Tuberculosis increases the subsequent risk of acute coronary syndrome: a nationwide population-based cohort study

OBJECTIVE: To evaluate the effects of pulmonary tuberculosis (PTB) on the risk of subsequent acute coronary syndrome (ACS) development. METHODS: The incidence and risk factors of ACS were investigated in 10 168 newly diagnosed tuberculosis (TB) patients from Taiwan's National Health Insurance Research Database between 1997 and 2010, and 40 672 controls without TB from the general population. The follow-up period ran from the diagnosis of new TB to the date of the ACS event, censoring or 31 December 2010. RESULTS: During the follow-up period, the overall incidence of ACS was higher in TB patients than in non-TB patients (2.10 vs. 1.51 per 1000 person-years). The incidence of ACS increased by 40% in TB patients after adjusting for age, sex and co-morbidities. Male sex, age, hypertension and diabetes were independent factors for the risk of ACS development. The probability of ACS increased in the years following the TB diagnosis. CONCLUSION: This nationwide population-based cohort study provides compelling evidence that TB patients are at higher risk of developing ACS, and that the risk increases with age. Clinicians should be aware of this and strive to reduce ACS risk factors in TB patients.