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. 2020 Dec;34(6):773-780.
doi: 10.1007/s10557-020-06991-1.

The Clinical Role of Angiopoietin-Like Protein 3 in Evaluating Coronary Artery Disease in Patients with Obstructive Sleep Apnea

Juan Li  1 , Yunyun Yang  1   2 , Xiaolu Jiao  1   2 , Huahui Yu  1   2 , Yunhui Du  1   2 , Ming Zhang  3 , Chaowei Hu  1   2 , Yongxiang Wei  4   5 , Yanwen Qin  6   7
Affiliations

The Clinical Role of Angiopoietin-Like Protein 3 in Evaluating Coronary Artery Disease in Patients with Obstructive Sleep Apnea

Juan Li et al. Cardiovasc Drugs Ther. 2020 Dec.

Abstract

Purpose: Hyperlipidemia is the most important early atherosclerosis and coronary artery disease (CAD) indicator. Angiopoietin-like proteins (ANGPTLs) 3, 4, and 8 are lipid dysfunction markers that may be linked to CAD. We investigated whether these circulating ANGPTLs are associated with CAD in patients with obstructive sleep apnea (OSA).

Methods: A total of 327 individuals participated in this study: 221 patients with OSA and CAD, 50 patients with OSA alone, and 56 controls. The Gensini Score was used to assess the severity of CAD. Serum ANGPTL3, ANGPTL4, and ANGPTL8 were measured in all subjects using Human Magnetic Luminex Screening Assay. The independent association between levels of ANGPTLs and CAD was evaluated by multivariate regression analysis.

Results: Serum ANGPTL3 levels were significantly higher in patients suffering from OSA and CAD compared with patients having OSA alone (46.97 ± 13.89 vs 38.25 ± 15.94 ng/ml, P < 0.001). Univariate analysis demonstrated that ANGPTL3 was a risk factor for CAD (OR = 1.72/10 ng ANGPTL3, 95% CI, 1.29-2.28, P < 0.001). In addition, multivariate analysis revealed that ANGPTL3 was independently associated with the presence of CAD (OR = 1.74/10 ng ANGPTL3, 95% CI, 1.29-2.35, P < 0.001) even after adjusting for cofounding factors. Furthermore, circulating ANGPTL3 levels were positively associated with triglyceride (r = 0.16, P = 0.01) and total cholesterol (r = 0.14, P = 0.02) levels, while ANGPTL3 levels had no significant correlation with the severity of CAD. No significant associations were found between the levels of ANGPTL4 and ANGPTL8 and CAD even after adjusting for established risk factors.

Conclusion: Elevated levels of ANGPTL3 were independently associated with a higher likelihood of CAD in patients with OSA. It may be a novel biomarker for OSA patients at high risk of developing cardiovascular diseases.

Keywords: Angiopoietin-like proteins; Coronary artery disease; Lipid metabolism; Obstructive sleep apnea.

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Conflict of interest statement

The authors declare that there are no competing interests.

Figures

Fig. 1
Fig. 1
Study flow. About 327 participants were consecutively enrolled including 221 CAD combined OSA patients, 50 non-CAD OSA patients, and 56 non-OSA controls. Abbreviations: OSA obstructive sleep apnea, AHI apnea-hypopnea index, CAD, coronary artery disease
Fig. 2
Fig. 2
Circulating ANGPTL3 levels were higher in patients with CAD compared with controls. The comparison of the concentration of ANGPTL3 in CAD and non-CAD patients is shown in a dot plot. The concentration in the CAD group is 46.97 ± 13.89 ng/ml, and the concentration in the non-CAD group is 38.25 ± 15.94 ng/ml. Data are expressed as the mean ± standard deviation. Abbreviations: CAD coronary artery disease, ANGPTL3 angiopoietin-like protein 3 ** P < 0.001
Fig. 3
Fig. 3
ANGPTL3 was positively correlated with TG and TC. Correlation between TG/TC and ANGPTL3. There was significant positive correlation between TG/TC and ANGPTL3. ANGPTL3 angiopoietin-like protein 3, TG triglycerides, TC total cholesterol
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) analysis. ROC for predicting CAD using ANGPTL3. The area under the curve (AUC) for the plasma ANGPTL3 levels was 0.65, P = 0.001
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