WHAT
This nationwide population-based study examined the association between prior pulmonary tuberculosis (TB) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Korean adults. Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), the analysis included 69,331 participants after excluding individuals with missing weight variables or ASCVD data. Among the final sample, 3,101 participants (approximately 4%) were classified as post-TB survivors, while 66,230 participants (96%) had no history of TB and served as the control group.
Baseline characteristics showed that individuals with prior TB differed substantially from those without TB. The post-TB group was older on average (53.73 vs. 45.35 years), had a higher proportion of men (60.20% vs. 49.53%), and included more underweight individuals (6.58% vs. 4.33%). They were also more likely to be smokers (53.84% vs. 44.60%), less likely to be unmarried (10.01% vs. 23.01%), had lower household income (25.88% vs. 30.55% high income), and had lower educational attainment (P < 0.001 for all comparisons).
Comorbidity burden was also higher among post-TB survivors. Compared with controls, the post-TB group had higher prevalence of asthma (5.75% vs. 2.76%), stroke (2.33% vs. 1.46%), chronic obstructive pulmonary disease (2.41% vs. 0.33%), diabetes mellitus (14.04% vs. 10.32%), hypertension (35.16% vs. 26.48%), cardiovascular disease (5.11% vs. 3.11%), liver cirrhosis (0.64% vs. 0.22%), and cancer history (4.46% vs. 2.96%) (P < 0.001 for all). Depression was also more common in the post-TB group (4.66% vs. 3.65%, P = 0.012), while dyslipidemia was slightly higher but not statistically significant (53.69% vs. 51.89%, P = 0.105).
When comparing cardiovascular risk, post-TB survivors demonstrated significantly higher 10-year ASCVD risk. The proportion of participants classified in the high-risk category was markedly greater in the post-TB group compared with controls (40.46% vs. 24.00%, P < 0.001). Logistic regression analysis further showed that prior TB was associated with increased cardiovascular risk. Compared with controls, post-TB survivors had higher odds of intermediate ASCVD risk (OR 1.14, 95% CI 1.04–1.23) and substantially higher odds of high ASCVD risk (OR 1.69, 95% CI 1.59–1.78).
Among individuals with TB, several factors were independently associated with cardiovascular disease in multivariable analysis. Increasing age (adjusted OR [aOR] 1.10, 95% CI 1.07–1.12), current smoking (aOR 2.63, 95% CI 1.34–5.14), high family income (aOR 2.48, 95% CI 1.33–4.62), diabetes mellitus (aOR 1.97, 95% CI 1.23–3.14), and depression (aOR 2.06, 95% CI 1.03–4.10) were significantly associated with increased cardiovascular disease risk among post-TB survivors. These findings suggest that individuals with prior TB represent a population with elevated cardiovascular risk and multiple contributing risk factors.
HOW
This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide population-based surveillance system conducted by the Korea Disease Control and Prevention Agency since 1998. The analysis included five survey cycles: KNHANES IV (2007–2009), V (2010–2012), VI (2013–2015), VII (2016–2018), and VIII (2019). Participants were selected using a stratified multistage sampling design to ensure national representativeness.
During the 13-year study period, 105,732 individuals without age restrictions were initially enrolled. Participants with missing weight data or missing 10-year ASCVD risk values (n = 36,401) were excluded, leaving 69,331 participants in the final analytic sample. Participants were categorized into two groups based on prior TB diagnosis. Previous pulmonary TB was defined as either a physician-diagnosed history of pulmonary TB or formal chest radiograph interpretation indicating prior TB.
The primary outcome was 10-year ASCVD risk, calculated using the American Heart Association risk equations. This risk model incorporates multiple variables, including age, sex, race, cholesterol levels, blood pressure, medication use, diabetes status, and smoking history. ASCVD risk was categorized into four groups: low risk (0–4.9%), borderline risk (5.0–7.4%), intermediate risk (7.5–20%), and high risk (>20%).
Demographic, socioeconomic, and clinical variables were obtained from the KNHANES database. These included age, sex, waist circumference, body mass index (BMI), smoking status, alcohol consumption, marital status, income, and educational level. BMI was categorized using Asian-specific criteria: underweight (<18.5 kg/m²), normal (18.5–22.9 kg/m²), overweight (23.0–24.9 kg/m²), and obese (≥25.0–29.9 kg/m²). Heavy alcohol consumption was defined as more than 30 g/day.
Comorbidities were defined primarily using physician-reported diagnoses. Diabetes mellitus was defined as fasting glucose ≥126 mg/dL, use of antidiabetic medications, or physician diagnosis. Hypertension was defined as physician diagnosis, antihypertensive medication use, systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg. Dyslipidemia was defined by physician diagnosis, lipid-lowering medication use, total cholesterol ≥240 mg/dL, or fasting triglycerides ≥200 mg/dL.
Source: Yang, J., Kim, S.H., Sim, J.K., Gu, S., Seok, J.W., Bae, D.H., Cho, J.Y., Lee, K.M., Choe, K.H., Lee, H. and Yang, B., 2024. Tuberculosis survivors and the risk of cardiovascular disease: analysis using a nationwide survey in Korea. Frontiers in Cardiovascular Medicine, 11, p.1364337.
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