INTRODUCTION The risk of cardiovascular disease increases in patients with acute pancreatitis (AP). However, it remains unknown whether this increase varies between sexes. OBJECTIVES Our aim was to assess sex differences in cardiovascular outcomes in AP patients during long -term follow-up. PATIENTS AND METHODS The participants were recruited from the United Kingdom Biobank, which is a population -based cohort study consisting of 502 368 individuals aged 40-69 years old. Cardiovascular outcomes were defined as major cardiovascular and cerebrovascular adverse events (MACCEs), en- compassing all -cause death, myocardial infarction, and stroke. We compared sex difference in MACCE incidence using incidence rate per 1000 person -years. The association between sex and MACCE risk was assessed using the Cox proportional hazards models and win ratio method, adjusted for demographic, lifestyle, metabolic factors, and medication use. RESULTS A total of 1371 participants with AP were included, 42.5% were men. Over the median (interquartile range) follow -up of 13.9 (13-14.7) years, 226 MACCEs occurred. The incidence rate of MACCE was 16.44 for men and 9.8 for women. The multivariate Cox regression analysis indicated a higher risk of MACCEs in men than in women (hazard ratio [HR], 1.8; 95% CI, 1.36-2.38). Adjusted HR for all -cause mortality, myocardial infarction, and stroke were 1.49, 2.75, and 1.67, respectively. The adjusted win ratio by inverse probability of treatment weighting was 0.55 (P <0.001), suggesting a worse outcome in men. CONCLUSIONS Men experienced more adverse cardiovascular outcomes than women in long follow -up after AP, suggesting a need for sex -specific management strategies in AP patients.