Early Colectomy and Long-Term Risk of Cardiometabolic Disease in Ulcerative Colitis: A Nationwide Cohort Study

Background: Ulcerative colitis (UC) is characterized by chronic gastrointestinal inflammation often requiring corticosteroids, both of which may increase long-term cardiometabolic risk. Early colectomy, by eliminating these exposures, may mitigate this risk, though data are limited. Methods: We performed a matched cohort study using the Swedish National Patient Register and ESPRESSO histopathology cohort, identifying individuals aged ≥18 with incident UC (2006–2021, follow-up through 2023). Patients who underwent total colectomy within two years of diagnosis (early colectomy) were matched 1:1 to those without early colectomy using propensity score matching. The primary outcome was incident cardiovascular disease (CVD), with type 2 diabetes mellitus (DM2) assessed as a secondary outcome. Kaplan–Meier and Cox proportional hazards models were used for analyses. Results: Among 1,832 individuals (median age 45 years, 64.6% male, median post-matching follow-up of 9 years), early colectomy was associated with a significantly lower cumulative incidence of CVD on unadjusted Kaplan-Meier analysis (p=0.02). The CVD incidence rate was 9.1 per 1,000 person-years in the early colectomy group versus 13.0 in controls; after adjustment for baseline covariates, early colectomy was associated with a 32% lower risk of CVD, though this did not reach statistical significance (aHR 0.68, 95% CI 0.44–1.06). A numerically lower risk of DM2 was also observed (incidence rate: 5.5 vs 5.8 per 1,000 person-years; aHR 0.76, 95% CI 0.39–1.48); findings were consistent across sensitivity analyses. Conclusions: Early colectomy was associated with numerically lower risks of CVD and DM2 in UC, raising the possibility that earlier surgical intervention may mitigate long-term cardiometabolic risk beyond established IBD-related benefits, though confirmation in larger studies is needed.