ANGPTL3 and CFTR-related metabolic syndrome/CF screen positive, inconclusive diagnosis: Cluster 4 (stable low TyG) may be characterized by intact triglyceride metabolism, preserved LPL clearance, balanced ANGPTL3/4/8 regulation, and lower burdens of insulin resistance, DKD and CRMS; based on data from two cohorts, moderate lipid-modifying drug use and higher ACEI/ARB adoption may further mitigate atherogenic stress and underpin this cluster’s superior prognosis.