51 Background: The relationship between gastrectomy for gastric cancer and subsequent cardiovascular risk modifications has been noted, yet the direct consequences of such surgeries on cardiovascular incidences are not fully established. This study evaluated cardiovascular event rates among patients who received gastrectomy versus a matched general cohort. Methods: In a nationwide retrospective cohort analysis, we examined individuals diagnosed with gastric cancer who underwent gastrectomy (n=18,698), and a control group matched for demographics (n=81,787) from 2004 to 2008. Criteria for inclusion were patients devoid of any previous cancer diagnosis (except gastric cancer), myocardial infarction, or ischemic stroke. The primary outcome was the incidence of major adverse cardiovascular events (MACE) such as acute myocardial infarction (MI) or acute ischemic stroke, in patients with gastric cancer. Results: Within a seven-year observational window, 2.7% of the gastrectomy group (or 4.29 events per 1000 person-years) experienced new MAC). The gastrectomy group showed a significantly lower incidence rate of MACE compared to the matched control subjects (hazard ratio [HR] 0.65; 95% confidence interval [CI] 0.63–0.71; P<0.001), MI (HR, 0.68; 95% CI, 0.60–0.78; P < 0.001), and stroke (HR, 0.73; 95% CI, 0.66–0.79; P<0.001). In the subgroup analyses, no significant interactions were identified between the study groups and baseline variables. Conclusions: The study indicates a decreased risk of developing cardiovascular diseases post-gastrectomy for gastric cancer, as opposed to the general population. Beyond their significance for public health strategies aimed at cardiovascular risk management in gastric cancer patients, these findings empower both patients and healthcare providers with enhanced knowledge for making decisions about gastric cancer surgical options. Furthermore, this study lays the groundwork for future investigations into the metabolic effects of gastric cancer surgeries, notably their potential in lowering cardiovascular risk.