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W. Alberto Sifuentes Giraldo: Temporal Structure of Cardiovascular and Thromboembolic Risk in AAV
W. Alberto Sifuentes Giraldo/LinkedIn
Oct 30, 2026, 23:34

W. Alberto Sifuentes Giraldo: Temporal Structure of Cardiovascular and Thromboembolic Risk in AAV

W. Alberto Sifuentes Giraldo, Rheumatologist at Hospital Nuestra Señora de Sonsoles (Sacyl), shared a post on X about a recent article by Clemens Untersulzner et al., published in Rheumatology, adding:

“Temporal Structure of Cardiovascular and Thromboembolic Risk in AAV

Advances in treatment have transformed ANCA-associated vasculitis (AAV) from a fatal disease into a chronic condition. Consequently, cardiovascular disease and thromboembolism (CVD-TE) have become major comorbidities.

However, standard clinical practice has often overlooked this risk because traditional research reported it as a uniform average over time, masking its true temporal pattern.

Study Overview and Methodology

A nationwide matched cohort study by Lindberg et al. utilized Swedish registry data (2005–2020) to pinpoint when CVD-TE risk is highest:

  • Cohort: 4,317 adults with AAV—3,159 with granulomatosis with polyangiitis (GPA) and 1,158 with microscopic polyangiitis (MPA).
  • Control Groups: 21,582 general population controls (matched by age, sex, and county) and 25,568 first-degree siblings.
  • Evaluated Outcomes: Myocardial infarction (MI), ischemic stroke, hemorrhagic stroke, deep vein thrombosis (DVT), pulmonary embolism (PE), CVD-TE-related death, and a composite of all six. High specificity for venous events was ensured by requiring an anticoagulant prescription within 30 days of diagnosis.

Key Findings

1. Comparable Risk Across Entities: After adjusting for age, sex, cardiovascular comorbidity, and kidney disease, the composite CVD-TE risk was elevated in both GPA and MPA, with no significant differences between the two diagnoses.

2. Extreme Early-Phase Risk Peak: The excess risk is heavily concentrated around the time of diagnosis:

  • First 90 Days: Hazard ratios (HRs) peaked dramatically at 29.4 for DVT and 18.0 for PE, compared to 3.53 and 3.67 over full follow-up.
  • Composite Risk: Reached an HR of 7.69 in the first three months. Stroke risk peaked at 3.39 (vs. 1.29 overall).
  • Pre-Diagnosis Elevation: Risk was already elevated before formal diagnosis (rate ratio of 5.04 in the 90 days prior), supporting similar findings from Denmark.
  • Long-Term Trajectory: Beyond the first year, cumulative hazard curves ran nearly parallel, maintaining a much lower but persistent risk.

3. Genetic Implications: Siblings of AAV patients showed no elevated CVD-TE risk compared to control siblings, and patients had a higher risk than their own siblings. This indicates that shared genetic susceptibility plays a minimal role in the observed CVD-TE excess.

Clinical and Methodological Takeaway

Reporting CVD-TE risk as a single overall hazard ratio is misleading because it assumes constant risk over time.

An overall average flattens the acute initial surge and fails to represent either the early hyper-acute phase or the lower chronic phase accurately.

Recognizing this early peak is essential for designing targeted, timely preventive strategies and early interventions.”

Title: Cardiovascular risk in ANCA-associated vasculitis: a plea for early intervention

Authors: Clemens Untersulzner, Andreas Kronbichler

W. Alberto Sifuentes Giraldo

Other posts featuring W. Alberto Sifuentes Giraldo on Hemostasis Today.

AAV ANCA ANCA-Associated Vasculitis Andreas Kronbichler Blood Cardiology Cardiovascular Disease Clemens Untersulzner CVD deep vein thrombosis GPA Health Hematology Hemorrhagic Stroke Hemostasis Hemostasis News Hemostasis Today Ischemic stroke Medicine MI MPA Myocardial infarction PE Pulmonary embolism Rheumatology TE thromboembolism W. Alberto Sifuentes Giraldo
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