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. 2025 Feb 24;80(2):271-279.
doi: 10.1093/cid/ciae538.

Tuberculosis and Increased Incidence of Cardiovascular Disease: Cohort Study Using United States and United Kingdom Health Records

Julia A Critchley  1 , Elizabeth S Limb  1 , Anjali Khakharia  2 , Iain M Carey  1 , Sara C Auld  3   4 , Stephen De Wilde  1 , Tess Harris  1 , Lawrence S Phillips  2   5 , Derek G Cook  1 , Mary K Rhee  2   5 , Umar A R Chaudhry  1 , Liza Bowen  1 , Matthew J Magee  4
Affiliations

Tuberculosis and Increased Incidence of Cardiovascular Disease: Cohort Study Using United States and United Kingdom Health Records

Julia A Critchley et al. Clin Infect Dis. .

Abstract

Background: Limited evidence suggests elevated risks of cardiovascular disease (CVD) among people diagnosed with tuberculosis (TB) disease, though studies have not adjusted for preexisting CVD risk. We carried out a cohort study using 2 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 = 2121; 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 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: incident rate ratios were US, 3.5 (95% confidence interval, 2.7-4.4), and UK, 2.7 (2.2-3.3). Rate ratios remained high after adjusting for differences in preexisting CVD risk: US, 3.2 (2.2-4.4); UK, 1.6 (1.2-2.1).

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

Keywords: cardiovascular diseases; cohort study; electronic health records; post-TB; tuberculosis.

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Conflict of interest statement

Potential conflicts of interest. L. S. P. declares that there is no duality of interest associated with this manuscript. With regard to potential conflicts of interest, L. S. P. has served on Scientific Advisory Boards for Janssen, and has or had research support from Merck, Pfizer, Eli Lilly, Novo Nordisk, Sanofi, PeriodBio, Roche, Abbvie, Vascular Pharmaceuticals, Janssen, Glaxo SmithKline, and the Cystic Fibrosis Foundation. L. S. P. is also a cofounder and Officer and Board member and stockholder for a company, Diasyst, Inc., which markets software aimed to help improve diabetes management. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/tuberculosis-and-increased-incidence-of-cardiovascular-disease-cohort-study-using-us-and-uk-health-records?utm_campaign=tidbitlinkshare&utm_source=ITP
Figure 1.
Figure 1.
A, B, 30-day incidence rates for cardiovascular events, 2 years either side of tuberculosis diagnosis. The overall incidence rate ratio (IRR) for each period is statistically significant for US people in the preacute, acute and postacute periods and for UK people, for all periods (Table 2). Abbreviation: TB, tuberculosis.
See this image and copyright information in PMC

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