Long-term impact of cholecystectomy on myocardial infarction, ischemic cerebrovascular accident, and peripheral vascular disease: insights from a nationwide analysis.

Introduction: Acute myocardial infarction (MI), ischemic cerebrovascular accident (CVA), and peripheral vascular disease (PVD) are significant global health burdens that have been associated with cholelithiasis by multiple studies. However, the relationship between cholecystectomy and these vascular morbidities remains unclear. This study aims to investigate the long-term impact of cholecystectomy on MI, CVA and PVD. Methods: This nationwide study analyzed data, which accounted for 59% of the Israeli population. Adult patients with cholelithiasis and no prior vascular morbidity (MI, CVA, and PVD) were followed for over 8 years and categorized into two groups: those who underwent cholecystectomy and those who did not. Incidence rates of MI, ischemic CVA (including transient ischemic attack), and PVD were compared between the groups using Cox regression models adjusted for demographics and comorbidities. Results: Among the 142 834 eligible patients with cholelithiasis, 37 173 underwent cholecystectomy. Cholecystectomy cohort was associated with a modest protective effect on MI, ischemic CVA, and PVD, with lower incidence rates of MI (HR 0.91, 95% CI 0.86 to 0.96), ischemic CVA (HR 0.94, 95% CI 0.89 to 0.99), and PVD (HR 0.87, 95% CI 0.80 to 0.95) compared with the No-cholecystectomy cohort. Kaplan-Meier curves demonstrated significant separation in cumulative incidence rates favoring the cholecystectomy group for all three outcomes. Conclusion: Cholecystectomy appears to be associated with reduced cumulative incidences of MI, ischemic CVA, and PVD in patients with cholelithiasis. Nonetheless, the relatively modest risk reduction observed in our study raises questions about the procedure's overall benefit versus the potential risks in the context of risk reduction measures. Level of evidence: Level IV.