566. Tuberculosis is Associated with Increased One-Year Risk of Acute Myocardial Infarction: A Propensity Score-Matched Analysis
Session: Poster Abstract Session: Tuberculosis Treatment and Outcome
Thursday, October 27, 2016
Room: Poster Hall

Background: To assess whether tuberculosis disease (TB) increases the risk of acute myocardial infarction (AMI) at one year.

Methods: We extracted de-identified data from a large dataset of patients born prior to 1980 who were enrolled in a U.S. commercial insurance policy between 2007 and 2011. We established a cohort of TB patients who had their first TB claim (ICD-9 codes, 0.10.0–0.18.9) between 2008 and 2010.  We matched these patients to a cohort of non-TB patients using propensity scores (PS). Follow-up time for each patient was calculated from date of first TB claim for each matched-pair to the date of AMI or death or insurance disenrollment or completion of one-year follow-up for each patient. HIV/AIDS and transplant patients were excluded. AMI events (ICD-9 codes, 410.0–410.9) were compared between cohorts using Kaplan-Meier curves and Cox regression models.

Results: Data on 2,239 patients with TB and 2,239 PS-matched patients without TB were included in the study. Advanced age and comorbidities were common (see Table). AMI was more frequent in the TB cohort compared to the non-TB cohort, 78 (3.1%) vs. 36 (1.6%) cases, P < .01; see Kaplan-Meier curve. TB was associated with an increased one-year risk of AMI (adjusted hazard ratio [HR], 2.37, 95% CI, 1.6–3.5). Results were similar when the analysis was restricted to pulmonary TB claims (HR; 2.72, 95% CI, 1.7–4.4).

Conclusion: In this matched analysis of commercially insured U.S. patients with predominantly advanced age and multiple comorbidities, TB was associated with an over 2-fold increased risk of AMI at one year. Cardiovascular disease (CVD) risk assessment should be considered in TB patients. Further epidemiologic and mechanistic studies of TB and CVD are warranted.

Table. Characteristics

Characteristics *

No TB disease

n=2,239

TB disease

n= 2,239

P value

Birth year ≤1940

1,794 (80.1)

1,781 (79.6)

 .63

Black race

364 (16.3)

373 (16.7)

 .72

Male sex

978 (43.7)

978 (43.7)

 1.0

Diabetes

1,106 (49.4)

1,099 (49.1)

 .83

Hyperlipidemia

1,250 (55.8)

1,255 (56.1)

 .88

Hypertension

1,999 (89.3)

1,998 (89.2)

 .96

Obesity

328 (14.7)

346 (15.5)

 .45

Tobacco use

403 (18.0)

392 (17.5)

 .67

Chronic renal disease

367 (16.4)

371 (16.6)

 .87

Autoimmune disease

439 (19.6)

445 (19.9)

 .82

* Data presented as n (%)

Figure. Kaplan-Meier curves

Moises Huaman, MD, MSc1, Richard Kryscio, PhD2, David Henson, BA1, Elizabeth Salt, PhD1 and Beth Garvy, PhD3, (1)Department of Medicine, University of Kentucky, Lexington, KY, (2)Department of Biostatistics, University of Kentucky, Lexington, KY, (3)Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, Lexington, KY

Disclosures:

M. Huaman, None

R. Kryscio, None

D. Henson, None

E. Salt, None

B. Garvy, None

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