Relationship between serum angiopoietin-like protein 2 and plaque vulnerability in patients with coronary artery disease and diabetes.

Abstract

Obesity is characterized by low-grade inflammation state and excessive inflammatory cytokine production of adipose tissue. Angiopoietin-like protein 2 (ANGPTL2), a novel proinflammatory adipokine, has recently been suggested to be involved in the pathogenesis of atherosclerosis in animal studies. However, no data regarding the relationship between ANGPTL2 and morphologic characteristics of coronary plaques in humans are available. The aim of the current study was to investigate the in vivo association between serum ANGPTL2 level and plaque vulnerability in patients with coronary artery disease (CAD) and diabetes. 72 consecutive patients with clinically proven CAD and diabetes were enrolled between October 2013 and December 2014. Circulating ANGPTL2 concentration was measured using a human ANGPTL2 sandwich enzyme-linked immunosorbent assay (ELISA) kit. The morphologic characteristics of non-culprit lipid-rich plaques were assessed by optical coherence tomography. Fibrous cap thickness was significantly and negatively correlated with serum ANGPTL2 levels (r = -0.29, P = 0.005). A significant and positive correlation was observed between mean lipid core arc and serum ANGPTL2 concentration (r = 0.32, P = 0.01). In addition, levels of serum ANGPTL2 were significantly higher in patients with thin-cap fibroatheroma (TCFA) than those without TCFA (P < 0.001). Multivariate logistic regression analysis showed that a higher serum ANGPTL2 concentration was a powerful predictor of TCFA (odds ratio: 3.18, P = 0.002). Serum ANGPTL2 level is significantly associated with plaque vulnerability in patients with CAD and diabetes. Systemic ANGPTL2 comprises an inflammatory adipokine that links the adipose tissue and coronary plaque.