The serum ANGPTL4 level and severe coronary artery calcification: from association to risk prediction using a...

Coronary artery calcification (CAC) is an important indicator of atherosclerosis in the coronary arteries, the degree of which is closely associated with the risk for cardiovascular events. Angiopoietin-like protein 4 (ANGPTL4) plays a significant part in lipid metabolism and energy balance, and may also participate in the progression of CAC. This study was designed to examine the association between ANGPTL4 and CAC and to develop a nomogram to predict the risk of severe CAC.

A total of 600 individuals who underwent multi-slice computed tomography (CT) of the coronary arteries and had available Agatston coronary artery calcification scores (CACS) at Beijing Anzhen Hospital were enrolled. Participants were divided into two groups: those with non-severe CAC (CACS ≤ 400) and those with severe CAC (CACS > 400). Determination of ANGPTL4 levels using an Enzyme-Linked Immunosorbent Assay (ELISA) kit. Identifying variables independently associated with severe CAC through least absolutely shrinkage selection operator (LASSO) regression analysis and logistic regression analysis.

Serum ANGPTL4 levels exhibited significantly higher concentrations in patients with severe CAC compared to those with non-severe CAC (p = 0.007). ANGPTL4 levels were positively associated with CAC severity, independent of other clinical risk factors. Age, smoking status, statin use, glycated hemoglobin A1c (HbA1c), serum phosphate, and ANGPTL4 were included in the predictive model for severe CAC. Receiver operating characteristic (ROC) curve analytics indicate that this model demonstrates acceptable discriminatory ability for severe CAC, with an area under the curve (AUC) of 0.708 [95% confidence interval (CI): 0.649-0.767].

This study indicates that ANGPTL4 is independently associated with severe CAC, suggesting that ANGPTL4 could serve as a candidate biomarker and treatment target for vascular calcification.