What does this research mean for the field?

Elevated serum ANGPTL4 levels are positively and independently associated with the risk of severe coronary artery calcification. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 7, 2026Frontiers in Cardiovascular MedicineOpen Access

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

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Why the study?

ANGPTL4 plays a significant role in lipid metabolism and may participate in coronary artery calcification progression, motivating this evaluation of their association and a predictive nomogram.

Structured PICO

Population

600 individuals (100% male) aged ≥18 years who underwent multi-slice spiral coronary computed tomography (CT) scan with CACS measured using the Agatston method at Beijing Anzhen Hospital. Excluded patients with chronic renal failure, acute coronary syndrome, insulin-dependent diabetes mellitus, degenerative aortic valve disease, or history of PCI/CABG.

Intervention

Serum ANGPTL4 level measurement (biomarker evaluation)

Comparator

Low vs. high ANGPTL4 levels (or non-severe CAC vs. severe CAC groups)

Outcome

Presence of severe coronary artery calcification (CACS > 400 Agatston Units)surrogate

Serum ANGPTL4 levels are independently associated with severe coronary artery calcification and can be incorporated into a nomogram to improve risk prediction.

Limitations

Exclusion of patients with prior PCI or CABG limits findings to early-to-mid stages of CAD rather than advanced disease.
Cross-sectional/observational design precludes definitive causal conclusions.
Single-center study with all-male cohort limits generalizability.

Implication

ANGPTL4 may refine severe CAC risk prediction; leaves open causal role and nomogram validation in prospective cohorts.

Abstract

Background: 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. Methods: 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. Results: = 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]. Conclusions: 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.