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

Basham, C. Andrew; Smith, Sarah; Romanowski, Kamila; Johnston, James C.

doi:10.1371/journal.pone.0235821

Cited by 46 publications

(39 citation statements)

References 55 publications

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“…A systematic review and meta-analysis found that patients diagnosed with TB have a higher risk of cardiovascular diseases (CVD) morbidity and mortality compared with those not diagnosed with TB. 24 However, in our study, the primary cause of death among CKD patients with TB was an infection, followed by heart disease. To our knowledge, this is the first time the cause of death for CKD patients with TB has been reported.…”

Section: Discussionmentioning

confidence: 50%

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Xiao¹,

Ge²,

Zhang³

et al. 2022

IJGM

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Background The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB. Methods This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed. Results Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients ( p <0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; p =0.019), hypoalbuminemia (HR:2.879; p =0.004), CKD stage 4–5 (HR:4.719; p =0.018) and HD (HR:6.13; p =0.005) were associated with mortality. Discussion CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4–5, and HD were independent predictors of mortality.

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Section: Discussionmentioning

confidence: 50%

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Xiao¹,

Ge²,

Zhang³

et al. 2022

IJGM

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Chidambaram

Castillo

Kumar

et al. 2021

Sci Rep

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Tuberculosis (TB) and atherosclerotic cardiovascular disease (ASCVD) have a close epidemiological and pathogenetic overlap. Thus, it becomes essential to understand the relationship between ASCVD and TB outcomes. From our retrospective cohort on drug-susceptible TB patients at the National Taiwan University Hospital, we assessed the association of pre-existing ASCVD (coronary artery disease (CAD) and atherothrombotic stroke (ATS)) with 9-month all-cause and infection-related mortality and the extent of mediation by systemic inflammatory markers. We determined the effect of pre-existing ASCVD on 2-month sputum microbiological status. Among ASCVD patients, we assessed the association of statin use on mortality. Nine-month all-cause mortality was higher in CAD patients with prior acute myocardial infarction (CAD+AMI+) (adjusted HR 2.01, 95%CI 1.38–3.00) and ATS patients (aHR 2.79, 95%CI 1.92–4.07) and similarly, for infection-related mortality was higher in CAD+AMI+ (aHR 1.95, 95%CI 1.17–3.24) and ATS (aHR 2.04, 95%CI 1.19–3.46) after adjusting for confounding factors. Pre-existing CAD (AMI- or AMI+) or ATS did not change sputum culture conversion or sputum smear AFB positivity at 2 months. The CAD+AMI+ group had significantly higher levels of CRP at TB diagnosis in the multivariable linear regression analysis (Adjusted B(SE) 1.24(0.62)). CRP mediated 66% (P = 0.048) and 25% (P = 0.033) of the association all-cause mortality with CAD+AMI− and CAD+AMI+, respectively. In summary, patients with ASCVD have higher hazards of 9-month all-cause and infection-related mortality, with elevated serum inflammation mediating one to three-quarters of this association when adjusted for confounders. Statin use was associated with lower all-cause mortality among patients with ASCVD.

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“…A previous report suggested that risk of cardiovascular disease in persons who develop tuberculosis is higher than in persons without a history of tuberculosis [ 18 ]. A recent paper showed that tuberculosis appears to be a marker for increased CVD risk [ 19 ]. Chronic infection with several viruses and bacteria has been reported in association with high blood pressure [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Ang II-Induced Hypertension Exacerbates the Pathogenesis of Tuberculosis

Cho

Choi

Lee

et al. 2021

Cells

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It has been known that infection plays a role in the development of hypertension. However, the role of hypertension in the progression of infectious diseases remain unknown. Many countries with high rates of hypertension show geographical overlaps with those showing high incidence rates of tuberculosis (TB). To explore the role of hypertension in tuberculosis, we compared the effects of hypertension during mycobacterial infection, we infected both hypertensive Angiotensin II (Ang II) and control mice with Mycobacterium tuberculosis (Mtb) strain H37Ra by intratracheal injection. Ang II-induced hypertension promotes cell death through both apoptosis and necrosis in Mtb H37Ra infected mouse lungs. Interestingly, we found that lipid accumulation in pulmonary tissues was significantly increased in the hypertension group compared to the normal controls. Ang II-induced hypertension increases the formation of foamy macrophages during Mtb infection and it leads to cell death. Moreover, the hypertension group showed more severe granuloma formation and fibrotic lesions in comparison with the control group. Finally, we observed that the total number of mycobacteria was increased in the lungs in the hypertension group compared to the normal controls. Taken together, these results suggest that hypertension increases intracellular survival of Mtb through formation of foamy macrophages, resulting in severe pathogenesis of TB.

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

Cited by 46 publications

References 55 publications

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

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

Ang II-Induced Hypertension Exacerbates the Pathogenesis of Tuberculosis

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