February 6, 2026

Prognostic predictive value of circulating angiopoietin-like protein 3 in patients with chronic coronary syndrome

Q: What does this research mean for the field?

Serum ANGPTL3 levels above 109.7 ng/mL are associated with a significantly higher incidence of major adverse cardiovascular events in patients with chronic coronary syndrome (p = 0.0001). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Serum ANGPTL3 levels above 109.7 ng/mL independently predict higher 1-year MACE incidence in chronic coronary syndrome patients, even with LDL-C ≤70 mg/dL.

Key Points

The study aims to evaluate the prognostic predictive value of circulating ANGPTL3 levels in patients with chronic coronary syndrome.
Enrolled 226 patients with chronic coronary syndrome
Quantified serum ANGPTL3 levels using an enzyme-linked immunosorbent assay
Examined the 1-year incidence of major adverse cardiovascular events including all-cause mortality and myocardial infarction
Conducted multivariate Cox regression analyses to determine the relationship between ANGPTL3 levels and MACEs
Performed Kaplan-Meier analysis to compare the incidence of MACEs based on ANGPTL3 levels.
20 (7.7%) patients developed major adverse cardiovascular events during follow-up
Serum ANGPTL3 levels independently predicted incidence of MACEs in multivariate models (p < 0.05)
Optimal cutoff level for ANGPTL3 to predict events was identified at 109.7 ng/mL
Higher incidence of MACEs observed in patients with ANGPTL3 levels exceeding 109.7 ng/mL (log-rank test, p = 0.0001)
This trend also applied to patients with LDL-C levels of ≤70 mg/dL (log-rank test, p < 0.0001).

Structured PICO

Does elevated circulating ANGPTL3 predict major adverse cardiovascular events in patients with chronic coronary syndrome?

Population

226 patients with chronic coronary syndrome (CCS), including those with optimally controlled low-density lipoprotein cholesterol (LDL-C). Mean age 74 years, 74% male.

Intervention

Elevated serum ANGPTL3 levels (>109.7 ng/mL)

Comparator

Lower serum ANGPTL3 levels (≤109.7 ng/mL)

Outcome

1-year incidence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause mortality, nonfatal myocardial infarction, heart failure requiring hospitalization, and ischemic strokecomposite

Elevated circulating ANGPTL3 levels (>109.7 ng/mL) independently predict 1-year major adverse cardiovascular events in patients with chronic coronary syndrome, including those with optimally controlled LDL-C.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Angiopoietin-like protein 3 (ANGPTL3) is an emerging therapeutic target for managing lipid profiles; however, its prognostic significance in patients with chronic coronary syndrome (CCS) remains undefined. Aim To examine the prognostic predictive value of circulating ANGPTL3 levels in a cohort of patients with CCS, including those with optimally controlled low-density lipoprotein cholesterol (LDL-C). Methods We enrolled 226 patients with CCS (mean age, 74 years; male patients, 74%; mean body mass index, 24 kg/m2; diabetes, 49%; median estimated glomerular filtration rate, 57 mL/min/1.73 m2). Serum ANGPTL3 levels were quantified using an enzyme-linked immunosorbent assay (R 0.05 in all models). Receiver operating characteristic curve analysis revealed a serum ANGPTL3 level of 109.7 ng/mL as an optimal cutoff value for event discrimination. Kaplan-Meier analysis also showed a significantly higher incidence of MACEs in patients with ANGPTL3 levels exceeding 109.7 ng/mL than in those with lower levels (log-rank test, p = 0.0001). A similar trend was also observed in the subset of patients with LDL-C levels of ≤70 mg/dL (log-rank test, p 0.0001). Conclusion Circulating ANGPTL3 levels can serve as a prognostic marker in patients with CCS, providing effective risk stratification for CCS overall and within CCS cohorts that have achieved target LDL-C levels.

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