Cardiovascular Mortality among Tuberculosis Patients

Tuberculosis and cardiovascular disease (CVD) are significant health concerns in developing countries. Evidence indicates a link between tuberculosis infection and CVD development. The immune response to Mycobacterium tuberculosis, involving monocytes, macrophages, lymphocytes, and cytokines, promotes atheroma formation and atherosclerosis, leading to cardiovascular complications. This study aimed to assess mortality patterns among tuberculosis patients due to CVD, describe the proportion and types of CVD-related deaths in a Malaysian tertiary care facility, and examine associated demographic and clinical characteristics.

This retrospective cohort study used an observational analytic design and descriptive mortality analysis at Penang General Hospital, Malaysia. Medical records of adult tuberculosis (TB) patients who died between January 2015 and December 2022 were reviewed. Patients with pre-existing cardiovascular disease were excluded. Causes of death were determined from clinical records and death certificates, with cardiovascular deaths classified based on clinical, laboratory, and imaging findings. Descriptive statistics were used, and exploratory unadjusted associations were assessed using chi-square or Fisher's exact tests as appropriate.

Of 657 TB patient deaths analyzed, 82 (12.5%) were attributed to cardiovascular causes. Acute coronary syndrome was the most frequent (8.37%), followed by acute pulmonary embolism (1.37%). Exploratory analyses suggested associations between cardiovascular deaths and clinical factors such as anemia and drug resistance.

These findings align with global evidence that cardiovascular diseases are a leading cause of death among tuberculosis patients. Prior studies support the elevated risk of CVDrelated mortality in this population. This research provides detailed data on specific cardiovascular disorders, particularly acute coronary syndrome as the primary cause of death. Intravenous drug use showed a strong correlation with CVD mortality (p < 0.001), while anemia was a notable comorbidity despite its low prevalence. The lack of significant associations with diabetes and hypertension suggests that inflammatory or infectious processes may play a greater role in CVD development among TB patients. Regional differences in CVD mortality rates highlight the influence of sociodemographic factors and healthcare resources. The study's exclusion of patients with pre-existing CVD allows for a focused assessment of TB's impact on cardiovascular outcomes.

In this tertiary-care cohort, cardiovascular disease represented a significant proportion of deaths among tuberculosis patients, with acute coronary syndrome as the leading subtype. These results reinforce the need for cardiovascular risk awareness in TB care and highlight the importance of prospective studies to clarify risk factors and causality.