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

Abstract 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...

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Autores principales:	Vignesh Chidambaram, Jennie Ruelas Castillo, Amudha Kumar, Justin Wei, Siqing Wang, Marie Gilbert Majella, Akshay Gupte, Jann-Yuan Wang, Petros C. Karakousis
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0d8f4950a93b4efbb6c8e077efd9ebd3
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spelling	oai:doaj.org-article:0d8f4950a93b4efbb6c8e077efd9ebd32021-12-02T16:24:59ZThe association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis10.1038/s41598-021-94590-x2045-2322https://doaj.org/article/0d8f4950a93b4efbb6c8e077efd9ebd32021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94590-xhttps://doaj.org/toc/2045-2322Abstract 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.Vignesh ChidambaramJennie Ruelas CastilloAmudha KumarJustin WeiSiqing WangMarie Gilbert MajellaAkshay GupteJann-Yuan WangPetros C. KarakousisNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Vignesh Chidambaram Jennie Ruelas Castillo Amudha Kumar Justin Wei Siqing Wang Marie Gilbert Majella Akshay Gupte Jann-Yuan Wang Petros C. Karakousis The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
description	Abstract 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.
format	article
author	Vignesh Chidambaram Jennie Ruelas Castillo Amudha Kumar Justin Wei Siqing Wang Marie Gilbert Majella Akshay Gupte Jann-Yuan Wang Petros C. Karakousis
author_facet	Vignesh Chidambaram Jennie Ruelas Castillo Amudha Kumar Justin Wei Siqing Wang Marie Gilbert Majella Akshay Gupte Jann-Yuan Wang Petros C. Karakousis
author_sort	Vignesh Chidambaram
title	The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
title_short	The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
title_full	The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
title_fullStr	The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
title_full_unstemmed	The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
title_sort	association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/0d8f4950a93b4efbb6c8e077efd9ebd3
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The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis

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