Sex and anticitrullinated protein antibodies modify the relationship between inflammation and cardiovascular risk in rheumatoid arthritis
Authors' conclusion
The effect of disease activity at enrolment on cardiovascular risk in prevalent RA varies across patient groups with different sex and ACPA characteristics.
Study context
- Population
- Patients with prevalent (established) rheumatoid arthritis (RA) from an international observational cohort enrolled 1985–2012
- Participants
- 4,008 patients
- Exposure
- Disease activity, sex, anticitrullinated protein antibodies (ACPA) and their interactions on CV risk
- Outcome
- MACE (CV death, MI and stroke) and iCVE (MACE, angina, revascularisation, TIA and peripheral arterial disease)
Methodological detailsinternational observational cohort, multivariable Cox models stratified by centre risk
- International observational cohort
- Multivariable Cox models stratified by centre risk
Main finding
As reported in the abstract
- MACE events
- 193
- iCVE events
- 299
- Disease activity and sex associated with MACE
- all p≤0.017
- Disease activity and sex associated with iCVE
- p≤0.005
- ACPA associated with MACE only
- p=0.043
- Three-way interaction on MACE (not iCVE)
- p=0.034
Observational data: associations, not effects.
Further findings
MACE in ACPA-negative patients (subgroup)
- Disease activity associated with MACE in males, HR
- 1.57 (1.14 to 2.16) (95% CI)
- Not in females; p-for-interaction
- P for interaction = 0.022
MACE in ACPA-positive patients (subgroup)
- Disease activity x sex interaction not significant
- P = 0.929
- Main effect of disease activity not significant
- P = 0.124
- Male sex, HR
- 1.61 (1.15 to 2.27) (95% CI)
MACE in females (subgroup)
- Disease activity x ACPA interaction not significant
- P = 0.523
- Disease activity not significant
- P = 0.319
- ACPA, HR
- 1.57 (1.02 to 2.42) (95% CI)
Original publication
Sex and anticitrullinated protein antibodies modify the relationship between inflammation and cardiovascular risk in rheumatoid arthritis. RMD Open. Published 2 February 2026. doi:10.
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