Key result
ANGPTL4 predicts 5-year mortality in suspected coronary chest pain with ~0.72 AUC, comparable to BNP.
Why the study?
Although both BNP and ANGPTL4 serve as prognostic indicators in ACS, their relative prognostic weighting in a cross-continental setting and the association of ANGPTL4 with circulating lipids in patients with suspected coronary chest pain required evaluation.
Does ANGPTL4 improve prognostic prediction of 5-year all-cause mortality compared to BNP in patients with suspected coronary chest pain across different continents?
Cohort (n=1,014)
Yes
Does ANGPTL4 improve prognostic prediction of 5-year all-cause mortality compared to BNP in patients with suspected coronary chest pain across different continents?
Both ANGPTL4 and BNP independently predict 5-year all-cause mortality in patients with suspected coronary chest pain, though their relative prognostic performance varies between South American and European populations.
Answers are grounded in this paper and cite their sources.
Similar 5-year mortality across continents despite lipid differences; leaves open regional optimization of ANGPTL4 versus BNP for risk stratification.
BNP is predominantly synthesized in the ventricular myocardium in response to ventricular distension. ANGPTL4 modulates lipid metabolism, vascular integrity and angiogenesis. Both biomarkers serve as prognostic indicators in acute coronary syndrome (ACS). The purpose of this study is to compare the prognostic weighting of ANGPTL4 with BNP in a cross-continental setting and to assess the former’s association with circulating lipids in patients with suspected coronary chest pain. Patients were recruited in Norway (NOR) and Argentina (ARG) and matched exactly by propensity scoring according to age, sex and previous use of statins, yielding 507 subjects in each group. Cox regression models were fitted for standardized loge ANGPTL4 and loge BNP, respectively, with all-cause mortality within 5 years as the dependent variable. Receiver Operating Characteristic (ROC) analysis was applied for the area under curve (AUC). Death rates were similar: (ARG = 20.1%) and (NOR = 22.7%), p = 0.320. ANGPTL4 and BNP were independently associated with all-cause mortality in each cohort. Concentrations of ANGPTL4 and triglycerides (TG) were higher, and total cholesterol (TC), LDL-C and HDL-C were lower in ARG compared to NOR (each p < 0.001). ANGPTL4 correlated negatively with each lipid fraction and positively with C-reactive protein (CRP) but did not correlate with body mass index (BMI) in the cohorts combined. AUC for ANGPTL4 outperformed BNP in ARG, and the reverse was observed in NOR. However, AUC for ANGPTL4 in the combined cohorts was 0.718 (95%CI 0.680–0.756) and for BNP it was 0.730 (95%CI 0.691–0.769). Their different pathogenic pathways may improve prognostic information, with a pattern that may differ between continents.
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Nilsen et al. (2026) conducted a cohort in Suspected coronary chest pain (n=1,014). Angiopoietin-Like 4 (ANGPTL4) vs. B-Type Natriuretic Peptide (BNP) was evaluated on All-cause mortality within 5 years (AUC 0.718, 95% CI 0.680-0.756). ANGPTL4 independently predicted 5-year all-cause mortality in suspected coronary chest pain with a combined AUC of 0.718 (95% CI 0.680-0.756) vs 0.730 (95% CI 0.691-0.769) for BNP.
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