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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 …
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Twitter @KristineAllin, @J_Kirchgesner
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.
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