ANCA Specificity Regulates Cardiovascular Risk in Vasculitis

TOPLINE:

Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) who presented with antimyeloperoxidase (anti-MPO) ANCA appeared to have a higher risk for major adverse cardiovascular events (MACE) and a shorter time to their occurrence than those who presented with antiproteinase 3 (anti-PR3) ANCA.

METHODOLOGY:

Researchers conducted a retrospective observational study of 402 patients with AAV (mean age at diagnosis, 61 years; 55% men) who were treated at two French hospitals between January 2011 and March 2021.
Patients were stratified by ANCA specificity, of whom 236 were positive for anti-MPO ANCA and 166 positive for anti-PR3 ANCA.
Patients were followed up for a mean of 7.5 years.
The primary outcome was MACE, defined as the occurrence of myocardial infarction, stroke, or all-cause death.

TAKEAWAY:

During follow-up, 78 incidences of MACE occurred. The incidence rate of MACE was higher in the anti-MPO ANCA group than in the anti-PR3 ANCA group (33.1 vs 21.4 per 1000 patient-years; P = .036).
The mean time elapsed between the diagnosis of AAV and the occurrence of the first MACE was shorter in the anti-MPO ANCA group than in the anti-PR3 ANCA group (6.1 vs 7.6 years; P < .001), with a similar pattern observed for myocardial infarction and stroke.
The presence of anti-PR3 ANCA was associated with a lower risk for stroke (adjusted hazard ratio, 0.61; P = .049); no such association was observed for myocardial infarction.

IN PRACTICE:

“[The study] findings further support the existence of distinct phenotypic and prognostic differences in AAV based on ANCA specificity and the need for developing a more patient-tailored management,” the authors wrote.

SOURCE:

The study was led by Jon Idoate Lacasia, Internal Medicine, Hôpital Tenon, Paris, France. It was published online on January 22, 2026, in RMD Open.

LIMITATIONS:

The study’s retrospective design limited data collection. The cause of death could not be determined for nearly half of deaths recorded during follow-up. The lack of homogeneity in patient-level data prevented the inclusion of important variables such as proteinuria and cumulative glucocorticoid dose.

DISCLOSURES:

The study did not receive any specific funding. The authors did not declare having any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.