Tuberculosis and increased incidence of cardiovascular disease: Cohort study using US and UK health records.

IF 8.2 1区 医学 Q1 IMMUNOLOGY
Julia A Critchley, Elizabeth S Limb, Anjali Khakharia, Iain M Carey, Sara C Auld, Stephen DeWilde, Tess Harris, Lawrence S Phillips, Derek G Cook, Mary K Rhee, Umar A R Chaudhry, Liza Bowen, Matthew J Magee
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Abstract

Background: Limited evidence suggests elevated risks of cardiovascular disease (CVD) among people diagnosed with tuberculosis (TB) disease, though studies have not adjusted for pre-existing CVD risk. We carried out a cohort study using two separate datasets, estimating CVD incidence in people with TB versus those without.

Methods: Using data from the United States (Veterans Health Administration) and the United Kingdom (Clinical Practice Research Datalink) for 2000-2020 we matched adults with incident TB disease and no CVD history 2-years before TB diagnosis (US n=2,121; UK n=15,820) with up to 10 people without TB on the basis of age, sex, race/ethnicity and healthcare practice. Participants were followed beginning 2-years before TB diagnosis and for 2-years subsequently. The acute period was defined as 3-months before/after TB diagnosis. TB, CVD and covariates were identified from electronic routinely collected data (primary and secondary care; mortality). Poisson models estimated incident rate ratios (IRR) for CVD events in people with TB compared to those without.

Results: CVD incidence was consistently higher in people with TB, including during the baseline period (pre-TB) and particularly in the acute period: IRRs were US 3.5 (95% Confidence Interval 2.7-4.4), UK 2.7 (2.2-3.3). Rate Ratios remained high after adjusting for differences in pre-existing CVD risk: US 3.2 (2.2-4.4), UK 1.6 (1.2-2.1).

Conclusion: Increased CVD incidence was observed in people with TB versus those without, especially within months of TB diagnosis, persistent after adjustment for differences in pre-existing risk. Enhancing CVD screening and risk management may improve long-term outcomes in people with TB.

肺结核与心血管疾病发病率的增加:利用美国和英国健康记录进行的队列研究。
背景:有限的证据表明,确诊为肺结核(TB)患者的心血管疾病(CVD)风险较高,但相关研究并未对已有的心血管疾病风险进行调整。我们利用两个独立的数据集开展了一项队列研究,估算结核病患者与非结核病患者的心血管疾病发病率:我们利用美国(退伍军人健康管理局)和英国(临床实践研究数据链)2000-2020 年的数据,根据年龄、性别、种族/民族和医疗保健实践,将结核病诊断前 2 年患有结核病且无心血管疾病史的成人(美国 n=2121;英国 n=15820)与最多 10 名无结核病者进行配对。在确诊肺结核前 2 年和确诊后 2 年对参与者进行随访。急性期定义为肺结核确诊前/后的 3 个月。肺结核、心血管疾病和协变量由电子常规收集数据(初级和二级医疗;死亡率)确定。泊松模型估算了肺结核患者与非肺结核患者心血管疾病事件的发病率比(IRR):结果:肺结核患者的心血管疾病发病率一直较高,包括基线期(肺结核前),尤其是急性期:内部比率分别为:美国 3.5(95% 置信区间 2.7-4.4),英国 2.7(2.2-3.3)。调整原有心血管疾病风险的差异后,比率仍然很高:美国为 3.2 (2.2-4.4),英国为 1.6 (1.2-2.1):结论:肺结核患者与非肺结核患者相比,心血管疾病发病率增加,尤其是在肺结核确诊后数月内,在调整原有风险差异后,心血管疾病发病率仍持续增加。加强心血管疾病筛查和风险管理可改善肺结核患者的长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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