Before starting an advanced therapy, record the cardiovascular baseline you will be asked about later

The evidence on cardiovascular risk from advanced IBD therapies is unresolved and will stay that way for years, because the answer has to come from long-term cohorts rather than trials. What that means in clinic is that you will at some point be asked whether a patient's cardiac event had anything to do with their biologic, and the quality of the answer depends on what was written down before the drug was started.

Make the pre-treatment cardiovascular assessment explicit and dated: blood pressure, smoking status, lipids, diabetes, family history, and any existing ischaemic or thromboembolic history. It takes one line in the letter. It also does the more useful job of catching the patient whose modifiable risk has never been addressed because every appointment for a decade has been about their bowel.

• Record a dated cardiovascular risk baseline in the letter before starting any advanced therapy.
• Include smoking status explicitly - it is both an IBD and a cardiovascular variable and is often left out.
• Check lipids and blood pressure at the same visit rather than referring them elsewhere.
• Note any prior venous thromboembolism, which is relevant to class choice on existing labelling.
• Use the baseline visit to address modifiable risk, not only to document it.

Why it matters

The cardiovascular question about these drugs will only ever be answered by cohort data, and cohort data are only as good as the baselines clinicians wrote down.

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