The Karolinska-led matched cohort study in The Lancet Regional Health—Americas (2026) analyzed over 207,000 U.S. adults with celiac disease or dermatitis herpetiformis from 2005-2025 records, revealing an 18% elevated all-cause mortality risk and modest increases in major adverse cardiovascular events compared to matched controls. This observational design, not an RCT, benefits from its scale but cannot establish causation and lacks data on gluten-free diet adherence—a key limitation. Prior European studies yielded mixed cardiovascular findings; this U.S. registry clarifies a consistent, population-level signal. Broader patterns in autoimmune disease, including rheumatoid arthritis cohorts (e.g., BMJ 2019 meta-analysis of 24 studies, n>100k), show similar endothelial inflammation driving excess heart failure and stroke independent of traditional risks. The original coverage underplays how dermatitis herpetiformis shares these hazards, potentially missing unified monitoring protocols. Conflicts of interest appear minimal, with authors declaring standard academic disclosures. These findings reinforce that reducing celiac to digestive complaints overlooks systemic immune effects now linked to lymphoma and early death.