Location of recurrent cardiovascular events and anticardiolipin antibodies

Eur J Clin Invest. 2021 Jul;51(7):e13533. doi: 10.1111/eci.13533. Epub 2021 Mar 11.


Background: The relationship between anticardiolipin (aCL) antibodies and cardiovascular events is uncertain and may vary according to arterial location.

Materials and methods: FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral artery disease (PAD). The rate of subsequent ischaemic events was cross-referenced with the presence of aCL antibodies (any isotype, IgG or IgM).

Results: As of June 2017, 1387 stable outpatients were recruited. Of these, 120 (8.7%) showed positive levels of aCL antibodies. Over an average follow-up of 18 months, 250 patients developed subsequent events: 101 myocardial infarction, 57 ischaemic stroke and 92 critical leg events. Patients with positive aCL antibodies had a higher risk of distal artery events (a composite of ischaemic stroke or critical leg events) than patients with undetectable or low levels (rate ratio: 1.66; 95% CI: 1.07-2.60). However, an association with central coronary events was not found. The multivariate Cox analysis after adjustment for relevant clinical covariates showed that positivity of aCL antibodies is an independent risk factor for distal events (hazard ratio: 1.60; 95% CI: 1.01-2.55; P < .05).

Conclusions: Positivity of aCL antibodies is associated with an increased risk of subsequent distal artery ischaemic events (cerebral or leg arteries) but not coronary artery events. Anticardiolipin antibodies appear to have a different relationship on the localisation of ischaemic events in patients with symptomatic artery disease.

Keywords: IgG; IgM; anticardiolipin antibodies; ischaemic event; myocardial infarction; symptomatic artery disease.

MeSH terms

  • Aged
  • Antibodies, Anticardiolipin / immunology*
  • Cerebrovascular Disorders / immunology*
  • Coronary Artery Disease / immunology*
  • Female
  • Humans
  • Ischemia / epidemiology
  • Ischemia / immunology
  • Ischemic Stroke / epidemiology
  • Ischemic Stroke / immunology*
  • Lower Extremity / blood supply
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / immunology*
  • Peripheral Arterial Disease / immunology*
  • Proportional Hazards Models
  • Recurrence
  • Registries


  • Antibodies, Anticardiolipin