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BACKGROUND AND AIMS: Inflammatory diseases are associated with an increased risk of incident major adverse cardiovascular events (MACEs). However, data on MACEs are lacking in large population-based histopathology cohorts of microscopic colitis (MC).METHODS: This study included all Swedish adults with MC without previous cardiovascular disease (CVD) (1990-2017, n=11,018). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded intestinal histopathology reports from all pathology departments (n=28) in Sweden. MC patients were matched for age, sex, calendar year and county with up to five reference individuals (n=48,371) without MC or CVD. Sensitivity analyses included full sibling comparisons, and adjustment for cardiovascular medication and healthcare utilisation. Multivariable-adjusted hazard ratios (aHRs) for MACEs (any of ischemic heart disease, congestive heart failure, stroke and cardiovascular mortality) were calculated using Cox proportional hazards modelling.RESULTS: Over a median of 6.6 years of follow-up, 2,181 (19.8%) incident cases of MACEs were confirmed in MC patients and 6,661 (13.8%) in reference individuals. MC patients had a higher overall risk of MACE outcomes compared to reference individuals (aHR=1.27, 95%CI=1.21-1.33) and higher risk of its components: ischemic heart disease (aHR=1.38, 95%CI=1.28-1.48), congestive heart failure (aHR=1.32, 95%CI=1.22-1.43) and stroke (aHR=1.12, 95%CI=1.02-1.23), but not cardiovascular mortality (aHR=1.07, 95%CI=0.98-1.18). The results remained robust in the sensitivity analyses.CONCLUSIONS: Compared to reference individuals, MC patients had a 27% higher risk of incident MACE, equal to one extra case of MACE for every 13 MC patients followed for ten years.