Review Article

High Circulating Levels of ANGPTL2: Beyond a Clinical Marker of Systemic Inflammation

Table 1

Circulating levels of ANGPTL2 in cardiovascular diseases.

ReferencePatientsSerum ANGPTL2 (ng/ml)ELISA kitConclusion of the study

[48]Chronic kidney disease (stage 5) ± kidney transplant, Canadafrom 71 [53–95] to 11 [9–15] after kidney transplantUSCN Life Science Inc., ChinaHigh ANGPTL2 after kidney transplant is associated with aortic stiffness, pulse pressure, renal function, and mortality.
[44]Hisayama study, general population, JapanQ1: <2.2
Q4: >3.4
IBL, JapanHigh ANGPTL2 is an independent factor for T2DM development.
[50]Coronary artery disease versus age-matched controls, Canada~6.0 versus 1.0 in controlsUSCN Life Science Inc., ChinaANGPTL2 promotes atherosclerosis in mice.
ANGPTL2 is higher in CAD patients.
[45]Diabetes and chronic kidney disease (<stage 4), FranceQ1: <11.2
Q4: >19.5
USCN Life Science Inc., ChinaANGPTL2 improves risk stratification inT2DM: Q4 predicts MACE and mortality.
[51]Hisayama study, general Japanese populationQ1: <2.25
Q4: >3.62
IBL, JapanHigh ANGPTL2 is an independent factor for cardiovascular disease development.
[26]Coronary heart disease versus controls, Japan~4.6 versus 3.6 in controlsIBL, JapanANGPTL2 is higher in coronary heart disease patients.
Seniors (85–99 years old), general population, Japan4.1 [3.2–5.1]ANGPTL2 correlates with inflammation, IMT, and the presence of plaque: ANGPTL2 reflects atherosclerosis.
[52]Heart failure versus age-matched controls, Taiwan~4.6 versus 3.5 in controls
T1: <3.4
T3: >4.8
IBL, JapanANGPTL2 is higher in HF patients. Higher risk (2.97-fold) of HF in patients with ANGPTL2 levels in T3.
[53]T2DM, South KoreaQ1: <3.3
Q4: >5.2
IBL, JapanANGPTL2 correlates with carotid IMT: ANGPTL2 is important in atherosclerosis.
[7]Coronary artery disease versus age-matched controls, Canada~5.5 versus 2.0 in controlsUSCN Life Science Inc., ChinaANGPTL2 is higher in CAD patients.
Acute intermittent exercise reduces ANGPTL2.
[46]Diabetes with nephropathy versus controls, China36.1 to 50.2 versus 24.0 in controlsUSCN Life Science Inc., ChinaANGPTL2 is independently associated with albuminuria: role of ANGPTL2 in nephropathy in T2DM patients.
[58]Obese metabolically healthy women China4.2 (at risk for insulin resistance) versus 2.9 (normal IS)Not mentionedANGPTL2 is negatively correlated with insulin sensitivity and serum epinephrine levels.
[59]Overweight healthy men, Japan~3.0 versus 2.8 after diet and exerciseIBL, JapanLifestyle intervention reduces ANGPTL2.
Changes in ANGPTL2 reflect visceral fat and metabolic improvement.
[54]Acute coronary syndrome versus age-matched controls, Canada~3.4 versus 1.8 in controlsUSCN Life Science Inc., ChinaANGPTL2 is higher in acute coronary syndrome patients and is associated with reduced leukocyte DNA methylation in the promoter region of ANGPTL2 gene.
[55]Coronary artery disease versus controls, Japan~4.0–6.7 versus 3.0 in controlsIBL, JapanANGPTL2 is higher in patients with multivessel CAD than in those with single vessel disease.
[60]Severe obese ± bariatric surgery, Canada12.3 (9.3–14.9)USCN Life Science Inc., ChinaBariatric surgery decreases ANGPTL2 and this is associated with a better cardiometabolic profile, not with anthropometric parameters.
[77]Patients with acute myocardial infarction, Japan~2.0IBL, JapanStatin started early after the onset of myocardial infarction reduces ANGPTL2.
[5]Coronary artery disease, obese, diabetes versus controls, Japan~4.0–5.0 versus 2.5 in controlsIBL, JapanANGPTL2 is a key adipocyte-derived inflammatory mediator that links obesity to insulin resistance.
[8]Post-acute coronary syndrome patients, effect of exercise, CanadaMen: from 2.8 to 1.4 after EX
Women: from 4.4 to 5.1 after EX
USCN Life Science Inc., ChinaIn post ACS men (not women), ANGPTL2 is reduced by exercise training. ANGPTL2 reached at the end of the training reflects endothelial and cardiopulmonary functions.
[68]Dilated cardiomyopathy, JapanCoronary sinus: 4.6 versus 2.1
Aortic root: 2.4 versus 2.5
IBL, JapanA difference between ANGPTL2 in coronary sinus and aortic root reflects ANGPTL2 secretion from the heart.
[9]Hisayama study, general population, JapanQ1: 2.0
Q4: >3.7
IBL, JapanHigh ANGPTL2 is associated with the prevalence of chronic kidney disease.
[57]Acute coronary syndrome versus controls, ChinaQ1: <11.3
Q4: >43.7
versus 7–25 in controls
Cusabio, ChinaANGPTL2 is closely associated with ACS and provides risk stratification of the disease.
[47]Gestational diabetes, ChinaQ1: <2.0
Q4: >3.5
IBL, JapanANGPTL2 is higher in women with gestational diabetes. The risk of developing gestational diabetes is x2.9 in Q4.

ACS: acute coronary syndrome; CAD: coronary artery disease; EX: exercise; HF: heart failure; IMT: intima-media thickness; IS: insulin sensitivity; MACE: major adverse cardiovascular events; Q: quartile; T2DM: type 2 diabetes mellitus; T: tertile.