Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis

Abstract

SUMMARY Several pathogens have been associated with increased cardiovascular disease (CVD) risk. Whether this occurs with Mycobacterium tuberculosis infection is unclear. We assessed if tuberculosis disease increased the risk of acute myocardial infarction (AMI). We identified patients with tuberculosis index claims from a large de-identified database of ~15 million adults enrolled in a U.S. commercial insurance policy between 2008 and 2010. Tuberculosis patients were 1:1 matched to patients without tuberculosis claims using propensity scores. We compared the occurrence of index AMI claims between the tuberculosis and non-tuberculosis cohorts using Kaplan–Meier curves and Cox Proportional Hazard models. Data on 2026 patients with tuberculosis and 2026 propensity-matched patients without tuberculosis were included. AMI was more frequent in the tuberculosis cohort compared with the non-tuberculosis cohort, 67 (3·3%) vs. 32 (1·6%) AMI cases, respectively, P < 0·01. Tuberculosis was associated with an increased risk of AMI (adjusted hazard ratio (HR) 1·98, 95% confidence intervals (CI) 1·3–3·0). The results were similar when the analysis was restricted to pulmonary tuberculosis (adjusted HR 2·43, 95% CI 1·5–4·1). Tuberculosis was associated with an increased risk of AMI. CVD risk assessment should be considered in tuberculosis patients. Mechanistic studies of tuberculosis and CVD are warranted.

Clinical impact of cardiovascular disease on patients with bronchiectasis

“…We next explored the clinical characteristics of bronchiectasis subjects with and without cardiovascular disease. The group of patients who had bronchiectasis with CV disease were more likely to have a history of previous tuberculosis, which is consistent with recent epidemiological work that the risk of CVD in persons who develop tuberculosis is higher than that in persons without a history of tuberculosis [30][31][32][33]. Together, these data indicate that tuberculosis may play a part in the CVD pathogenesis, and further research is necessary to investigate the potential connection between tuberculosis, bronchiectasis and CVD.…”

Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis

“…Another LTBI study with coronary artery stenosis (CAS) as the outcome, measured via percutaneous coronary angiography, used both tuberculin skin test (TST>10mm) and QuantiFERON-TB Gold positive as their exposure assessment [38]. People with HIV were variously: included in study populations (two studies included only people living with HIV in their analytic samples [31,32]), excluded from study populations [15,16,38], or included as a proportion of the study population. The models and types of risk estimates varied considerably between studies but all were appropriate to answer our review question.…”

“…A recent narrative review described several plausible biological mechanisms for TB in CVD processes, including both active and latent TB [12], while a series of analyses from Taiwan investigated a range of CVD outcomes associated with TB, such as ischaemic stroke and acute coronary syndrome [13,14]. Acute myocardial infarction risk has also been linked to active and latent TB and other infectious diseases [11,[15][16][17]. A systematic review of TB and hypertension did not find a significant association [18].…”

A high C‐reactive protein level and poor performance status are associated with delayed sputum conversion in elderly patients with pulmonary tuberculosis in Japan

“…Second, the causality between TB and mortality cannot be determined in this study. The fact that an infectious disease, such as TB, can lead to exacerbation of underlying diseases, (eg, cardiovascular diseases), [31][32][33] can make distinguishing between TB-related and non-TB-related causes of death challenging, especially among elderly patients. Third, although we assessed the relationship between prognosis and immune-compromised status based on some factors (eg, CKD, hepatic disease, DM), we did not analyze the influence of HIV infection.…”