An increased incidence of acute myocardial infarction has been noted in 47,193 Medicare patients aged >65 years initiating anti-TNF therapy for rheumatoid arthritis (RA), especially in those receiving etanercept (adjusted HR 1.3, 95% CI 1.0–1.8) or infliximab (adjusted HR 1.3, 95% CI 1.0–1.6) versus those taking abatacept. Tocilizumab might not increase the risk of coronary heart disease (adjusted HR 0.64, 95% CI 0.41–0.99), although absolute differences in event rates were small and data on cardiovascular risk factors and RA disease severity were lacking.