# ANGPTL3-remmers verlagen breed lipidenspectrum, vooral remnant- en triglyceriden

*geplaatst 2026-05-05 · Cholesterol · European journal of preventive cardiology · doi 10.1093/eurjpc/zwag230 · https://hartvaat.nl/2026/04/22/angptl3-remmers-verlagen-breed-lipidenspectrum-vooral-remnant-en-triglyceriden/*

Meta-analyse van 9 RCT's (1.254 patiënten) over angiopoëtine-like protein 3 (ANGPTL3)-remmers liet brede lipidenverlaging zien: triglyceriden -47,1%, LDL-C -21,6%, ApoB -19,9%, non-HDL-C -31,5%, VLDL-C -40,6% en remnantcholesterol -72,7%. Lp(a) daalde 11,5%. Evinacumab (monoklonaal antilichaam) gaf de grootste reducties in LDL-C, ApoB en non-HDL-C; siRNA's (zodasiran, solbinsiran) gaven sterkere VLDL-C-reductie. Geen significant effect op hs-CRP. ANGPTL3-remming biedt vooral perspectief voor triglyceridenrijke lipoproteïnen — een belangrijke nieuwe pijler in residueel cardiovasculair risico.

## English: 

A meta-analysis of 9 RCTs (1,254 participants) showed that angiopoietin-like protein 3 (ANGPTL3) inhibition produces broad lipid lowering: triglycerides −47.1%, LDL-C −21.6%, ApoB −19.9%, non-HDL-C −31.5%, VLDL-C −40.6% and remnant cholesterol −72.7%. Lp(a) fell 11.5%. Evinacumab (monoclonal antibody) gave the largest LDL-C, ApoB and non-HDL-C reductions; siRNAs (zodasiran, solbinsiran) achieved more pronounced VLDL-C lowering. No effect on hs-CRP. ANGPTL3 inhibition is most promising for triglyceride-rich lipoproteins — a significant new pillar against residual cardiovascular risk.

## Abstract (original, from the publication)

AIMS: Inhibition of angiopoietin-like protein 3 (ANGPTL3) has been proposed as a promising approach to reduce residual cardiovascular risk. We conducted a meta-analysis of randomized controlled trials (RCTs) to provide a comprehensive evaluation of the metabolic effects of ANGPTL3 inhibitors. METHODS: Databases (PubMed, EMBASE, Web of Science, CENTRAL, ClinicalTrials.gov) were searched from inception to July 2025. Eligible studies were RCTs comparing ANGPTL3 inhibitors against placebo. Outcomes included triglycerides (TG), LDL-C, apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), very-low-density lipoprotein cholesterol (VLDL-C), apolipoprotein A1 (ApoA1), apolipoprotein C3 (ApoC3), lipoprotein(a) (Lp(a)), remnant cholesterol (RC), ANGPTL3 and C-reactive protein (CRP). Pooled estimates of percentage change from baseline were obtained using fixed- and random-effects models. Subgroup analysis was performed based on the mechanism of action: monoclonal antibodies (mAbs, evinacumab), antisense oligonucleotides (ASOs, vupanorsen), and small interfering RNAs (siRNA, zodasiran and solbinsiran). RESULTS: Nine RCTs (1,254 participants) were included. ANGPTL3 inhibition significantly reduced TG (-47.1%), LDL-C (-21.6%), ApoB (-19.9%), non-HDL-C (-31.5%), TC (-32.8%), VLDL-C (-40.6%), and RC (-72.7%). Modest but consistent reductions were also observed in Lp(a) (-11.5%), ApoA1 (-18.3%), and ApoE (-16.4%). ANGPTL3 inhibitors markedly reduced circulating ANGPTL3 protein (-70.7%), with no significant effect on high-sensitivity CRP. Subgroup analyses demonstrated greater reductions in LDL-C, ApoB, non-HDL-C, and TC with evinacumab compared to the other groups, whereas small interfering RNAs produced more pronounced VLDL-C lowering compared with vupanorsen. CONCLUSIONS: ANGPTL3 inhibition offers broad lipid-lowering benefits, with particularly marked reductions in TG-rich lipoproteins.

Auteurs: Sining Xie, Federica Galimberti, Elena Olmastroni, Alberico L Catapano, Manuela Casula

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Bron: European journal of preventive cardiology, https://doi.org/10.1093/eurjpc/zwag230. Bijgewerkt 2026-07-03T13:31:46Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.