Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: Retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002–2013

Abstract

Objectives:To estimate the incidence of diabetes, acute myocardial infarction (AMI), and stroke; and to determine factors associated with diabetes, AMI, and stroke incidence among patients previously treated for tuberculosis (TB) disease.Methods:A retrospective cohort study was conducted among non-pediatric TB patients registered in the Taiwan National Health Insurance Research Database (NHIRD) from 2002–2013. Diabetes, AMI, and stroke incidence were defined by International Classification of Diseases (ICD)-9 codes, drug prescriptions, and records of patient’s clinic visits. Cox proportional hazard models were used to estimate the hazard rate ratio (HR) of incident diabetes, AMI, and stroke.Results:From 2002–2013, there were 157,444 patients treated for TB registered in NHIRD. Among 129,453 patients with no prior history of diabetes, the age-adjusted incidence rate (IR) of diabetes was 3.85 (95%CI 3.70–4.01) per 1000 person-years. Among 143,646 patients with no prior history of AMI, the age-adjusted IR of AMI as 3.26 (95%CI 3.13–3.40). Among 118,774 patients with no prior history of stroke, the age-adjusted IR of stroke was 16.08 (95%CI 15.76–16.32).Conclusions:Chronic non-communicable disease risk factors like dyslipidemia, hypertension, and chronic kidney disease diagnosed before time of TB diagnosis were predictive of diabetes, AMI, and stroke incidence.

Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

“…In another example, a retrospective study using primary care data from the UK reported that the incidence of diabetes was significantly higher among those who previously had TB disease (pulmonary or extra-pulmonary TB) compared to those without a history of TB (incidence rate ratio range 2.2–5.4) [72]. Lastly, a preliminary retrospective cohort study of patients with history of pulmonary or extrapulmonary TB from Taiwan reported that the incidence rate of diabetes was higher among patients previously treated for TB disease compared to Taiwan’s national diabetes incidence estimates during a similar time period [73]. …”

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

“…Cause of death during treatment among people with TB and diabetes is not always clearly reported, but not only diabetes but also TB is associated with an increased risk of cardiovascular complications such as myocardial infarction [28,29] and stroke [30], possibly explaining the higher rate of deaths in the first few months of TB treatment in patients who also have diabetes [31,32]. Even after TB treatment success TB patients remain at increased mortality risk, possibly due to increased cardiovascular risk regardless of whether or not they have diabetes [28,33,34], although most studies have significant limitations (including limited follow-up time, lack of control of key confounders, or inappropriate selection of control series) [35]. [18][19][20]24,27] in text for evidence for and magnitude of possible relationships between diabetes and TB susceptibility, TB disease and prognosis).…”

The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis

“…In parallel, these regions account for almost 80% of global cardiovascular mortality 2 , 3 . Patients with TB, either active TB disease or latent TB infection, have an increased risk of developing atherosclerotic cardiovascular diseases (ASCVD), such as coronary artery disease (CAD) 4 – 6 , including acute myocardial infarction (AMI) 7 , 8 , and acute ischemic stroke 9 , 10 , as well as mortality due to these diseases 11 . However, the effect of pre-existing ASCVD on TB treatment outcomes is uncertain.…”