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Risk of acute arterial events associated with treatment of inflammatory bowel diseases: a nationwide Danish cohort study
  1. Daniel Ward1,2,
  2. Mikael Andersson2,
  3. Nynne Nyboe Andersen3,
  4. Kristine Højgaard Allin1,4,
  5. Laurent Beaugerie5,6,
  6. Tine Jess1,4,
  7. Julien Kirchgesner5,6
  1. 1 Center for Molecular Prediction of Inflammatory Bowel Disease, Department of Clinical Medicine Copenhagen, DK, Aalborg Universitet, Aalborg, Denmark
  2. 2 Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
  3. 3 Department of Medical Gastroenterology, Zealand University Hospital, Køge, Denmark
  4. 4 Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
  5. 5 Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
  6. 6 INSERM, Institut Pierre Louis d’Epidemiologie et de Santé Publique, Sorbonne Université, Paris, France
  1. Correspondence to Julien Kirchgesner, Department of Gastroenterology, Hôpital Saint-Antoine, Paris 75012, France; julien.kirchgesner{at}

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Kirchgesner et al recently found that anti-tumour necrosis factor (TNF) therapy for IBD was associated with a reduced risk of a first acute arterial event (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) in a nationwide French cohort,1 while the risk was increased compared with the general population.2 Nevertheless, a cardioprotective effect of thiopurines could not be excluded in the French cohort study as risk estimates were at the limits of statistical significance. The reduction in systemic inflammation following IBD treatment is thought to protect against cardiovascular disease,3 4 as elevated C-reactive protein (CRP) is now considered to be a cardiovascular risk factor.5 6 We sought to establish further evidence regarding cardiovascular risk and IBD treatments by investigating the risk of acute arterial events associated with thiopurines and anti-TNF in a nationwide Danish cohort study.

Using Danish nationwide registers,7 8 we assembled a cohort of patients with IBD aged 18 years or older in Denmark, in the period 2005–2018 (online supplemental methods). We defined current exposure to either anti-TNF (30 days from the date of administration of …

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  • Correction notice This article has been corrected since it published Online First. The affiliations for Kristine Højgaard Allin and Tine Jess have been updated.

  • Contributors JK, DW and MA: had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors: concept and design, acquisition, analysis or interpretation of data and critical revision of the manuscript for important intellectual content. DW: drafting of the manuscript. DW, MA, TJ and JK: statistical analysis. TJ and JK: supervision and co-last authors.

  • Competing interests JK received lecture fees from Pfizer and consulting fees from Roche, Pfizer and Gilead. LB received consulting fees from BMS, Janssen and Mylan; lecture fees from AbbVie, BMS, Janssen, MSD, Ferring and Takeda and research support from AbbVie, Celltrion, Ferring Pharmaceuticals, Hospira-Pfizer, Janssen, MSD, Mylan, Takeda and Tillotts.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.