Angiotensin-Converting Enzyme Inhibitors and Active Tuberculosis: A Population-Based Study

Area of Science:

• Pharmacology
• Infectious Diseases
• Epidemiology

Background:

• Epidemiological studies suggest angiotensin-converting enzyme inhibitors (ACEis) improve clinical outcomes in pneumonia.
• Tuberculosis (TB) shares airborne transmission characteristics with pneumonia, prompting investigation into ACEis' potential role in TB prevention.

Purpose of the Study:

• To investigate whether the use of ACEis is associated with a reduced risk of active tuberculosis (TB).
• To explore the relationship between the duration of ACEi use and TB risk.

Main Methods:

• A nested case-control analysis was performed using a large, longitudinally followed cohort from Taiwan's national health insurance research database.
• Rate ratios (RRs) for TB were estimated using conditional logistic regression, adjusted for a TB-specific disease risk score (DRS) with 71 covariates.
• Data spanned from January 1997 to December 2011, identifying 75,536 ACEi users and 7,720 new active TB cases.

Main Results:

• Current use of ACEis was associated with a decreased risk of active TB (DRS-adjusted RR, 0.87; 95% CI, 0.78-0.97).
• Chronic use (>90 days) of ACEis demonstrated a further reduction in TB risk (adjusted RR, 0.74; 95% CI, 0.66-0.83).
• A duration-response effect was observed, with longer ACEi use correlating with decreased TB risk across various patient subgroups and those on other cardiovascular medications.

Conclusions:

• Current and chronic use of ACEis are associated with a reduced risk of developing active TB.
• The findings suggest a protective effect of ACEis against TB, particularly with sustained use.
• Further research may elucidate the mechanisms behind ACEis' potential TB-preventive effects.