Abstract Background Ulcerative colitis (UC) is a chronic immune-mediated disease of the large intestine, characterized by recurrent or persistent inflammation. Chronic systemic inflammation may increase the long-term risk of comorbidities such as cardiovascular disease (CVD), diabetes, and dementia, and these risks can be further amplified by corticosteroid use. Early colectomy, however, may mitigate these cardiometabolic risks by definitively eliminating the source of ongoing inflammation and need for continued medical treatment. Therefore, in this nationwide matched cohort study, we compared the long-term risk of cardiometabolic disease among individuals who underwent colectomy within the first two years of UC diagnosis vs. those who did not. Methods Using Swedish nationwide registries, we identified all individuals aged ≥18 years with UC between July 2006 and December 2023. Individuals who had an early colectomy (≤2 years from diagnosis) were matched 1:1 to individuals without an early colectomy, based on age, sex, and calendar year (exact match at UC diagnosis). Additionally, nearest neighbor propensity scores were used to balance demographics and IBD- and clinical characteristics at colectomy. The primary outcome was incident CVD, with diabetes and dementia assessed as secondary outcomes. Cox proportional hazards models were then used to obtain adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results In the primary analysis, 1,832 individuals with UC and no prior history of CVD were included: 916 who underwent early colectomy (median time to colectomy 92 days) and 916 who did not undergo early colectomy. The median age at inclusion was 45.4 years, and 64.6% were male. During a median follow-up time of 8.8years, 8.0% developed CVD in the early colectomy group as compared with 11.4% in the non-colectomy group (aHR 0.68, 95% CI 0.44–1.06; Figure 1, Table 1). The proportion of individuals who developed dementia was numerically reduced by half among those who underwent early colectomy (1.2% vs. 2.4%), although this difference was not statistically significant (aHR 0.07, 95%CI 0.00-36.14). A similar pattern was observed for diabetes, with a numerically lower risk observed in the early colectomy group (aHR 0.76, 95% CI 0.39–1.48; Table 1). Conclusion In this nationwide matched cohort study of individuals with UC, colectomy within two years of diagnosis was associated with a numerically lower risk of CVD, diabetes and dementia. These findings suggest that early surgical intervention may help mitigate the risk of inflammation-related cardiometabolic disease, although further studies are needed to confirm these associations and evaluate long-term outcomes. Conflict of interest: Dr. Faye, Adam: Consulting/Educational funding from: AbbVie, Takeda, Eli Lilly Kochar, Bharati: Speaking or advisory/consulting fees from Bristol Myers Squibb, Janssen, Merck, Pfizer Inc., and Takeda Axelrad, Jordan: Research grants from BioFire Diagnostics, Genentech, Janssen, and Takeda. Consultancy fees, honorarium, or advisory board fees from Abbvie, Abviax, Adiso, BioFire Diagnostics, Biomerieux, Bristol-Myers Squibb, Celltrion, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Merck, Pfizer, Sanofi, Takeda, and Vedanta. Sun, Jiangwei: No conflicts Nordenvall, Caroline: none Halfvarson, Jonas: Grant support: Swedish Foundation for Strategic Research (RB13-0160 to J.H.), the Swedish Research Council (2020-02021 to J.H.), the Örebro University Hospital research foundation (OLL-890291 to J.H.), NordForsk (90569 to J.H.) and Vinnova (2019-01185 to JH and 2024-01155 co-applicant), IHI, EU, INTERCEPT (Grant agreement number 101194780, co-applicant), miGut-Health, HORIZON-HLTH-2022, EU (Grant Agreement 101095470, Co-applicant), 3TR, IMI 2, EU, (Grant agreement number 831434, Co-applicant), Janssen, MSD, and Takeda. Consulting and/or advisory board fees from: AbbVie, Alfasigma, Aqilion, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly, Ferring, Galapagos, Gilead Sciences, Hospira, Index Pharmaceuticals, Janssen, Johnson & Johnson, MEDA, Medivir, Medtronic, Merck, Merck Sharp & Dohme, Novartis, Pfizer, Prometheus Laboratories Inc., Sandoz, Shire, STADA, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, UCB and speaker’s fees from: AbbVie, Alfasigma, Bristol Myers Squibb, Celgene, Eli Lilly, Ferring, Galapagos, Gilead, Hospira, Janssen, Johnson & Johnson, Merck Sharp & Dohme, Novartis, Pfizer, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma and research grant support from Janssen, Merck Sharp & Dohme and Takeda. Olen, Ola: Karolinska Institutet has received research grants from Pfizer, Janssen, AbbVie, Takeda, Ferring, Bristol Myers Squibb, and Alfasigma for projects led by Olén. Ola Olén has also received fees for lectures from Pfizer, Janssen, Bristol Myers Squibb, and Takeda. Soderling, Jonas: None Ludvigsson, Jonas: Dr Ludvigsson has received financial support from Merck/MSD for a study on inflammatory bowel disease and fibrosis and for developing a paper reviewing national healthcare registers in China. Dr Ludvigsson also has an ongoing research collaboration on celiac disease with Takeda. Earlier support includes a grant from Janssen for an unrelated study on behalf of the Swedish IBD quality register (SWIBREG).
Faye et al. (Thu,) studied this question.