to an increased risk of heart disease and stroke.

PCSK9 variants and low cholesterol:

After researchers discovered the link between PCSK9 mutations and high cholesterol in 2003, other research showed that there are PCSK9 variants (loss-of-function) that lead to lower cholesterol levels. These variants with decreased function will cause more LDL receptors in the liver, thus causing more LDL particles (including cholesterol) to be removed from the bloodstream.

These loss-of-function variants are linked with lower lifetime LDL cholesterol levels and a lower risk of heart disease.  [ref]

Genetic variants:

PCSK9 Variants associated with decreased LDL-cholesterol (less PCSK9 enzyme function):

Check your genetic data for rs11591147 R46L(23andMe v4, v5; AncestryDNA):

  • G/G: normal
  • G/T: decreased LDL-cholesterol, 30% lower risk of heart disease[ref] [ref]
  • T/T: decreased LDL-cholesterol, > 30% lower risk of heart disease

Check your genetic data for rs28362286 (23andMe v4; AncestryDNA):

  • A/A: decreased LDL-cholesterol, lower risk of heart disease [ref][ref], decreased fasting glucose levels [ref]
  • A/C: decreased LDL-cholesterol, lower risk of heart disease, decreased fasting glucose levels
  • C/C: normal

Check your genetic data for rs67608943 (23andMe v4, v5;):

  • G/G: decreased LDL and decreased risk of heart disease [ref]
  • C/G: decreased LDL and decreased risk of heart disease
  • C/C: normal

Check your genetic data for rs72646508 (23andMe v4, v5):

  • T/T: decreased LDL and decreased risk of heart disease  [ref]
  • C/T: decreased LDL and decreased risk of heart disease
  • C/C: normal

PCSK9 variants associated with increased LDL-cholesterol:

Check your genetic data for rs505151 (23andMe v4, v5; AncestryDNA):

  • G/G: increased LDL, increased risk of coronary artery disease[ref] [ref] [ref]
  • A/G: increased LDL, increased risk of coronary artery disease
  • A/A: normal

Check your genetic data for rs28942112  (23andMe i5000370, v4; AncestryDNA):

  • C/T: greatly increased LDL, considered pathogenic for familial hypercholesterolemia[ref]
  • T/T: normal


Lifehacks for lowering LDL:

If you have the genetic variants that increase LDL due to PCSK9: Think about berberine!

Berberine is a natural inhibitor of PCSK9 and has been shown in human studies[ref][ref] and cell studies[ref] to decrease cholesterol.

You can buy berberine as a supplement on Amazon or at local stores. Keep in mind that it is also known to lower blood glucose levels, which could interfere with medications if you are diabetic.

Quercetin is another flavonoid that may decrease PCSK9. Animal studies show that it moderates LDL levels by decreasing PCSK9.[ref]

Quercetin-rich foods include apples and onions, but it is also found in low amounts in a lot of different fruits and vegetables. (Perhaps this is why eating onions decreases the risk of death from cardiovascular causes.[ref]) You can also get quercetin as a supplement. Taking it with fat may lead to better absorption.

Prescription Meds: There are PCSK9 inhibitors that are FDA approved prescription medications for lowering cholesterol levels.  If you carry one of the variants above that can lead to familial hypercholesterolemia, you should seriously consider discussing it with your doctor and/or get a full cholesterol panel run.

Other articles you may enjoy:

Low HDL Levels Can Be Genetic

Mediterranean Diet and Your Genes

Lipoprotein(a): A big genetic risk for heart disease


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