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.

中文翻译：

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结核病和心血管疾病发病率增加：使用美国和英国健康记录的队列研究


背景 有限的证据表明，被诊断患有结核病 （TB） 的人患心血管疾病 （CVD） 的风险更高，尽管研究尚未调整预先存在的 CVD 风险。我们使用两个单独的数据集进行了一项队列研究，估计了 TB 患者与非 TB 患者的 CVD 发病率。方法 使用 2000-2020 年来自美国（退伍军人健康管理局）和英国（临床实践研究数据链）的数据，我们匹配了结核病诊断前 2 年有结核病新发且无 CVD 病史的成年人 （US n=2,121;英国 n=15,820），根据年龄、性别、种族/民族和医疗保健实践，最多 10 人没有结核病。参与者在 TB 诊断前 2 年开始接受随访，随后随访 2 年。急性期定义为 TB 诊断前后 3 个月。从电子常规收集的数据 （初级和二级保健;死亡率） 中确定 TB 、 CVD 和协变量。泊松模型估计了结核病患者与非结核病患者相比 CVD 事件的发生率比 （IRR）。结果 结核病患者的 CVD 发病率始终较高，包括在基线期 （pre-TB） ，尤其是在急性期：IRR 为 US 3.5 （95% 置信区间 2.7-4.4），UK 为 2.7 （2.2-3.3）。在调整了先前存在的 CVD 风险差异后，比率仍然很高：美国 3.2 （2.2-4.4），英国 1.6 （1.2-2.1）。结论 与未患有结核病的人相比，观察到 CVD 发病率增加，尤其是在 TB 诊断后数月内，在调整预先存在的风险差异后持续存在。加强 CVD 筛查和风险管理可能会改善 TB 患者的长期结局。